The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation.

OBJECTIVE: To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. DESIGN AND SETTING: Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. PARTICIPANTS: Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. RESULTS: A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p < 0.001), with area under the curve of 0.73, positive predictive value of 0.29, and negative predictive value of 0.94. For the Fall Harm Risk Screen, area under the curve was 0.56, positive predictive value was 0.19, and negative predictive value was 0.86. Sensitivity and specificity of the SAFR (0.78 and 0.63, respectively) was higher than the Fall Harm Risk Screen (0.57 and 0.48, respectively). CONCLUSIONS: An evidence-derived, population-specific fall risk assessment may more accurately predict fallers than a general fall risk screen for stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted.

Novel approach to the application of botulinum toxin to the flexor digitorum superficialis muscle in acquired brain injury.

PRIMARY OBJECTIVE: To determine if the finger flexor mapping technique is useful in the reduction of spasticity when injecting neurotoxin within the flexor digitorum superficialis muscle. RESEARCH DESIGN: Case series of consecutive persons with acquired brain injury with upper limb spasticity. METHODS AND PROCEDURES: The flexor digitorum superficialis mapping technique was used to determine the optimal location for botulinum toxin A insertion into each belly of the flexor digitorum superficialis. Modified Ashworth Scale (MAS) ratings were recorded pre- and post-flexor digitorum superficialis injection from 17 patients (18 limbs) with upper limb spasticity. MAIN OUTCOMES AND RESULTS: The pre-injection mean MAS score was 3.0 +/- 0.7 and the post-injection mean MAS score was 1.5 +/- 0.9 for this cohort. Using the Wilcoxon matched pairs signed rank test, the mean MAS finger flexor scores decreased significantly ( p < 0.05). No adverse events were noted with the procedure. CONCLUSIONS: This novel technique appears to be feasible and effective for placement of botulinum toxin in the treatment of finger flexor spasticity. Further studies are warranted to compare this method of administration with other injection approaches for the treatment of finger flexor spasticity.