Fear of falling after brain injury

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Objectives: To investigate the prevalence and nature of fear of falling in a sample of people with severe acquired brain injury. Design: A descriptive study. Setting: A regional inpatient neurological rehabilitation unit. Participants: One hundred and five adults with acquired brain injury of mixed aetiology. Procedure: All 105 participants were rated by observers who were asked to judge the degree to which fear behaviour interfered with rehabilitation therapy (activity limitation). Eighty-two participants also rated themselves. They were asked to report the degree of distress caused by fear. Both participants and observers were asked to describe the focus of any reported fear. Two stepwise logistic regression analyses were carried out to identify variables that predicted fear giving rise to significant activity limitation and fear giving rise to significant subjective distress. Main measures: Self and observer rating scales designed and constructed specifically for the study. Results: Raters reported significant fear-related activity limitation in 12—15% of participants. Significant fear-related subjective distress was reported by 40% of participants. Fear of falling, fear of physical harm and fear of not making sufficient rehabilitation progress dominated the reports of both observers and participants. The variables predicting significant activity limitation were premorbid alcohol misuse, low functional ability and the occurrence of a fall since onset. The variables predicting significant subjective distress were poor motor coordination and organization, and good verbal comprehension. Conclusion: Fear of falling is a clinically significant phenomenon in younger adults recovering from severe acquired brain injury. Fear sufficient to cause high degrees of subjective distress was often not evident to observers. Proactive questioning about fear of falling is therefore advisable when working clinically with this group.