Regaining Balance

[Drayk]

Hi,
i was wondering what some of u guys do to help regain a patient's balance after Stroke.

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[ratri]

hi....well i would hav given him \ her tandom walkin ,parallel bar walkin,and various other equilibrium exs n coordination exs

[cheryl86]

Hi there, if the patient is on the bed, iwould have trained the trunk muscles including deep breathing technique and kegel's exercises. They are quite useful to increase the stability of the spine and able to reduce any discomfort as well. Next will be strengthening of the gait muscles power to at least 3+ and followed by the exercises that had been suggested by Ratri.

[ADDABAD]

I need trunk balance. How do I regain it?

[ADDABAD]

Hello,
Just Me Again. Looking For Help Regaining My Balance. Any Help? Exercises That Can Be Done In Bed. I Cannot Walk. Yet. Please Help Me.

Adam

[ADDABAD]

HI ALL,
JUST LOOKING FOR HELP. I WANT TO WALK. I HAVE ALL OF THE STRENGTH AND CAN STAND EASILY. BUT THAT IS IT. NO TRUNK BALANCE. PLEASSE HELP.
[email protected]

[Gawaine]

are you working with a physical therapist...?

it's kind of hard to prescribe exercises over the internet when i don't know your condition, current level of function, and other factors...

it's sort of like if i asked you "how much weight should i lift in the gym???"

[Geert]

Hi

For patients after stroke, there is the Trunk Impairment Scale (TIS) which can be used as an outcome tool and a guide for therapy since the development of the scale was based on the neurorehabilitation (clinical) literature and the opinion of experts in the field. I have attached the pdf (2004) of the article.

The TIS consists of 17 tasks ranging from sitting on the edge of the bed, sitting on the edge with a more narrow base of support, and various selective movements of the trunk (lateral flexion and rotation), initiated from the shoulder girdle and pelvic girdle.

A better performance on the TIS early after stroke has been shown as an important prognostic factor for ADL (Activities of Daily Living) outcome at six months after stroke (see attached 2007 pdf).

Of course trunk stability and selective movements are only the first step in a recovery process. Hopefully the TIS can be a first guide in this journey.

Good luck!
Geert

[ADDABAD]

How dou you get a patient to regain TRUNK balance after a TBI. If they have all of the stregnth and can stand easily.

[Geert]

Hello again

Balance is a difficult concept.
In the earlier days, people thought it had a hierarchical organization with a lot of neural elements in the subcortical region.

That view has changed now and people like to speak about the dynamic systems framework. This framework sees balance as an interaction between
- the individual;
- the task and
- the environment.

The environment has a great influence on balance, whether it's sitting or standing balance. Walking up stairs will be quite different in the home environment or in a dark cinema room to go to the toilet for instance.
The task relates of course to what you want to do and with increasing difficulty, more demands will be necessary to keep balance. Quiet standing is a basic prerequisite, reactive balance (as a reaction when being pushed) and proactive balance (as an anticipation on an incoming balance challenge) require more balance-related skills.
The individual is of course another crucial part. The motor system with its relevant muscle synergies need to work optimal for good balance; the sensory components for balance include vision, the vestibular system, and the sensory system and then there are of course cognitive aspects like being able to perform dual tasks.

As you can see, one had to look at all these different elements in order consider what treatment would be suitable.

I found it interesting that you mention balance problem of the trunk. Good strength and able to stand...
I would certainly check two things: is the balance problem of the trunk in sitting after coming from supine? Maybe it's dizziness? Then that could mean the vestibular system. Or selective trunk ataxia is also seen in what is called a vermis syndrome where the central part of the cerebellum is affected and what typically gives trunk ataxia in sitting.

