Excerpted and adapted from "Keeping Your Balance, Everyday Survival," Stroke Connection Magazine July/August 2003 (Science update May 2008)
About 40 percent of stroke survivors have serious falls within a year of their stroke.
In a study published in Stroke: Journal of the American Heart Association, women stroke survivors who reported difficulty maintaining their balance while dressing were seven times more likely to fall than women who didn’t report balance problems.
In addition, overall balance problems, dizziness or a “spinning” sensation as the result of stroke were associated with a five-fold increase in risk of falls.
People with balance problems often benefit from physical therapy. Your first step is to get a therapy prescription from your physician.
Physical therapist Sapan Palkhiwala works with stroke survivors at the Long Beach Memorial Balance and Vestibular Center in California. He says your body uses a combination of three systems to stay balanced: vision, vestibular and somatosensory.
The vestibular system helps by monitoring changes in your head movements with respect to the pull of gravity. It includes two parts: the central system (housed in your brain) and the peripheral system (in your inner ear). These systems are connected by the vestibular nerve.
Strokes are more likely to affect the central system. Some strokes affect the brainstem, and if this occurs, the vestibular system is injured. Symptoms of a brainstem stroke can be dizziness, vertigo causing imbalance. With the somatosensory system, your body uses information it receives from the pressure of your feet on the floor, and your ankle positioning, to help balance your body.
The Balance and Vestibular Center in Long Beach has a machine called the Balance Master. You use this machine by standing on moving platforms linked to a computer. The machine identifies which of your body’s balance systems are not working properly. The test can pinpoint what muscles need to be strengthened in order to help your balance, and can determine if you need vestibular rehabilitation and exercises to help you deal with dizziness.
Sapan says a majority of stroke survivors have balance problems because one side is stronger than the other. He encourages survivors to build up their affected side by using it in daily activities, such as reaching for a glass of water.
Sapan uses constraint-induced movement therapy (CI therapy), which forces survivors to use their affected side while restraining their unaffected side. He also has survivors practice getting up from a lying position on the floor. This increases confidence that they can get up if they fall, which reduces their fear of falling.
Sapan recommends a balance exercise that survivors can do at home. The caregiver can bring a chair into a corner of a room. While the survivor stands in the corner, he or she can hold on to the back of the chair and practice moving shoulders and hips together from side to side and then forward to backward. This exercise also forces the survivor to use and strengthen his affected side.
If the vestibular system is affected by the stroke, causing a “spinning sensation” (vertigo) or dizziness, exercises can also reduce these symptoms. For example, Sapan has survivors fixate on an object with their eyes while moving their heads in different directions.
Dr. Diemha Hoang, a physician at the center, explains, “This exercise may make the survivor feel more dizzy at first, but it trains the brain to accept the discomfort so that ultimately the symptoms are less. We also have the survivor repeatedly perform other activities or movements that temporarily worsen their symptoms of dizziness or vertigo so that their brain can adapt and thus lessen the symptoms.”
If a stroke affects your vision, you can learn to compensate. If you have a visual field cut so that you cannot see anything out of the left side of both eyes, you can practice scanning the room with the right side of your eye while turning your head.
Sapan says with the help of a therapist, survivors can also practice balancing on shifting surfaces like foam, grass, sand or seat cushions. Since your feet are not on a flat surface, you can’t use your feet to reference yourself. You are forced to use vision to balance yourself, thus strengthening this system.
Stroke survivor, Roy Breneman from Long Beach, Calif., had balance difficulties after his stroke in 1996. His left side was affected and he walked on the side of his left foot, so he needed a leg brace and orthotic shoes. He fell several times, once in 1999 when he broke his hip and again in 2001 when he broke the shoulder on his affected side. His doctor recommended tendon transfer surgery as an option.
In Jan. 2003, Roy had the surgery. “The surgery greatly helped my balance. I walk flatly on my foot now and do not need a leg brace to walk. I can also wear any style of shoes I want to without having pain in my foot.”
Surgery is the most extreme treatment for gait instability. It is not intended for the majority of people with balance problems.
Experts at the Long Beach Memorial Medical Center Balance and Vestibular Center give these suggestions for preventing falls at home:
- Use nightlights in bedrooms, bathrooms and hallways
- Make sure light switches are easily accessible
- Use bathmats with suction cups and non-adhesive strips in the tub
- Sit on a bench or stool in the shower and use a hand-held showerhead
- Don’t walk around in stocking feet. Wear shoes or slippers that fit snugly
- Remove throw rugs and secure area rugs with double-sided tape
- Use a sturdy step stool with a handrail when reaching items up high and store frequently used items at waist level
- Review medications with your doctor as some may cause dizziness and imbalance
- If you feel lightheaded when first sitting or standing up, sit down and stay seated until your head clears, then stand up slowly
- Ask for help. If needed, a caregiver or family member should be ready, willing and able to help out
- Slow down and take all the time you need when walking. There is no need to hurry, and it may be safer to go more slowly
Reducing risk of falls
Other conditions impacting physical abilities after stroke