Balance.
Balance is a complex feature that is affected by your vision (visual system), the sensation of your body position (somatosensory system), and the orientation of your body to the horizon (vestibular system). A stroke can affect any one or all 3 of these systems, thus affecting your balance. When one system is down, the others must take over. For example, when a patient has a stroke affecting their vision, the visual and vestibular systems must take over in order to maintain balance. Fortunately, there are ways to train the 3 systems in the case that one of them is not up to par.
Visual
Vision is one of our most powerful senses. You may notice that a lot of people walk with their head down as they look at the ground. This is because they are relying on their vision to provide feedback about their body position in order to prevent a fall. To train the visual system more selectively, you have to emphasize it. Using a mirror is a handy way to provide that constant visual feedback during movement. |
Somatosensory
The somatosensory system is what we use when we stand on a soft surface. The receptors in our joints, muscles, tendons, etc. provide information on the position of our body's symmetry. For instance, while walking on a rocky dirt path your feet land on rocks, divots, etc. Your somatosensory system sends messages back to the brain about the position of your body in order to create symmetry between the two sides. Training this system can be as simple as standing and performing exercises on a foam pad. |
Vestibular
This system is what fails when you become intoxicated. This is what some call their "equilibrium." The inner ear contains crystals in a fluid that moves around a system of tubing. When the crystals get stuck in a part of the tubing they do not belong, the vestibular system fails. This can cause nausea, a sensation of spinning, or constant leaning toward one side. Patients with problems in this system tend to see the world at a different angle, and may present as Pusher's Syndrome (pushing heavily toward their involved side). Training this system may be a matter of referral to a vestibular specialist or enhancing the other 2 systems and promoting symmetrical stance during all movements. Giving your patient a line of reference can be a helpful tool. |