Best of luck
Geert

[ADDABAD]

Hi, I am begging for some help. It's been just over six years now, and I cannot go on any longer. Don't get me wrong. I am thankful to still be alive, just not like this. I need help. Intense physical therapy. Perhaps I should elaborate. On the night of Sept. 23, 2003 I was in a near fatal motorcycle accident. And I was not speeding or wasted. I don't really remember it but here it sis, in a nutshell: I was changing the location of my karate school, and had to clear my head, so I took a drive down the coast on my Yamaha VMAX motorcycle when I ran into 6, I am told, dead Wild Boar, lying on the highway.
I was thrown from the motorcycle. And luckily for me my 30+ years of martial arts training paid off. As I tucked and rolled. This move definitely saved my life. But, as I was thrown ahead of the motorcycle, it caught up to me and hit my head. So I suffered a Traumatic Brain Injury.
I was in a coma for 30 days. And in, what I am told is a semi-coma for five months after. I am at home now, but am disabled. I cannot walk. And not because of loss of limbs. As I am very strong and can stand easily. It is a balance issue. I have none. My doctor says that the nerves in my ‘core’ are damaged.
It is just very difficult. As I am very strong. As at the time of the accident I was a US amateur middleweight kickboxing champion.
Anyway I am now begging for some help. I want to walk. Don’t get me wrong. I am thankful to be alive. It’s just, not like this. I can’t even roll myself in my wheel chair. As when I hit, like I said, I tucked and rolled. And I landed on my left shoulder. Breaking my left clavicle. So I cannot use my left arm or hand. And cannot hold onto or grip a walker.

Adam Rogers
456 Oak St. Apt. J
Monterey, CA 93940
(831)717-4139
[email protected]

[gcoe]

Hi Adam

What sort of rehab did you have?
Did you get extensive physical therapy from a neurological physiotherapist? And if so when did it stop?

My guess is that getting one-to-one treatment with a competent neurological physiotherapist would be your best bet.

Seven years have now passed since your injury so further brain recovery maybe somewhat limited at this point. However if you haven't had treatment for a while or you didn't get much to start off with you may benefit from a burst of rehab.

there are many aspects of balance that can be affected when you can't walk. One technique that has gained some interest in recent years is body weight support treadmill training (BWSTT).

22883.jpg

The technique is quite simple in theory. You wear a harness that is suspended above a treadmill, that supports some of your weight and stops you from falling over while you practice walking on the treadmill. this can give you the opportunity to get considerable practice in to improve you skill at balance walking.

there are also some quite fancy robotic versions but the technique is basically the same:

Lokomat.jpg


I don't know if BWSTT would be right for you but it may be worth finding out if you make some enquiries

[ADDABAD]

Thank you. And where can I find help. I am just very frustrated. I am growing tired of waiting for balance to just come. I am willing to work for it. Just where? Where can I go for therapy?

Adam

[Fyzzio]

Hi Adam,
I have just googled Monterey and neuro rehab and came across this:

Director
Phone: 831-625-4835
Community Hospital of the Monterey Peninsula - Community Hospital of the Monterey Peninsula
Community Hospital of the Monterey PeninsulaRehabilitation Services
PO Box HH
Monterey, CA, 93942
USA Certified vestibular therapists.

Specialties: General Balance Retraining, Geriatrics/Elderly Fallers, Neuro-Rehab, Orthopedic Rehab, Vestibular Assessment , Vestibular Rehab

They are not neccessarily TBI specialists, but should be able to do a thorough assessment and/ or refer you on to a specialist Physiotherapy service.

Regrads,
Andrea

[ADDABAD]

Thank you all, so much. I am trying to keep the faith. And just so everyone knows, I have never had intense physical therapy. I just know it is a balance issue. As I can walk easily, with asistance. And I stand everyday, holding onto a rail outside my apartment.

[manc11]

hi my name is Niamh and I'm 17 years old, I recently have been having problems walking. I was born with a rare disease and in the last 3 years it has spread to my cerebellum in the brain, at the moment I am able to walk with assistance and stand holding onto something solid, I know that it's only a balance and strength problem that is holding me back from being able to walk again and I was wondering if there are any special exercises that will help me achieve this as quick as possible

[gcoe]

Hi Mancc11

If the main problems are comimg from the crebellum then yes balance is a key feature of problems and you may also be experencing some problems coordinating your movement when you walk so movements may become clumsy and there may be a shaking movemnt when you move. There usually isn't true weakness as other parts of the brain tend to produce strong movements. you may of course be weak but then that mayindicate other parts of the brain may be invoved.

