risks and reported changes in activity and participation. The development of fear of

falling may have great impact on every day life, for some, it becomes all-consuming.

Assessing fear of falling and openly discussing it with patients and their caregivers may

help them manage more efficiently after discharge.

 (5) Strategies for the management of fear of falling: participants discussed

individual techniques to manage falls and fear of falling. Many discussed restricting or

modifying performance of ADLs, IADLs, and social participation due to fear. Activity

restriction is common in those with fear of falling in the community dwelling elderly [43,

113, 114, 143, 148, 186, 187, 225-230]. Those with fear of falling related activity

restrictions may become increasingly dependent on caregivers. This may impact stroke

caregiver burden and depression. The use of assistive devices such as walkers, canes, and

wheel chairs was also common. Others discussed being careful or cautious to manage

falls and fear of falling. Overall, the development of strategies indicate that a certain,

normal, healthy fear may reduce future falls. Because fall risks are multidimensional [52,

65-67], the independent use of multiple strategies represents the need for

multidimensional and individualized interventions.

 In summary, the process of fear of falling may begin at the time of the fall, often

coinciding with the stroke, possibly making the time of the development of fear an

important issue. We found that mobility issues related to changes in the body greatly

impact falls and fear of falling, and that the actual fear or concern may differ dependent

on individuals, ability levels, and possible fear of stigma or embarrassment. Interestingly,

participants naturally developed strategies to manage fear of falling and their fall risks.