Balance Problems and Preventing Falls After Stroke
Falls are among the most common complications after a stroke, both in hospital and after returning home [1]. They can cause fractures, loss of confidence and fear of moving, which in turn slows rehabilitation.
Why is balance affected?
- Weakness and spasticity of one leg
- Loss of sensation and position sense
- Visual field loss and neglect of one side
- Attention problems and impulsivity
- Medicines that cause drowsiness or low blood pressure
Further reading: the guide “Stroke” and the articles Stroke Rehabilitation: Ischaemic and Haemorrhagic Stroke and Spasticity After Stroke: Causes and Treatment.
Preventing falls
The evidence for specific fall-prevention programmes after stroke is still limited, and individual assessment is important [2]. Practical measures include:
- Balance and gait training with a physiotherapist
- Suitable walking aids and footwear
- An ankle-foot orthosis for foot drop; in our study of patients with chronic spastic hemiparesis it improved balance and reduced fall risk [3]
- Making the home safe: removing loose rugs, installing grab bars, improving lighting
- Reviewing medicines and checking vision
How common are falls?
Falls are among the most frequent complications after stroke, both in hospital and after returning home. Weakness of one leg, reduced sensation in the foot, spasticity (muscle tightness), visual field loss, neglect (not paying attention to one side), dizziness, certain medicines and fear of falling all increase the risk. Many falls happen when standing up, turning, walking to the bathroom at night or trying to move without help.
How balance is assessed
The PM&R physician and the team examine strength, sensation, muscle tone, vision, attention and blood pressure on standing up. Standardised balance and walking tests (for example timing how long it takes to stand up, walk a few metres and sit down again) help measure the fall risk and track progress. Medicines that can cause drowsiness or low blood pressure are reviewed, and the home situation is discussed.
Treatment options in general terms
- Balance training: practising standing, shifting weight, stepping and turning with gradually increasing difficulty
- Strength and walking training, including training on different surfaces and stairs
- Treatment of spasticity and foot drop (difficulty lifting the front of the foot), for example with stretching, an ankle-foot orthosis (a lightweight brace) or electrical stimulation
- Walking aids chosen and adjusted to the patient
- Robot-assisted or treadmill-based gait training in selected patients, as an addition to conventional therapy
Home safety: what families can do
- Remove loose rugs, cables and clutter; keep walkways clear
- Install night lights between the bedroom and the bathroom
- Fit grab rails in the bathroom and beside the toilet; use a shower chair and non-slip mats
- Choose stable, closed shoes with non-slip soles
- Encourage the patient to stand up slowly and sit for a moment before walking
- Learn, with the team, how to help someone get up safely after a fall
When to see your physical medicine and rehabilitation specialist
After acute hospital care, the rehabilitation process is best led and advised by a physician specialised in physical medicine and rehabilitation (PM&R, also called physiatry). At home, too, it is worth consulting a PM&R specialist, who examines the patient, sets goals and guides therapy and supportive treatments together with the physiotherapist and the wider team. Ask for a review if:
- function is getting worse instead of better, or progress has stalled for several weeks
- new pain, stiffness, swelling or falls appear
- mood, sleep, swallowing or bladder control change
- you are wondering whether a robotic or other advanced therapy might be suitable
Whether robotic or other advanced therapies are suitable is decided by a PM&R specialist focused on neurorehabilitation. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, consult a PM&R specialist near you.
Call emergency services immediately for sudden new weakness, facial drooping, difficulty speaking, a severe headache or loss of consciousness: these can be signs of a new stroke.
Frequently asked questions
Should a patient who has fallen stop walking? No. Inactivity weakens muscles and increases risk. The aim is safe, supervised practice.
When is a walking aid needed? It is decided after assessment. See When will a stroke patient walk?
Does fear of falling matter? Yes. Fear can lead to avoiding activity, which weakens muscles and increases the risk of falling. Gradual, supervised practice usually helps rebuild confidence.
Should a fall always be reported? Yes. Even a fall without injury is a reason to review balance, medicines and the home environment with the PM&R specialist.
Assessment and contact
You can request an appointment or a second-opinion review of existing reports and imaging: Contact & second opinion (WhatsApp). This page is general health information. Diagnosis and treatment decisions are made individually after examination.
Sources
- Batchelor FA, et al. Falls after stroke. Int J Stroke. 2012. PMID: 22494388
- Denissen S, et al. Interventions for preventing falls in people after stroke. Cochrane Database Syst Rev. 2019. PMID: 31573069
- Cakar E, et al. The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. Eur J Phys Rehabil Med. 2010. PMID: 20927002