You will find physios who work with nervous system diseaseswill be reluctant to prescribe exercise when they have'nt properly assessed your situation -so that is a big ask over the internet. However we may be able to give you some general points to work on if you give us some more info about how you experience moving.

May I ask what the diesease is that you have? And could you describe in detail what happens when you try to walk?

[manc11]

the disease is called langerhans histiocytosis. I have weakness because I was on tablets that reduced tone in my legs but at the same time weakened the muscles, but I am currently not taking this medication any more. When I stand up to walk it's as if I have no ability to walk by myself, I can take two steps without holding on to anything but I can't do this all the time, sometimes when I'm walking with crutches I get a feeling that I'm going to fall (usually when I'm in a wide area with nothing to hold on to or if there are a lot of people walking around me) this disease only effects my legs, the rest of my body works normally, the main question I have is will I ever walk again properly. Can anybody be thought to walk again no matter what their history is?

[gcoe]

Hi Manc11

Thanks for your info. First off I need to say I am not familiar wth Langerhans Hystocytosis so anything I say re: exercise, you should check out with your specialist to check if it is ok and get some help from a physio.

Will you walk again? This is a very important question for you and I am sorry I can't really answer it. As I said I don't know your illness but from a quick bit of reading there is a wide range of severity of the disease and being a rare disease I would suspect it would be quite hard for the people who have treated you to come up with an answer. Here would be some factors to consider:

* depends on whether anyof the brain tissue damage is temporary and reversable or whther the damage s permanent. In a lot of systemic diseases it is often a mixture of these two things.

*you are young and have age on your side. Younger people do have more potential for recovery as the brain seems less set and more amenable to changes.

*neuroplasticity - the ability for the brain to remodel itself (and on some cases even regrow cells) has greatly surprised us in more recent years. The brain has much more ability to change when extensive practice is used. In order to drive positive neuroplastic changes and relearn movement practice that is intensive and extensive, and highly demanding but leaves you feeling a bit more confident about your abilities at the end and not despondent, may provide the best condiond for improving

*motivation makes a huge diference. I take it you may not be short on this so giving it your best shot can help. However if you find it impossible to improve then you shouldn't blame yourself- better to accept that you did the best you can

Weakness

From what you described the weakness might benefit from progressive resistance training where you go for strngthening and muscle hypertrophy. So this is your typical weighhts on the gym you repeat each exercise 8-12 times so you can't do anymore. An overall weights program may be good and in the legs working on the muscles that work against gravity -so gluts quads, hamstrings, calf muscles. If by chance your muscles are too weak for weights in the gym a physio can devise other forms of resistance that can bridge the gap - so using finer increments of weights, elastic rubber bands (called theraband) . Howeveer i would definitely get the go ahead from your specialist - with systemic disease sometimes the normal adaptions to weights is affected and you cpuld do yourself some harm. Second i wpuld get a tailored program with a physio or a Personal trainer who under supervision from a physio. A physio could assess you for the weakest muscles and design a targgetted programme.

Balance in walking

From what you described when you attempt to wakl the information from your inner ear is not getting processed in your cerebellum and informing what your muscles need to do in order to keep your balance. This is normally a very fast system and it is relatively automatic - so now you can't trust itand you have to consciously focus on what you are doing - even then you can't keep your balance for long. You may also have some incoordination that is throwing you off balance.

One of the best solutions for practising to try to improve your balance is Body Weight Support Treadmill Training (BWSTT) or body weight support overland waalking. Have you tried this? Here you wear a harness a bit like rock climbers or abseillers and you are suspended overhead. In your case you don't want much support as your muscles may be strong enough to hold your legs against gravity, but the harness acts as a "safety net" in this case allowing to practice walking hundreds of steps at a time and learning from mistakes but the support is firm enoght that when you throw yourself off balance it keeps you upright and you can continue stepping. As yoou get better you slowly make the harness less supportive to increases the challenge. In order to benefit fom this you should be doing at least 1/2 an hour a day, preferably more and you may need to build up to it. This is definitely a physio gym activity.

