title: The Impact of Falls on Motor and Cognitive Recovery after Discharge from In-Patient Stroke Rehabilitation.
abstract: BACKGROUND
  Falls are common among community-dwelling stroke survivors. The aims of this study were (1) to compare motor and cognitive outcomes between individuals who fell in the 6 months' postdischarge from in-patient stroke rehabilitation and those who did not fall, and (2) to explore potential mechanisms underlying the relationship between falls and recovery of motor and cognitive function.
  
  
  METHODS
  Secondary analysis of a prospective cohort study of individuals discharged home from in-patient rehabilitation was conducted. Participants were recruited at discharge and completed a 6-month falls monitoring period using postcards with follow-up. Nonfallers and fallers were compared at the 6-month follow-up assessment on the Berg Balance Scale (BBS), the Chedoke-McMaster Stroke Assessment (CMSA), gait speed, and the Montreal Cognitive Assessment (MoCA). Measures of balance confidence and physical activity were also assessed.
  
  
  RESULTS
  Twenty-three fallers were matched to 23 nonfallers on age and functional balance scores at discharge. A total of 43 falls were reported during the study period (8 participants fell more than once). At follow-up, BBS scores (P = .0066) and CMSA foot scores (P = .0033) were significantly lower for fallers than for nonfallers. The 2 groups did not differ on CMSA leg scores (P = .049), gait speed (P = .47), or MoCA score (P = .23). There was no significant association between change in balance confidence scores and change in physical activity levels among all participants from the first and third questionnaire (r = .27, P = .08).
  
  
  CONCLUSIONS
  Performance in balance and motor recovery of the foot were compromised in fallers when compared to nonfallers at 6 months post discharge from in-patient stroke rehabilitation.
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Inness
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada. Electronic address: avril.mansfield@uhn.ca.
authors.forename: Avril
authors.initials: A
authors.lastname: Mansfield
mesh_terms: D000058:Accidental Falls; D000368:Aged; D003071:Cognition; D004185:Disability Evaluation; D005260:Female; D005528:Foot / Q000294:innervation*; D005684:Gait; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010351:Patient Discharge; D004856:Postural Balance; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Stroke; accidental falls; recovery; rehabilitation