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How to restore balance following

stroke?

By
Rajul vasa B. Sc. P T
Applied movement scientist
Mumbai [India]
www.brainstrokes.com
What is balance?

 Balance is an ability of an individual to control,


restore and regulate the COM [centre of mass] of the
body automatically without thinking.
 Following stroke, when one side of the body muscles
are weak, paralyzed and may be they are spastic as
well, it is unable to control, restore and regulate the
COM against the force of gravity. This leads to….
 Automatic switch of control of balance to the non
paretic good side by selforganizing brain for; safety
of COM is a priority for all living organism.
Sensory Proprioception

With balance control switched to good non paretic side by self-


organized brain following stroke, the story does not end rather it
begins……..
 Self-organized brain also wants to secure the safety of COM by
unloading the paretic lower limb of the responsibility of the
large inertial mass of the head arm trunk to be born on the
paretic hip, it endorses the mechanical unloading of paretic hip
from unopposed pull of normal trunk muscles by neural
endorsement of ongoing peripheral input from normal
peripheral nervous system[PNS]
 Unloading of lower limb results in consequential effect on the
proprioceptors in the muscle and joint receptors. I believe that
instead of poor proprioception there is hyper proprioception /
hyperesthesia from unloading to make reloading of paretic
lower limb an impossible task thereby maintain COM safety
with good side.
Invisible consequences

 Invisible changes begin to take place to


enable the entire body to continue to
function with paretic side of the body
behaving differently in the 3 dimensional
space during postural tasks when
movement of COM needs to be controlled
and restricted within the safe territory of
good side of the central axis the vertebral
column.
Walking in 3 dimensional space.

 The imaginary balancing point of the body, the


COM in a stroke subject shifts towards the good side
of the central axis and unloading of paretic lower
limb and shift of inertial load of head arms trunk
onto good side restricts COM movement in unsafe
territory of paretic side of the central axis in 3
dimensional space of X axis, Y axis and Z axis
depending on where in space lies the safety and
what remains unsafe and what could pose a threat
when COM of the body needs to be accelerated
forwards to walk. This leads to…
The new role for paretic side: To follow

 With control on COM switched to non paretic good


side, paretic body anatomically and mechanically
connected to the good side at the central axis [the vertebral
column] it (paretic side) learns a new role to play to remain

functionally integrated with the good side by itself


“following” the good side and by letting the good
non paretic side to “lead” the entire body all the time
against the force of gravity for; safety is a priority for
all.
Visible Consequences

 With new role to follow the good side and allow the
good side to lead; the exchange of role between two sides
of the body when normal before stroke, becomes a
history and a past making “Normally abnormal, to be
Normal” for stroke subject.
 Paretic intrinsic foot muscles and ankle muscles though
weak and paretic begins its efforts to maintain the grip
with the floor by clawing the toes or hooking it to the
ground and ankle joint goes in planter flexion to
maintain contact with the support surface for balance,
being the last segment of the multi link of lower limb
which is constantly following the good limb and is
connected to the good side at the pelvis; the basin.
What to do for hooking of the toes?

 To get rid of the clawing and hooking of the toes to


the ground, one needs to restore balance of head arm
and trunk over the paretic hip of the paretic lower
limb to begin with in different postures like Buddha,
Side sitting, and Namaz.
Side sitting posture.

Try to destabilize the side sitting posture as under.


 Make the stroke subject to sit as shown in fig 1, then
ask him to move his good limb ( his paretic limb must not move)
as shown in fig 2
Buddha and Namaz posture

 Buddha posture for good mechanical stability.

 Namaz posture for mechanical stability.


Forward-backward

 Standing on the paretic lower limb when the good


limb moves forward and backward.
 Dear shreyas here can we…..
 Can we show the film in media envelop titled Bharat
and Manoj leg forward backward?
Balance thro’ paretic side

 As you succeed to restore balance and COM control


with paretic trunk and limbs hooking of toes,
clawing of toes and other segmental changes in the
upper limb and lower limb and trunk segments will
disappear automatically.
Conclusion

Self organizing brain is responsible for safety of balance with good


side but……
 It is also responsible why the paretic lower limb gets incapacitated
to reload the limb and to control and to restore COM, therefore
therapeutics must speak the same language of self-organized brain
and that is controlling COM from within and not from outside with
paretic limbs.
 All manmade efforts to retrain balance with externally induced
therapeutics and with high tech manmade machines will fall short
and remains dwarf in comparison to overpower the decision of the
selforganized brain and therefore will only lead to compensation
and compromise with vision and touch.
 Somatosensory touch on the wall, touch on the furniture, cane
crutch or help from therapists for balance is like laying an inroad to
habit and adaptation making it very difficult to restore sensory
motor control for stroke subject .