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Drop foot after stroke may be addressed using an ankle foot orthosis (AFO) or a foot drop stimulator (FDS). The Functional Ambulation: Standard Treatment versus Electric Stimulation Therapy (FASTEST) trial was a multicenter, randomized, single-blinded trial comparing FDS and AFO for drop foot among people ≥3 months after stroke with gait speed 0.8 ms.

Introduction:Community-dwelling, ambulatory stroke survivors fall at very high rates in the first 3-6 months. Current inpatient clinical assessments for fall risk have inadequate predictive accuracy. We found that a pre-discharge obstacle-crossing test has excellent specificity (87%) but lacks acceptable sensitivity (67%) for identifying would-be fallers and non-fallers post discharge.Hypothesis:We assessed the hypothesis that combining the obstacle-crossing test with other highly discriminatory mobility factors would compensate for the obstacle-test’s fair sensitivity and yield an instrument with superior prediction accuracy.Methods:45 ambulatory stroke survivors (60±11 years old, 15±11 days post stroke) being discharged home completed a battery of mobility and dynamic balance performance-based and self-reported measures 1-3 days prior to discharge. After discharge, participants were prospectively followed for 3 months and classified as fallers (≥1 fall) or non-fallers at 3 months. Four pre-discharge measures with the largest effect sizes for differentiating fallers and non-fallers (obstacle-crossing test, Walk-12, 5-meter gait speed, and paretic-limb Step Test score) were combined into a composite index.Results:The composite index significantly differentiated those who subsequently fell (11.1±4.5 points) from non-fallers (4.8±4.1 points, d=1.46, p<0.001). A person with an index discharge score of 11 was 6 times more likely to fall in the first 3-months post discharge than a person with a score of 5. The goodness of fit of the regression model with the composite index was significantly better than the model with only the obstacle-crossing test, χ2(1) = 6.036, p=0.014. Furthermore, whereas the obstacle-crossing test had acceptable discrimination (AUC 0.75, 95% CI 0.60-0.90), the composite index had excellent discrimination ability (AUC 0.85, 95% CI 0.74-0.96).Conclusion:Strategic aggregation of performance-based and self-reported mobility measures, including a novel and demanding obstacle-crossing test, can predict post-discharge fallers with excellent accuracy. This brief tool is highly pragmatic for inpatient use and may facilitate identification of high-risk stroke survivors before the first fall.

Objective:To examine the relationship of the Berg Balance Scale (BBS) to out come after acquired brain injury. Methods:Forty consecutive patients with acquired brain injury were admitted for multidisciplinary rehabilitation. Patients were assessed with the BBS. The BBS was originally designed as a quantitative measure of balance and risk for falls in community-dwelling elderly patients. The BBS comprises 14 dif ferent tasks graded on a 56-point scale. Community-dwelling elders with a BBS score of ≤42 have >90% risk for falls. Results: In our study, there were 27 patients with a low BBS score (≤42) and 13 patients with a high BBS score (≥43). The discharge total Functional Independence Measure (FIM) scores were lower in the low BBS pa tients (96.4 ± 21.2) compared with the high BBS patients (111.5 ± 12.5) (p < 0.007). The length of stay (LOS) was significantly longer in the low BBS patients (38.9 ± 18.5 days) compared with the high BBS patients (14.2 ± 6.1 days; p < 0.000). Among the three patients that experienced falls during their hospitalization, all exhibited low BBS scores. The admission BBS score strongly correlated with admission total FIM scores (r = 0.86; p < 0.000) and moderately correlated with discharge total FIM scores (r = 0.56; p < 0.000) and LOS (r = -0.55; p < 0.000). Using a multiple regression analysis, the admission FIM score was found to be the better predictor of discharge FIM scores, and time admitted after injury was the better predictor of LOS. Conclusions: Prediction of rehabilitative outcome might be enhanced by the use of the BBS scores in combination with other clinical measures on admission to inpatient acute rehabil itation. Key Words:Functional Independence Measure—Berg Balance Scale—Ac quired brain injury.