CHAPTER 4
 FEAR OF FALLING AFTER STROKE

 Introduction

 Stroke is the primary cause of disability in the United States and is the third leading

cause of death in the country for those over 65 [2-4]. The American Heart Association

reports that stroke is a common neurological event occurring in 700,000 people a year

[159]. Those surviving a stroke are often left with sensory, cognitive, motor, and balance

impairments which negatively influence mobility and other activities of daily living

(ADLs) and instrumental activities of daily living (IADLs) [222-224]. Fall rates increase

due to post-stroke mobility deficits [78] and are considered the most common medical

complication after stroke [166]. The annual 30% [49] incidence of falls in the community

dwelling elderly population rises to 73% within the first six months post-stroke [79].

Those who fall post-stroke may be prone to developing fear of falling. The development

of fear of falling, with the cascading consequences of further mobility disability and

declines in activity and participation may be related to an overall decrease of

independence and quality of life [56, 170].

 There is currently an abundance of research regarding falls after stroke and fear of

falling in the community dwelling elderly, but there is little specific to how people

describe the experience of fear of falling after stroke or how fear of falling develops

among this population. Fear of falling has been operationally defined for this study as "a

developed and lasting concern about falling related to a loss of confidence in balance

abilities and mobility and is often related to an avoidance of activities that he/she remains