Falls risk and confidence after stroke

Falls risk and confidence covers both the physical risk of falling after stroke and the fear of falling that limits activity.

Falls cause injury and can create fear that reduces activity, leading to deconditioning and even more risk.

• Weakness, balance, and coordination changes.
• Hazards such as poor lighting, rugs, cords, and unstable seating.
• Dual-tasking, rushing, nighttime toileting, and low blood pressure.
• Vision changes, footwear, and poorly fitted assistive devices.

• Reduce hazards first (lighting, rugs, cords) so practice is possible.
• Practice the specific fall-risk moments: toilet transfers, shower entry, stairs, and the night bathroom.
• Build confidence gradually with a "confidence ladder" of safe exposures.
• Track near-falls — often the best early warning signal.
• Re-check vision, footwear, and assistive-device fit.

• Removing all activity after a fall (fear-avoidance leads to deconditioning and more risk).
• Over-relying on "be careful" instead of changing the environment.
• Practicing balance only in clinic, not in real contexts.

• Falls are a common post-stroke complication, with high incidence in the first year. Source
• In one inpatient cohort, falls complicated 22% of strokes. Source