This study aims to analyze the relationship between stroke location and the timing and direction of accidental near falls through a retrospective analysis of routinely measured data from a 3D gait analysis system.
We selected records of 78 near falls (56 patients) from a review of gait data from participants whose gait had been routinely measured using the 3D motion capture system (VICON) over 12 years (41,943 trials, 2,725 patients). A near fall was defined as a CoM forward velocity of less than 0 m/s, with manual assistance from a therapist preventing the fall. Near-fall timing was demarcated into four phases: loading response (LR), single-stance (SS), pre-swing (PS), and swing (SW). Near-fall direction was classified into four directions: forward, backward, paretic side, and non-paretic side. Brain lesions were categorized into five groups: 1) right and 2) left white matter lesions (subcortical, corona radiata, and internal capsule); 3) right and 4) left gray matter lesions (thalamus, putamen, and caudate); and 5) brain stem or cerebellar lesions. The relationship between brain lesions and the timing and direction of near falls was examined using Fisher’s exact test (α = 0.05).
There was a significant correlation between brain lesions and near-fall direction (P 0.05). Individuals with left gray matter lesions were more likely to fall forward by stumbling (13 trials); individuals with right gray matter lesions were more likely to fall onto the paretic side (9 trials); and individuals with right white matter lesions were more likely to fall onto the non-paretic side (4 trials). There was also a significant correlation between brain lesions and near-fall timing (P 0.001). Individuals with right gray matter lesions were more likely to fall during the PS phase (21 trials); and less likely to fall during the SS (5 trials) and SW phases (5 trials). Individuals with left gray matter lesions were less likely to fall during the PS phase (2 trials). Individuals with brain stem or cerebellar system lesions were more likely to fall during the SS phase (8 trials).
Individuals with left brain lesions nearly fell forward by stumbling, possibly due to lower extremity motor paralysis. Falls were relatively rare in individuals with white matter lesions; however, individuals with right gray matter lesions had more falls during the PS phase, on the paretic side, indicating severe balance problems during gait. The finding that individuals with brain stem or cerebellar lesions nearly fell during the SS phase aligns with clinical observations of balance dysfunction during the stance phase due to ataxia.
Our findings indicate a specific relationship between brain lesions and the direction or timing of near falls, which may inform future fall prevention strategies for such patients.
gait
fall
