Submissions from Readers

Feeling of Falling from a Stroke

Question: My mother had a stroke. Can you please give me some advice as her balance has been affected, and she feels like she is falling. What could we do to help this stop?


ANSWER: Stroke can affect balance in several ways. A stroke victim's fear of falling may be justifiable because one side may be significantly weaker. The muscles on the weaker side may be paralyzed or too weak to hold the person's body weight. Many patients can learn to compensate by shifting weight to their strong side, but they should also work on learning to take weight through the weak side as well. This is often scary at first, and therapy is often required to relearn standing balance. Confidence often grows over time. If your mother is unusually fearful, it is important that she has a therapist she trusts.

There are other factors involved with maintaining balance that have to be considered as well. Three systems that the body uses to maintain balance include the visual, vestibular, and somatosensory systems. Vision can be impaired because of stroke, and sometimes the visual field on the weak side may be cut. If this is the case, the stroke victim may run into things which obviously can increase risks for falls and make the person fearful. Vision retraining would be in order if this is a problem. Vision retraining often involves scanning exercises to the weak side (or learning to turn the head to compensate).

The vestibular system controls the sense of movement and balance and provides information about position of the body relative to gravity. If a stroke has affected the vestibular system, a patient may have dizziness and vertigo. The natural response from persons who have these symptoms is to avoid head movements and activities that exacerbate symptoms. Often patients with dizziness and vertigo are less willing to cooperate during therapy. Vestibular rehab or medication may be in order to help the patient overcome vertigo. A physician can identify if a patient has had a stroke that has damaged the vestibular system. Vestibular rehab should be done by a qualified therapist who has experience with vestibular therapy.

The somatosensory system is involved in balance because it allows us to sense joint position as well as pressure on the feet and hands. If the somatosensory system is not functioning properly, it is difficult for the stroke patient to sense where their body parts are in space and how much weight they are actually taking through the hands and feet. As you can imagine, this could be very scary for the patient when they are standing. Visual compensation strategies or exercises to improve awareness of body position are needed when there are somatosensory problems.

One other factor to consider is medication. Medication can have side effects such as drowsiness and dizziness so it is important to examine medication as a cause of balance problems.

In order to help your mom, I recommend that you have a therapist determine which systems have been affected by stroke and then provide exercises and activities (including home exercises) to help improve these systems. Over time, your mom should gain more confidence and have less fear about falling.

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Cerebellar Stroke and Balance Problems

by TULIKA
(BOKARO STEEL CITY)

Question: Does the cerebellum also get affected in a stroke? How do you know whether the cerebellum is affected?

Answer: Yes, the cerebellum can be affected by a stroke. The only way to clearly know what part of the brain is affected by stroke is by imaging studies such as a CAT scan or MRI. These scans may need to be repeated if stroke symptoms persist but no damage was identified at first. The reason for this is that sometimes these studies may miss the stroke if done too early, the area of damage is too small, or if the damage is in an area that is difficult to visualize on the imaging study. The effects of a cerebellar stroke often are:

* Impaired coordination and balance
* Ataxia
* Dizziness
* Direction changing nystagmus or multi-directional nystagmus

The patients I see with cerebellar stroke often retain movement but present with uncoordinated movements or gait, decreased balance, and often complain of being dizzy. Symptoms can vary person to person though depending on the extent and location of damage.

If you think you are experiencing stroke symptoms, seek medical attention immediately.

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Balance Problem After Stroke

by shamkumarsharma
(new-york,usa)

Question: I have a balance problem as my left side is paralyzed. I had heart attack and after bypass surgery, I had a stroke at night. I have problem in balance and every time I walk, I have to bend on my left side to keep from falling. I do not like physical exercises and want some medicines to improve it.

Answer: It is outside of my scope of practice to recommend medications. There are medications that help with dizziness and spasticity, but if your balance is due to weakness or paralysis, it is unlikely to improve without practicing balance exercises. Consult your physician regarding medications that might be of benefit to you. I hope you will consider adding exercises to help improve your balance as I think that is your best bet.

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BALANCE REHAB

by Evie
(Illinois)

Question:I had a cerebellar stroke on 9/23. Is there a DVD I can purchase that contains balance exercises? I have problems with balance/vision since the stroke.

Answer: I would not be able to recommend a specific DVD since I have not viewed any of them, but there are DVDs that have balance exercises. I recommend doing a search for "balance exercises DVD" and "stroke balance exercises DVD" on a search engine. You can also search on YouTube for these terms which will provide you with some videos and possible even small bits from DVDs on the market. There is a website called exerciseforbalance.com that offers a DVD put together by a physical therapist who has experience with balance and dizziness disorders. I am not familiar with the DVD, but the website pulled up when I did a search for balance exercises for stroke, and it may be worth looking over.

