Falls occur frequently during inpatient rehabilitation for stroke and may lead to serious injuries or death. Stroke-related impaired balance, hemineglect, and difficulty performing activities of daily living (ADLs) are known to increase stroke survivors'risk of falling during inpatient rehabilitation. Yet the role of post-stroke cognition in falls in relation to these physical, perceptual, and functional factors is largely unexplored. Executive dysfunction, the most common type of cognitive dysfunction affecting at least 50% of stroke survivors, is manifested by impairment in multiple domains: disinhibition;impaired ability to think abstractly or synthesize information;verbal or motor perseveration;inability to shift from one task, behavior, or construct to another;and difficulty sequencing thoughts and actions. Prior research suggests a positive association between executive dysfunction and falls, though these findings must be interpreted with caution due to methodological limitations of the studies. Because of the frequency of executive dysfunction and our lack of understanding of the relationships between post-stroke cognition and falls, we are proposing a prospective observational study to explore these relationships. Specifically, we aim to examine the extent to which (1) post-stroke cognition predicts falls during inpatient rehabilitation, and (2) executive dysfunction moderates the relationship between impaired balance, hemineglect, and ADL performance deficit and falls during inpatient rehabilitation. We will track all falls occurring among 200 stroke inpatients enrolled in a randomized, controlled clinical trial (RCT) that is the parent study of this investigation. Using baseline measures of balance, visuospatial function, and ADL performance, as well as post-fall interviews and medical record data, we will perform descriptive and multiple regression analyses to address our aims. Falls occur frequently during inpatient rehabilitation for stroke and may result in injury or death. This research explores the role of post-stroke cognitive function, particularly executive dysfunction, in the incidence of falls among stroke patients. Gaining a better understanding of cognitive deficits in relation to other known risk factors will help clinicians identify and intervene with high-risk individuals to prevent falls.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Pittsburgh
Schools of Nursing
United States
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Plummer, Prudence; Eskes, Gail; Wallace, Sarah et al. (2013) Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Arch Phys Med Rehabil 94:2565-2574.e6