Falls are the most common serious adverse event in stroke recovery. Weakness, balance deficits, spasticity, sensation loss, cognitive impairment, and medication effects combine to make post-stroke fall risk dramatically higher than the general population.

Section 01

Why Stroke Survivors Fall More

  • Hemiparesis: Asymmetric weakness is easily disrupted.
  • Balance deficits: Cerebellar damage or proprioception loss impairs the ability to detect and correct imbalance.
  • Cognitive deficits: Impulsivity (right hemisphere stroke), inattention, and memory deficits lead to unsafe decisions — standing without assistance, forgetting the cane.
  • Medication effects: Blood pressure medications, anticoagulants, antidepressants, and sedatives all independently increase fall risk.
  • Fatigue: Fall risk increases significantly in afternoon and evening as fatigue accumulates.
Section 02

Environmental Fall Prevention

✓ Fall-proofing the home
  • Remove all loose rugs — the most common single fall cause
  • Install grab bars in bathroom (toilet and shower)
  • Adequate lighting, especially the path from bedroom to bathroom
  • Non-slip mat inside and outside tub/shower
  • Shower chair — standing in the shower is high risk
  • Night light for nighttime navigation
  • Clear walking paths between bed and bathroom
Section 03

The Most Common Fall Scenario

⚠ Getting up alone at night
The most common fall in stroke recovery is the client getting up without assistance — often to use the bathroom at night. They don't want to be a burden, or they forget in the night. Night call devices, bedside commodes, and clear communication about asking for help before rising are essential. A fall that undoes weeks of progress is worth asking for help to prevent.
Section 04

Assistive Devices — Used Correctly

  • Cane: Held in the hand OPPOSITE the weak leg — counterintuitive but correct. The cane supports stance on the stronger side, allowing the weaker leg to swing. Report incorrect use to nurse.
  • Walker: Wider base of support than a cane. PT prescribes standard (lift to advance) vs. rolling — follow the prescription exactly.
  • AFO (Ankle Foot Orthosis): Holds the foot lifted to prevent foot drop. Must be worn inside the shoe as prescribed whenever the client is walking.
Section 05

After a Fall

🚨 Post-fall protocol
  • Do not move the client immediately — assess first. Conscious? Pain? Head impact? Can they move all limbs?
  • Head impact, loss of consciousness, inability to move a limb, or significant pain — call 911
  • If no emergency signs — help up with adequate assistance, assess for injury, call supervising nurse
  • Document everything: time, activity at time of fall, what they hit, pain complaints, your response
  • Any fall involving a stroke survivor on anticoagulants requires medical evaluation even if they seem fine — internal bleeding risk
Knowledge Check

Lesson 3 Quiz

5 questions · Passing score: 80%
Question 1
Which medication category independently increases fall risk in stroke survivors?
Question 2
A stroke survivor is prescribed a cane. In which hand should it be held?
Question 3
The most common fall scenario in stroke recovery is:
Question 4
A stroke survivor on warfarin falls and hits their hip. They say they feel fine and can walk. You should:
Question 5
Falls are most likely to occur at what time of day for stroke survivors?