Hope this is of help

[manc11]

No I have not tried BWSTT I have been on a treadmill but only to practice walking and without a harness, I don't think there is a harness that you describe in the physiotherapy gym I go to. I will try the exercises you have advised me, as I have plenty of therabands at home I will try that exercise before trying weights. Is there a way I can reprocess the information getting sent from my inner ear to go to the cerebellum? I feel as if I have balance but I have no confidence to walk by myself, I can only cruise from furniture to furniture or use crutches how would I know if I have the balance needed to walk? although I know I should listen to my physiotherapist and obey her, I feel as if the ones I get are of no help or little help for fixing what I prioritize as most important but I am scared that she will tell me that there is nothing else I can do to regain walking if I ask her if there is any hope. I appreciate your help and advice trying to help me understand what I should be doing in order to walk again.

[gcoe]

Is there a way I can reprocess the information getting sent from my inner ear to go to the cerebellum?

if the lesion is in the cerebellum itself then the problem is not with the information itself, rather the procssing of it withon the damaged cerebellum. As I understand it when you practice walking now two things that can help come intp play:

1. Circuits in the cerebellum that are still intact may be able to take over in part
2. Other parts of the brain that also control walking my learn how to compensate and do some of the job of the cerebellum.

In order to get these processes to work you have to do a huge amount of practice and although there may eventually be some ways to speed up this sort of learning ( eg certain drugs or gene therapy or stem cell therapy) we are just not there yet. So at this stage the best we can is apply our understanding about how we improve our motor skills. And the most important of things is just putting n the practice. If you havedone this and you aren't getting any improvement then unfortunately there may not be much ability for these processes to do more. However physiotherapy in real life may often not be intensive enough - in rehab it is often hard for economic reasons to provide the hours required. So ythat might be something to consider.

I feel as if I have balance but I have no confidence to walk by myself, I can only cruise from furniture to furniture or use crutches how would I know if I have the balance needed to walk

that sounds to me like that is very much to do with lack of balance. You have enough muscle power to get yourself from A to B. But you can't do it without going off course or falling over. So cruthes and furniture are ways you use to compensate for that lack of balance. The problem is like this: every time you use a crutch or hold onto furniure you successfully compensate for the blance problem but then you don't get the needed practice in to relearn how to correct your walking. In that way the problem is very much like learning a very demanding skill if your brain is not damaged. You couldn't learn to balance on a skateboard if you used crutches to steady yourself - you just have to do it. That is where the BWSTT comes in - aims to keep you upright enough to keep you on track but allows you to make errors in your balance and to correct those errors

although I know I should listen to my physiotherapist and obey her, I feel as if the ones I get are of no help or little help for fixing what I prioritize as most important but I am scared that she will tell me that there is nothing else I can do to regain walking if I ask her if there is any hope.

i am glad to hear you are working wiyh a physio. Managing working together is not easy at the best of times. You may be worrying that she may be thinking she has done all she can for you and if you " rock the boat" she may just discharge you. My comment would be is that she knows you and your problem a lot better than I or anyone on an internet site can. It may be that you need to trust her enough just to be really frank (but polite of course) and have a good talk with her about these things and what is worrying you. Trust is very important. It might help to thi k about it from her point of view. Here you are - young guy with a very major movement problem that is rare. She knows a lot about physio for these problems generally but she may be struggling to know how this might apply in your case as she may have never seen someone with your disease. Who knows... She might be feeling frustrated that she isn't managing to help you more. She is only human so i suggest you have a good talk to her soon. Choose a time when she isn't too busy and just say what is on your mind.

[ADDABAD]

Hello all,
It is me, once again, asking for some help. It has been seven years now. I am strong, can move my legs, and even stand. But that is it. o balance. Does anyone know of any inpatient physical therapy clinics I could go to? You can reach me here: [email protected].