A brain injury can be a life-changing event, in ways both big and small. There are many different causes of brain injuries, which include not only concussions and traumatic brain injuries, but also events such as a stroke. Depending on the severity of the brain injury and where in the brain the injury occurred, the ability to balance may be affected. It is important to address balance issues to decrease the risk of falls and other associated injuries, such as broken bones.
Balance Problems After Brain Injury: An Overview
- How a Brain Injury Affects Balance
- How to Improve Balance After Brain Injury
- 5 Seated Exercises to Improve Balance
- 5 Standing Exercises to Improve Balance
Balance is a key part of everyday life and involves the coordination of many different systems within our bodies. We use our ability to balance for everything; from sitting and standing upright to walking and performing daily tasks such as, cooking, cleaning, and self-care. Common balance disorders after a brain injury may include:
- A sensation of dizziness where it may seem as if you or your surroundings are moving.
- Unsteadiness when standing upright and walking
- Lightheadedness and associated unsteadiness
Issues with balance can occur as a result of damage to structures within the inner ear (vestibular system), difficulty with eyesight (vision), or damage to parts of the brain that help us sense where our body is in space (proprioception). After a brain injury, most patients will work with their doctor to determine the specific cause of imbalance. The doctor will monitor things such as blood pressure and medication use, to ensure that these are not contributing factors to a patient’s symptoms.
Some patients may attend physical therapy to begin working on improving their balance. A therapist will perform a detailed evaluation in order to establish a personalized treatment plan for each patient. Prescribed treatment and exercises will then be performed to help improve symptoms. It is important to address both strength and flexibility when exercising, since our bodies use different strategies from various muscle groups to help us stay upright.
- Practice sitting upright without support so that you have to use your core muscles. If this is easy, you can attempt to reach up, down, and to the side, and then return to center.
If sitting on a stable surface (such as a hard chair) and reaching is also too easy, you can practice sitting on a less stable surface to further challenge your balance. For example, sit on a soft cushion, then progress to something like a big therapy ball. Be sure to stay in a corner or near a stable surface, so that you may have something to hold onto for safety as needed.
Ankle exercises are also important because the muscles in our ankles are often some of the first to contract when we experience a loss of balance. Ankle exercises include performing heel raises and toe raises when sitting. You can also make circles, or trace the alphabet with your foot. Just be sure to hold your leg still so the movement is isolated only to the ankle joint and not the hip or knee joints.
Practice moving from sitting to standing to strengthen your hip muscles.
Use a light resistance band placed around the upper thighs to practice clamshells. A clamshell exercise can be performed by opening and closing the legs to work the outer hip muscles.
Place a pillow between your knees and practice squeezing the pillow. Hold each squeeze for five seconds. This exercise will work the inner thigh muscles. Work up to performing three sets of ten repetitions of each exercise.
- Stretch your calf muscles to provide enough motion at the ankle joint for walking and balancing. You can use a stair at home and let one heel hang off the stair while holding onto the railing. Or you can perform a “Runner’s Stretch” at the wall. Hold each stretch for 30-60 seconds.
- Perform the heel and toe raises for ankle strengthening in standing vs. sitting for added resistance.
- Perform “mini squats” at a support surface, such as the counter or back of a sofa. Be sure to send your bottom backwards as if you are sitting in an invisible chair, so that your knees do not go over your toes.
- Challenge your balance in standing. First, stand with your feet together. If this is easy, you can switch your foot position and place one foot in front of the other so the heel of your front foot touches the toes of your back foot. Progress to standing on one foot when you are ready. Try to hold each position for at least 30 seconds. You can make this activity even more challenging by closing your eyes, or performing head turns or nods while attempting to balance.
- Perform reaching in standing and try to move your arms and body over your feet without moving your feet. You can practice reaching up, down, and side to side. To make exercises four and five even more challenging, you can try standing and reaching on an unstable surface. For example, place a couch cushion on the floor and try balancing and reaching while standing on the cushion.
As with any physical activity, please make sure you have been cleared by your doctor before starting a new exercise routine. Also, because you will be challenging your balance, please make sure that you perform these activities with a caregiver or near a stable surface that can provide support to prevent falls or additional injury. Balance work can be challenging, but it will make a difference in your ability to perform daily activities safely and independently.
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- Kristin P. Jacono, PT, DPTKristin is a physical therapist and health writer based out of North East, MD. Kristin has 10 years of clinical experience and has served as an adjunct professor and a Creative Movement instructor.