Prism Adaptation Treatment May Reduce In-Hospital Falls Among Individuals With Spatial Neglect After Stroke

Background Spatial neglect (SN) is a risk factor of in-hospital falls among stroke survivors. Our prior study showed that receiving more sessions of prism adaptation treatment (PAT) in inpatient rehabilitation facilities (IRFs) predicted greater SN reduction and functional improvement. Objective To identify circumstances of falls specific to SN and explore whether increasing PAT sessions may reduce fall incidence. Methods The present study was a retrospective analysis of fall-related documentation, clinical data and notes regarding SN assessment, and treatment as part of standard care. Records of 3020 patients admitted to an IRF after stroke were reviewed, and 1489 (49%) had SN based on the Catherine Bergego Scale (CBS). Results A total of 276 patients (9% of all patients) fell at least once during their IRF stay, and 173 fallers (67% of all fallers) had SN. SN increased fall incidence (incident rate ratio [IRR] = 1.44, P = .005) after controlling for 5 covariates including age, sex, cognitive and motor functional level at admission, and length of stay. While independent of type or cause of falls, SN was associated with location of falls—SN increased fall incidence in hospital rooms (IRR = 1.55, P = .024), after controlling for the 5 covariates. 62 (36%) of fallers with SN received a median of 4.5 PAT sessions (range = 1-11; interquartile range = 2-10). Increased PAT sessions were associated with fewer falls after PAT (IRR = 0.82, P = .022), controlling for the 5 covariates and 2 additional factors including CBS and number of falls before PAT. Conclusions Treatment for SN such as PAT should be considered to reduce the risk of falls in these patients. Future research is needed to determine fall prevention measures for stroke survivors with SN, especially in their hospital rooms.