Understanding Stroke Recovery: Improving Balance for Optimal Recovery

Stroke is damage to the brain cells caused by reduced blood circulation or the rupture of blood vessels in the brain. This damage can lead to paralysis, loss of movement, and balance problems during the later phases of stroke recovery.

What is Balance?

Balance is a fundamental aspect of human physiology. It involves maintaining a stable position of our body, whether we are standing still or moving. This ability is crucial for activities ranging from walking and running to dancing and playing sports. Various systems within our body, including the muscular, vestibular, and visual systems, work together to achieve and maintain balance.

In physiotherapy, balance is defined as the ability to keep our body’s Center of Gravity (COG) within the Base of Support (BOS). The Base of Support is the area created between our feet when we stand. This area can change depending on our posture and movements. For example, standing with feet shoulder-width apart increases stability.

How the Brain Maintains Balance

1. Sensory Input: Our eyes, inner ear (vestibular system), and muscles (proprioceptors) provide the brain with information about our body's position and movements.

   
   

2. Processing: The cerebellum and other brain regions integrate these signals to determine our orientation relative to the environment.

   
   

3. Motor Output: After processing the signals, the brain sends instructions to coordinate muscle activity, helping us maintain balance.

   
   

What Happens After a Stroke?

After a stroke, the brain struggles to process information from various sensory systems. This impairment occurs because a stroke can damage areas responsible for interpreting sensory input. As a result, individuals may have difficulties recognizing objects, sounds, or even their own body sensations. Additionally, muscles may not receive signals from the brain, leading to paralysis or weakness. This lack of communication can severely hinder daily tasks, such as walking, grasping objects, or maintaining balance.

Assessing Balance Problems in Stroke Patients

Before starting a neurological balance assessment, I first evaluate the patient's drowsiness and psychological status. This initial assessment is crucial for understanding the patient's balance capabilities.

After assessing sensory and motor functions, I use various special tests to evaluate balance in different postures. It's vital to assess balance in positions such as sitting with and without back support, standing, and walking.

Special Tests Used for Balance Assessment

• Static Balance Test: Functional reach test in sitting and standing.

• Static and Dynamic Balance Tests: Berg balance test, Fullerton Advanced balance test, Balance evaluation system test.

  
  

• Dynamic Balance Test: The Four Stage Balance Test, The Functional Gait Assessment, The Biodex Balance System.

  
  

In addition to these tests, B2LCARE.COM employs various mobile applications, such as the King-Devik application and Gait and Balance Application, to assess balance in stroke patients.

How Physiotherapy Improves Balance in Stroke Patients

To understand how physiotherapy enhances balance, it's essential to grasp the goals of a neuro physiotherapist before treatment begins.

Goal Setting

Short-term Goals (2-4 weeks):

• Improve static and dynamic balance during tasks like standing, walking, and transferring.

• Enhance gait speed and symmetry during functional walking tasks.

• Increase tolerance to balance exercises and improve awareness of fall risks.

• Start coordination training to improve motor control.

  
  

Long-term Goals (6-12 weeks):

• Achieve independent walking with enhanced gait symmetry and postural control.

• Reduce fall risk through improved functional mobility and dynamic balance.

• Improve proprioception and motor coordination in more complex tasks.

• Return to community mobility and activities of daily living (ADLs) with minimal to no assistance.

  
  

Balance Training Protocols

Balance plays a crucial role in daily mobility. To enhance balance in stroke patients, I categorize training protocols into several sectors:

1. Enhancing Sensory System: Sensory integration therapy uses various stimulations to improve the function of receptors and sensory nerves.

   
   

2. Improving Trunk and Leg Muscle Strength: Stronger lower limb muscles are essential for supporting and transporting body weight.

   
   

3. Burst of Muscle Activity: This training program includes short, intense contractions of muscle fibers for powerful, quick movements.

   
   

4. Task-Specific Exercises: These exercises are tailored to the patient's conditions and needs.

   
   

5. Postural Control: Effective postural control during movement and position changes is crucial for daily activities.

   
   

6. Loading Lower Limb: Properly loading body weight over the feet is essential for balance. I emphasize exercises that focus on this aspect.

   
   

7. Maximizing Skill: Training aims to make stroke patients more independent in daily activities, such as riding a bus or running.

   
   

I use various methods, such as changing the base of support or modifying the sensory system by closing eyes or using a foam surface. Additionally, I incorporate devices like Swiss balls and balance boards to enhance patients' balance skills.

Conclusion

Improving balance after a stroke is essential for recovery. Through targeted physiotherapy, I help patients regain their balance and independence. By understanding the role of balance and the brain, we can work together to achieve optimal recovery and improve quality of life.