fall after stroke, determinants and intervention

The fall incidence of stroke patients is high. Most falls occur during gait
activity, and consequences can be severe. Although effective fall prevention
programs exist for healthy elderly people, these programs are not effective in
people with a stroke. Therefore the etiology appears to be different in this
population.

In this study we would like to investigate which gait parameters, measured in a
laboratory setting and at home, are associated with fall risk. This knowledge
helps us identifying stroke patients at risk of falling. Furthermore it helps
to develop a novel fall prevention program specifically designed for this
population. Furthermore we will exam if it is possible to improve the with
fall associated gait parameters in these stroke patients.

This research project exists out of two research questions:

Firstly we will determine which gait parameters are associated with fall risk.
Secondly develop a novel fall prevention program based on the associated fall
risk gait parameters. To determine the possible effectiveness of the
intervention we will exam whether it is possible to improve the with fall
associated gait parameters in this population.

The aims of this research project are:

1) Which gait parameters are associated with fall events in stroke patients?

2) Can we improve the with fall risk associated gait parameters by using the
developed fall prevention program?

To answer the first research question we will track down or patients fall in
the past six months. Based on this information we will divide patients into two
equally sizes groups, 'fallers' and 'non fallers'. Subsequently, fall events
will be registered prospectively during the next six months with a fall diary
and monthly phone calls.

To determine the association with gait parameters prior to the prospective
monitoring period we will perform a gait assessment in an laboratory.
Furthermore subjects will wear an accelerometer during 1 week at home to
determine gait parameters derived in an at home setting as well.

The second research question will be answered by a 'proof of concept'. Stroke
patients at risk of falling will an intervention. We will exam if the group
improves at the associated fall risk gait parameters.

The gait assessments and intervention will be executed with the Gait Real Time
Analysis Interactive Lab (GRAIL).The GRAIL is a treadmill with virtual
environment, it gives us the opportunity to measure not only steady state gait
parameters but as well measure the responses of a patient after the patient
received an external perturbation during gait.

The fall prevention intervention will be performed together with the GRAIL*.
Patients will train on the GRAIL one hour twice a week, during a zeven week
period. each training session will last no longer than 1 hour. The training
will mainly focus on the fall associated gait parameters. For instance if the
results from research question 1 indicate that medio-lateral perturbations
during gait are strongly associated with fall events, in this case the training
will frequently be focussed on medio-lateral perturbations.


* The GRAIL is a treadmill with virtual reality environment. The GRAIL is
capable of accurately detecting gait parameters, gait performance can be tested
combined with a dual task furthermore the GRAIL is capable of perturbating gait
at a fixed moment in the gait cycle.

The risk when participating in the study is limited. The experiments will be
performed at the GRAIL. Subjects will wear a fall armour, which make falling
during the experiments impossible.

The subjects will be tested at preferred gait speed and so will not be pushed
towards maximum performances. There is sufficient recovery time between the
trails. There is sufficient time to build in extra breaks if the patient wishes
so.


The amount of testing time is limited.
The first research question will take 1 visit from a proximally 2 hours.
Subsequently the patient will wear an accelerometer during one week.


The second research question will require more visits and time. The
intervention lasts for 7 weeks, each week contains 2 training sessions and each
session will not take longer than 1 hour. Furthermore a pre and post test will
be executed similarly to the test in research question 1 and as well patients
will wear an accelerometer prior and after the intervention.

If the training is effective, patients will benefit from this intervention in
terms of a more stable gait patterns and possibly fewer falls.