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Difficulty with balance and walking?

by Stephanie Lambert
(New Orleans, LA)

Question: What exercises are recommended for difficulty with balance and walking 11 months s/p stroke?

Answer: There is not a specific set of exercises recommended for patients based on how long it has been since they've experienced a stroke. The type of balance exercises one may need would depend on how the stroke affected the individual including sensation, muscle weakness, proprioception, pain, spasticity, cognition, vestibular function, and a host of other factors. Some patients cannot even stand after 11 months. Other patients can walk without any obvious deficits. There is really no way for me to answer your question as the individual would have to be evaluated for their specific needs. I will try to give you the general progression of balance exercises though in simplistic form. The progression in balance may look something similar to this:

1)Learning postural control in order to sit up unassisted first in a static (non-moving) position and then with a dynamic component (e.g. sitting while reaching for something without falling over). Sitting balance exercises would involve shifting weight side to side, forward and back, and advance to weight shift while using arms.

2) Next, one would progress to learning sit to stand, however, sometimes, patients have difficulty achieving this on their own and may need continued help to get to a standing position. Sit to stand can be facilitated by using a hi lo mat in a raised position if the patient has trouble getting up from a low surface.

3) Once standing, the patient will work on static balance and trying to take weight through the weaker leg and maintaining equal weight through both legs. If one leg is severely paralyzed, a patient may not be able to maintain weight through the weak leg. Some patients will have increased spasticity in the weaker leg which sometimes can actually keep the leg straighter and keep it from buckling. Just as in sitting, the patient will first work on maintaining balance in standing with arm support and simple weight shifting.

4) Next one will add a dynamic component to standing such as stepping forward, back and side or learning to stand without arm support if able.

5) Next one will learn to try and walk. There are various components to gait which are beyond the scope of this discussion, but one's physical therapist could help a patient determine what is needed to improve gait.

6) Other balance exercises one may learn would be trying to get up and down from the floor, standing on one leg, tandem gait, walking backwards, adding arm movements, and other more advanced balance exercises.

Many stroke patients are high fall risks so exercises should be taught by a therapist and done with the therapist or trained caregiver. I know that probably doesn't answer your question, but the best response I can give you is to have the specific patient see a physical therapist for an evaluation of their exercise needs.

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Weak Right Hand and Legs Without Balance

by Erma M. Berzuela
(Lucena City Philippines)

Question: How can he attain balance? Is there any device for that? I am in the Philippines.

Answer: One should see their physical and occupational therapist to help them regain balance and hand function. The progression for balance generally goes as follows. First, one should be able to do sitting balance exercises without losing balance. See www.stroke-rehab.com/balance-exercises.html for examples of sitting balance activities. Once a patient can do these sitting balance exercises, they should work on sit to stand with the assist of a therapist or trained caregiver. Once standing in place is achieved, the patient will work on weight shifting and steps. I go through the progression of these exercises at www.stroke-rehab.com/difficulty-with-balance-and-walking.html.

There are devices that assist with standing and walking such as the Lite Gait which involve putting the patient in a harness and allowing the patient to stand and attempt to take steps with only partial weight bearing. The harness helps suspend the patient and take away some of the weight. I am not familiar with the rehab facilities in the Philippines so I do not know if there are facilities that have this type of device. There are other devices on the market as well. Here is a website with pictures of the device:

http://litegait.com/pictures.html

For attempting to regain hand function, you can visit www.stroke-rehab.com/stroke-hand-rehab.html.

I also have a stroke rehab e-book that provides pictures for all types of exercises including leg/balance/arm exercises as well as resource information for patients and caregivers. It is available online for $14.99 at www.stroke-rehab.com/stroke-rehab-ebook.html

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Imbalance/fall issues

by Lisa
(Buffalo, NY)

Question: My name is Lisa Peterson and I am inventing a toileting device for stroke victims that supports the entire spinal column. It is light-weight and folds to 180 degrees for easy storage. I am working with my local University on this project. Just wanted to get your feedback on whether you feel there is a need for such a device to assist your patients while toileting. I am not including the picture due to the fact that it is intellectual property with a patent pending. Thank you so much for your help!

Answer:: Hi, Lisa. Without seeing it, it's hard to know, but it sounds like something that would benefit patients who do not have good trunk control. Many acute stroke patients in hospitals and inpatient rehabs tend to lean backwards at first when sitting so it seems like something to support their spinal column would be beneficial.

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