Improving Balance After Stroke - Part 2
Oct 29, 2019
Improving Balance After Stroke - Part 2

Last week we talked a bit about how balance can be seriously affected after a stroke, and we began to talk about things you can do to improve your balance and overall safety. Look back here if you would like to take a few minutes to refresh yourself on the first few balance strategies!

Remember, each person may experience balance difficulties in a different way after having a stroke. To experience the most well-rounded gains, you may want to choose a few options from the list for improving your balance and safety. Always consult with your physician and/or therapist before starting a new exercise program, especially after a stroke. While advocating for yourself, be sure to explain what your plans are for addressing balance so that you can collaborate with your practitioner and make decisions that are the best and safest for you!

Before we get to some more strategies to improve your balance, let’s talk about some differences in types of balance that may affect you.

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Sitting balance: your ability to keep yourself steady while accomplishing a task from a seated position (in a chair, wheelchair, or at the edge of the bed, for example)

Standing balance: your ability to keep yourself upright while accomplishing tasks while up on your feet

Static balance: keeping control of your upright position while not moving around (for example, sitting on a stool at the counter waiting for the coffee to brew, or standing still holding a walker while looking into the closet for your clothes)

Dynamic balance: maintaining steadiness while body parts are in motion/changing position (for example, keeping steady while bending to load dishes into the dishwasher, or controlling your body while sitting and putting on your socks)

Your body’s needs for postural control can change frequently throughout a given task, requiring you to change from sitting to standing, or from static to more dynamic stability, depending on the demands of each activity you are trying to accomplish. For example, you may start off your day sitting in a static position on the edge of your bed while you open your eyes and think about the day ahead. While you reach toward the ground to grab and put on your slippers, your sitting balance becomes dynamic. When you stand to look out the window at the weather, you are more static, and then when you reach into the closet and shift your weight to put on your robe, your standing balance becomes more dynamic. It is important to address all types of balance so that you have more control over your position and maximize your safety throughout all of the day’s tasks.

Here are some additional strategies to improve your balance, whether you are sitting or standing, and whether you are more still or moving about.

  1. Addressing the vision component
    In some cases, a stroke can impact a person’s vision in some fairly complex ways. When this happens, survivors may have difficulty using their eyes to fully scan and track in their environment, or they may start to feel dizzy or see double with slight movements of their eyes. They also may experience a visual neglect, where the brain is not giving them proper signals to fully notice objects in part of their environment. All of these complicated scenarios can make it difficult to stay upright in an ever-changing environment with multiple different task demands.

Working on specific vision-related exercise programs set by your therapist can help to reduce the impact these deficits can have. Your OT is specially equipped to recommend how to improve your ability to fully and steadily scan your entire environment, locate obstacles to avoid, and reduce dizziness/double vision to make it easier to remain balanced while sitting, standing, and walking throughout your activities. In the meantime, make sure you try to look back and forth and take note of obstacles in your path that may be trip hazards.

  1. Improving sensation, proprioception, vestibular system
    Along with the sense of vision, the body uses other complex senses to keep itself upright. Our brains help us to take inputs from our body as we move about in our environment, and put them all together to detect whether an arm is outstretched enough to grasp the counter, whether we are steady or wavering, and whether our feet feel firmly planted on the ground. After a stroke, these signals can get mixed up and make it difficult to tell what our bodies are doing to keep us upright.

Your therapist can describe a detailed plan to help you work on all of these sensory skills. Some activities may include weight bearing to achieve better input through your joints, practicing placing and holding various positions to get a clearer sense of what is the “right” upright position to keep balanced, and using various modalities for sensory reintegration in your feet, limbs, and trunk so that you can feel the surfaces used to keep upright and remember how to interact with your environment more safely.

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7. Modifying the environment or task
In many cases, your OT will recommend options to make your environment safer, as well as offer ideas for how to approach a task so that you can still complete it despite your impaired balance. While these strategies may not directly improve your balance skills, they do maximize your potential for independence while you are coping with decreased balance. Some examples may include:

-using various types of adaptive equipment in the home such as tub benches and grab bars, which can help you to perform a task more steadily

-performing a task while sitting instead of standing (such as sitting at a table to fold laundry) if your sitting balance is better than your standing balance

-moving closer to an activity before reaching to keep a better base of support and avoid more challenging dynamic balance if needed (such as stepping closer to a cabinet before opening the door)

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8. Trying out yoga
The practice of yoga promotes improvements in strength, muscle tone, flexibility, breathing patterns, reaction speed, and concentration. It can be modified based on skill level and safety/positional need (standing or sitting), and can be taught at a one to one level, or in groups. It is relatively easy to teach and perform, and research has shown that yoga intervention has improved balance scores in post-stroke patients. (1, 2)

Here at Neofect, we want to support you in your unique rehabilitation journey. Whatever strategies you choose, remember to think of your safety, and check in with your regular physician and/or OT or PT to make sure your plan works best for you.

References

Schmid, AA, et al. Poststroke balance improves with yoga: A pilot study. Stroke, 2012; 43: 2402-2407.

Hinsey, K, et al. Merging yoga and occupational therapy to improve balance and fall risk factor management: A pilot study. American Journal of Occupational Therapy, 2016; 70(4): 7011515237p1-7011515237p1.

Natalie Miller
Clinical Manager / Occupational Therapist

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