Int J Rehabil Res. 2013 Jun;36(2):134-9.

Effects of falls experience on cognitive functions and physical activities in community-dwelling individuals with chronic stroke.

Hwang S, Woo Y, Kim KH, Ki KI.

Department of Physical Therapy, Baekseok University, Cheonan, Republic of Korea.

 

Abstract 

The purpose of this study was to examine the effects of falls experience on cognitive functions and physical activities in community-dwelling patients with chronic hemiparetic stroke. Further, the feasibility of using the Montreal Cognitive Assessment (MoCA) to predict falls in the patients was evaluated. Forty-seven patients with chronic stroke participated in this study. The participants included 25 patients with falls experience (faller group) and 22 patients without falls experience (nonfaller group) in the previous 6 months. The participants were assessed clinically using the MoCA, the Berg Balance Scale, the Dynamic Gait Index (DGI), the Timed Up-and-Go Test, the 10 Meter Walk Test, and the 6 Minute Walk Test. The individuals in the nonfaller group performed significantly better in all clinical measures than those in the faller group. In the nonfaller group, the MoCA was moderately correlated with only two measurements, that is, the 10 Meter Walk Test and the DGI. In the faller group, the MoCA was moderately correlated with four measurements, including the Timed Up-and-Go Test, the 6 Minute Walk Test, the Berg Balance Test, and the DGI. Physical and cognitive functions play a role in falls. Therefore, to decrease the risk of falls among community-dwelling stroke patients, clinicians should consider their physical activities and cognitive functions irrespective of their falls experience.

PMID: 23165343

 

Supplement:

Falls threaten the quality of life and independence, and also lead to reduced activity and sedentary lifestyles in stroke patients. The experiences of falls are important for early identification, prevention, and intervention in functional recovery of stroke patients during the physical therapy and rehabilitation. Most of stroke patients have a range of symptoms that place them at risk of falls including physical impairments, but especially cognitive impairment and depression, and falls experience is unclear. And also, cognitive impairment is rarely assessed in clinical and research trials on stroke patients; physical and functional impairments are generally assessed. Providing appropriate measures for determine the risk factors for falls in individuals with chronic stroke to prevent falls and their recurrence in clinics are necessary. Generally, clinical measures provide a simple and convenient method for identifying problems and reducing the time spent in clinics. Therefore, we used the Montreal Cognitive Assessment (MoCA), Timed up and go test (TUG), 10 Meter Walk test (10MWT), 6 Minute Walk test (6MWT), Berg balance scale (BBS), and Dynamic Gait Index (DGI) to evaluate of impairments for stroke patients, and also we divide with two groups in experience of falls or not. As results of this study, cognitive measures, along with physical and functional abilities, can be used to decrease the risks of falls in community-dwelling stroke patient with or without falls experience. This study showed strong correlations between the MoCA and other measurements of balance and gait performance, such as the 6MWT, BBS, DGI, and the TUG test, in the faller group. Therefore, the MoCA may be an effective tool for the prediction and prevention of falls among community dwelling stroke patients. Appropriate, accurate, and evidence-based studies are urgently needed to help to reduce falls and related injuries in community-dwelling stroke patients, especially those at the highest risk. Our study shows that both cognitive and physical characteristics should be measured and that the MoCA can be used as a feasible screening tool for mild cognitive impairments among community-dwelling stroke patients. The results of this study will be useful for the evaluation of the risk of falls and for planning fall prevention programs for community-dwelling stroke patients.

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