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. 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.

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
[https://blog.neofect.com/regaining-balance-after-a-stroke-part-1/] 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!



Types of balance
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.

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.

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

Address 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.

Improve sensation, proprioception, and vestibular reactions
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.



Modify the environment or task
In many cases, your OT will recommend options to make your environment safer
[https://blog.neofect.com/fall-prevention-techniques-for-stroke-survivors/], 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)
   
   



Try 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.

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intended to be a substitute for professional medical advice, diagnosis, or
treatment. Always seek the advice of your physician or other qualified health
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