Do Cognitive-Communication Skills Matter? Exploring Cognitive-Communication Impairment and Falls After Stroke

Research

Objectives: To examine the association between specific domains of cognitive-communication impairment at discharge and falls within the first 3 months following discharge home from inpatient rehabilitation after stroke.

Design: In this prospective cohort study, we evaluated the discharge cognitive-communication profiles of post-discharge fallers and non-fallers, as defined by fall status at 3 months post discharge. The Cognitive-Linguistic Quick Test-Plus (CLQT+) was administered to all consenting individuals within 96 hours prior to discharge from inpatient rehabilitation. Additionally, a series of balance and mobility measures were administered as part of the interdisciplinary arm of this study.

Setting: Inpatient Rehabilitation Facility discharge to home.

Participants: Participants (n=25) were ambulatory stroke survivors being discharged home from inpatient rehabilitation following first stroke.

Interventions: This was an observational study. No direct interventions were administered.

Main Outcome Measures: Participants were followed prospectively for 3 months and fall status (occurrence of falls, number of falls) was collected. Fallers were defined as any individual who experienced one or more falls in the 3 months following IRF discharge.

Results: Of 25 consenting participants, complete cognitive-communication data (Full CLQT+ Administration) and falls data (Falls Calendar and 3-month follow-up contact) were collected for 21 individuals (mean age=64; 11 female, 10 male). Two-sample t-tests were performed to compare cognitive-communication skills for each CLQT+ subdomain between non-fallers (n=12) and fallers (n=9). There was no statistically significant difference in mean subdomain composite scores or total composite score between non-fallers and fallers. While not statistically significant, subdomains of attention, visuospatial skills and clock drawing, in particular, warrant further evaluation in a larger sample (attention subdomain: t(19)=1.59, p=0.13; visuospatial subdomain: t(19)=1.29, p=0.21; clock drawing: t(19)=1.28, p=0.22).

Conclusions: There are multiple factors that may impact an individual’s fall risk, highlighting the importance of considering a more holistic approach to exploring fall prediction. While this pilot data from a small sample demonstrated no statistically significant difference in cognitive-communication skills between non-fallers and fallers, further evaluation in a larger sample is warranted to better understand the impact of cognitive-communication skills on falls.

Author(s) Disclosures: None.