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BALANCE - A CHALLENGING ISSUE IN STROKE

Difficulties with balance tend to occur when there is problem with the information being sent to the brain.


"We really only realize how important our balance is when something goes wrong."

The balance system in our body is very complex.


Your eyes, muscles , joints ,inner ear ,and brain all have a key role to play in balance and co ordination.


A malfunction of just one of these systems can lead to imbalance and dizziness.


Patients with stroke typically show decreased motor skills and impairment to their senses, cognition, and visual perception.


They encounter impaired physical function , making independent walking difficult due to a reduction in balance ability, walking speed and gait endurance.


such a reduction in balance ability makes it difficult for patients to walk and produce functional movement which can lead to difficulties in everyday life.


Therefore, balance retraining is one of the most important categories for rehabilitation in patients with neurological impairment such as hemiparesis.


This guide explains how stroke can affect your balance, what can help, and how can you look after yourself if your balance is affected.



How does balance works ?


Balance involves the co ordination and stability of our body in our surroundings. It affects mostly day to day activities such as moving around and reaching for objects

If your balance is impaired after stroke, you may feel dizzy or unsteady.

This can reduce your confidence and increase your risk of having a fall.

If your balance problems last for a long time, you might felt that they affect your quality of life.


How can your balance be affected by stroke?

To have a good balance, different parts of body, like the brain, eyes and limbs need to work well together. A stroke can affect your balance system and the way they are more severe, your system will be unable to work effectively and you will probably feel unsteady.


How Physiotherapy can help?

A physiotherapist can assess you and recommend therapy or exercises that may help you to recover.


Balance retraining exercises

Exercise and balance retraining are very effective ways to treat balance problems.

To be effective the exercises need to be:

Intensive: you need to do as much as you can

Individual: you need to work on the things that you find difficult.

Functional: when it's safe to do so, you need to practice the everyday activities that you find difficult, such as standing up and sitting down, negotiating uneven surfaces and obstacles, changing direction and speed, walking up stairs.

Progressive: you need to move on to more challenging activities to keep improving.


1.REHABILITATION EXERCISES

The most common cause of poor balance after stroke is impaired muscle coordination in the legs and core.

If you can rewire the brain and improve coordination in your legs and core, then your balance will improve too.

Treatment:

To improve balance after stroke, start practicing rehab exercises that focus on 3 areas:

(i) strengthening balance rehabilitation exercises

(ii) Leg rehabilitation exercises

(iii) Core rehabilitation exercises

The more you rewire the brain through practice, the more your balance will improve.





2. FOOT DROP EXERCISE

Foot drop is a condition that impairs your ability to lift the front of your foot, which can cause it to drag on the floor when you walk.

This is a dangerous stroke side effect because it impairs your balance and increases the likelihood of falling.

Treatment:

Foot drop exercises can help you regain mobility in your foot when practiced with regularity.




3. HEEL RAISE WHILE HOLDING ON

· Stand close to a chair or a table that you can hold on to with ease and get good support.

· Hold on firmly and slowly rise up on your tiptoes. Make sure that you keep your knees straight and keep your upper body straight and erect.

· Hold the pose for a few seconds if you can, and gently lower yourself back towards the floor. Repeat a few times.




4. HEEL TO TOE WALKING

Use the same line that you created for the previous exercise. Instead of stepping to the sides, you will now have to use the line to move forward.

· Place your heel on the floor on the line and place the next foot directly in front of the toe. Make sure that the heel touches the toe. Keep going like this until the end of the line and then turn around.

· Repeat the same steps to come back to the other side. To make sure that you do not fall down, make sure there is something or someone around to hold on to.



5. SINGLE LEG STAND

· Stand straight on the floor with your feet flat. Start lifting one leg very slowly to the point that you can feel yourself balance comfortably on the other leg.

· Hold on to something initially if required.

· Hold the pose till a count of 10 and gently bring your leg down. Repeat with the other leg. Repeat the steps a few times each with both the legs.




6. SIDE STEP WHILE HOLDING ON

· Make a line across the floor along which you can step from side to side. You can use some sort of colored tape to make the line.

· You may have a sturdy chair or table to hold on to, or someone can hold your hand for the first few times.

· Stand on one side of the line and place your steps on the side, to cross over. First place one leg across the line, then the next. Wait for a few seconds and do the same sequence in the opposite direction, to cross back. Repeat a few times.

Regular exercising is a good way to ease yourself back into your earlier routine and improve your overall balance. To avoid a fall, start by holding on to objects or asking someone to hold your hand. Once you regain some balance, try doing these exercises independently.



7. BACKWARD WALK

· Before you begin, make sure that the path is clear and there is no risk of you bumping into something as you walk.

· Take a look at the room in advance to understand where you have to walk. Now stand straight in one corner and start walking back to the other corner. Try not to look back, but instead rely on your sense of balance.

· You can hold on to something initially and later do this free hand.



8. BALANCING ON UNEVEN SURFACES

Walking on mattress at home improves balance.

Balance pad can also be used for balancing in one position.



9. BALANCE BOARD EXERCISES

Balance board is a part of vestibular rehabilitation.

Many alternatives can be added on balance board like while balancing reaching forward, sideways etc.



10. PHYSIO BALL EXERCISES

Sitting over physio ball either with support or without support improves balance.

It also prevents osteoporosis.



Sincere thanks to all stroke survivors for their kind support from Hum Saath Hai Team.

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