What is balance?

Balance disorder is an important problem in stroke patients. Balance is the situation where the line of gravity, descending vertically from the center of gravity of the body in a sitting or standing person, remains within the support surface consisting of the parts of the person in contact with the ground and the area between these parts. Balance must be maintained for stationary (static) and mobile (dynamic) situations. Being able to sit upright without leaning back indicates sitting balance. Balance is evaluated separately during standing, walking or various movements.

How does one stay in balance?

For a good balance, the perception of joint position, the perception of the position and acceleration of the head from the balance organ in the ear, and visual signals are integrated in our central nervous system. Our cerebellum ratio is of particular importance for balance. In cases where one of the aforementioned systems does not work properly, sometimes the balance can be maintained with the data coming from other routes. Of course, musculoskeletal capacity, such as sufficient muscle strength, flexibility and range of motion, is also required to maintain balance.

In which problems is loss of balance seen?

The inability of the person to hold the gravitational line descending from the center of gravity of his body on the support surface on the ground is an expression of loss of balance. Loss of balance causes difficulty in walking and self-care activities and increases the risk of falling. Falls are an important cause of disability and death in the elderly . Loss of balance may occur in the elderly for reasons such as postural disorders and muscle weakness. In addition, balance disorders are observed in various neurological diseases such as stroke, Parkinson’s disease, and multiple sclerosis. Therefore, balance assessment is an important part of the examination.

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What causes balance disorder in stroke patients?

There may be various reasons for loss of balance in patients who remain paralyzed after stroke, a disease in which the brain is damaged due to sudden vascular causes. Disturbances in cognitive functions, lack of attention, dizziness, cerebellum damage, loss of sensation, decreased vision, stance disorder, asymmetry between the paralyzed and healthy side, neglect, too loose or tight muscles, stiffness in the joints, medication side effects can cause balance problems.

Since loss of balance can develop due to many factors, a good examination should be performed and the causes should be determined. In general, more than one factor coexists in the patient and affects the balance disorder to varying degrees.

How is balance assessment done?

Balance is evaluated separately during sitting, standing and walking. Physical examination methods, examination and questioning-based standard balance tests (functional reaching test, timed standing and walking test, Berg balance scale, posture assessment scale in stroke, etc.) and devices (computerized dynamic posturography, VEMP, etc.) can be used in balance assessment. Thus, it can be understood that which of the systems that help to establish balance in the body is affected and to what extent. The person’s history of falling is questioned and measures are taken to reduce the risk of falling.

Can balance disorder be corrected in stroke patients?

Balance rehabilitation or vestibular rehabilitation is a form of treatment based on exercises to improve balance and reduce dizziness. As with muscle weakness, arthritic conditions, postural disorders and other neurological diseases, balance disorders also benefit from this treatment in stroke patients. Depending on the components of loss of balance, the following treatments can be applied under the decision and supervision of a physical therapy and rehabilitation physician:

  • Exercises and trainings for relaxation, flexibility, strengthening and joint position sense
  • Static and dynamic balance exercises
  • conditioning exercises
  • Tai Chi exercises
  • Exercises to increase the control of eye movements (vestibular adaptation exercises, oculomotor exercises)
  • Practice exercises (Cawthorne-Cooksey exercises, etc.)
  • Exercises with specially designed devices to improve balance (posturography training)
  • Vestibular rehabilitation with virtual reality
  • Vestibular electrical stimulation
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Balance disorder can be treated in stroke patients by applying appropriate balance rehabilitation. Sitting without support, standing time, walking distance and safety can be increased. The risk of falling can be reduced. When necessary, walking aids such as walking sticks and walking sticks can be used to increase balance.

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