A stroke often damages the motor control centers in the brain, leading to significant challenges with balance and posture. This damage can also affect the pathways that process sensory information from the visual, vestibular, and somatosensory systems, which are all necessary for maintaining equilibrium. Regaining balance is a primary focus of rehabilitation because impairment severely limits independence in daily activities and increases the risk of falls. The recovery process is systematic, beginning with foundational stability before progressing to dynamic movement.
Training Postural Control and Core Stability
Rehabilitation begins with foundational exercises that focus on stabilizing the torso to control the body’s center of gravity. Core stability training enhances the ability to maintain the trunk and pelvis in a steady position, a function often compromised by stroke. Therapists utilize exercises designed to improve the muscular activation patterns necessary for anticipatory postural adjustments (APAs), which are the small, automatic movements the body makes before a voluntary movement to maintain balance.
A common starting point includes seated balance activities, such as controlled weight shifting and marching in place while maintaining a tall posture. These exercises strengthen the trunk flexors and extensors, which are crucial for keeping the body upright and preventing a forward lean. As stability improves, the progression moves to challenging the base of support, such as standing with feet closer together, practicing tandem stances, or performing heel and toe raises to improve weight shifting control.
Specific core exercises, such as back extensor isometric holds or lateral trunk flexions, directly target the muscles that stabilize the spine and pelvis. Performing these movements, sometimes on unstable surfaces like a physioball, gradually builds the endurance and selective control of the core musculature. This progressive challenge of static and semi-static balance prepares the patient for the more complex demands of walking and movement.
Dynamic Mobility and Gait Retraining
Dynamic mobility focuses on interventions necessary for movement and locomotion, where balance is constantly challenged. Gait retraining is a form of intensive, task-specific training aimed at improving the symmetry, speed, and endurance of walking. The goal is to restore an efficient walking pattern by addressing issues like decreased stride length and insufficient weight bearing on the affected side.
Treadmill training is frequently incorporated, often with partial body weight support provided by a harness system. This support reduces the load on the lower extremities, allowing the patient to practice the repetitive motion of walking for longer durations and at higher intensities. For patients who can walk independently, overground training involves structured exercises like side stepping and forward-to-backward weight shifting to enhance dynamic stability and lateral weight distribution.
Training also includes practical tasks such as turning practice and obstacle negotiation to improve the ability to adapt to environmental changes. A highly effective technique is dual-task training, which requires the patient to walk while simultaneously performing a cognitive task, like talking or counting. This practice mimics the demands of everyday life, improving walking ability and balance control in situations where attention is divided.
Sensory Integration and Compensation Techniques
Balance is a product of seamlessly integrating information from three sensory systems: vision, the vestibular system in the inner ear, and somatosensation (the body’s sense of position and movement). Following a stroke, somatosensory deficits are common, causing patients to rely excessively on visual input to maintain their balance. Interventions are designed to retrain the brain to process this sensory information effectively and to compensate for any damaged pathways.
Sensory integration training often involves challenging the patient’s balance on different surfaces or with altered visual input. For example, practicing standing balance on a compliant surface like foam reduces the reliability of somatosensory input, forcing the brain to prioritize the vestibular and visual systems. Conversely, visual reliance reduction exercises, such as standing with the eyes closed or while wearing specialized glasses, encourage the use of the somatosensory and vestibular systems.
These techniques expand the patient’s limit of stability (LOS), the maximum distance a person can lean without losing balance. For patients with dizziness or vertigo, specific vestibular habituation exercises are used to reduce sensitivity to movement and improve the inner ear’s contribution to postural control. Sensory re-education also involves tactile stimulation, such as touching different textures or applying consistent pressure, to help stimulate and retrain the sensory pathways.
Assistive Devices and Environmental Modifications
When intrinsic balance is compromised, external support becomes necessary to ensure safety and maintain mobility. Assistive devices are selected based on the patient’s specific needs, with the primary function of increasing stability and improving the base of support. Canes, particularly quad canes with a wider base, and various types of walkers are commonly prescribed to provide a stable point of contact during walking.
For managing personal care, specialized equipment is used to reduce the risk of falling in areas like the bathroom. This equipment includes tub transfer benches, which allow the patient to sit while moving into the shower, and grab bars installed near the toilet and shower stall for secure handholds. Occupational therapists provide assessments to determine the most appropriate devices and their proper placement.
Modifying the home environment is a practical measure to prevent falls. This involves removing tripping hazards such as loose throw rugs and securing electrical cords that cross walkways. Improving the lighting in hallways and stairwells and installing raised toilet seats or bedside commodes are simple adjustments that significantly enhance safety and ease of movement in the home.