how to restore balance following stroke?

8/8/2019 How to restore balance following stroke?

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What is balance?

Balance is an ability of an individual to control,restore and regulate the COM [centre of mass] of thebody automatically without thinking.

Following stroke, when one side of the body musclesare weak, paralyzed and may be they are spastic aswell, it is unable to control, restore and regulate theCOM against the force of gravity. This leads to.

Automatic switch of control of balance to the nonparetic good side by selforganizing brain for; safetyof COM is a priority for all living organism.


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Sensory Proprioception

With balance control switched to good non paretic side by self-organized brain following stroke, the story does not end rather itbegins..

Self-organized brain also wants to secure the safety of COM byunloading the paretic lower limb of the responsibility of the

large inertial mass of the head arm trunk to be born on theparetic hip, it endorses the mechanical unloading of paretic hipfrom unopposed pull of normal trunk muscles by neuralendorsement of ongoing peripheral input from normalperipheral nervous system[PNS]

Unloading of lower limb results in consequential effect on the

proprioceptors in the muscle and joint receptors. I believe thatinstead of poor proprioception there is hyper proprioception /hyperesthesia from unloading to make reloading of pareticlower limb an impossible task thereby maintain COM safetywith good side.


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Invisible consequences

Invisible changes begin to take place toenable the entire body to continue tofunction with paretic side of the body

behaving differently in the 3 dimensionalspace during postural tasks whenmovement of COM needs to be controlled

and restricted within the safe territory ofgood side of the central axis the vertebralcolumn.


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Walking in 3 dimensional space.

The imaginary balancing point of the body, theCOM in a stroke subject shifts towards the good sideof the central axis and unloading of paretic lowerlimb and shift of inertial load of head arms trunk

onto good side restricts COM movement in unsafeterritory of paretic side of the central axis in 3dimensional space of X axis, Y axis and Z axisdepending on where in space lies the safety and

what remains unsafe and what could pose a threatwhen COM of the body needs to be acceleratedforwards to walk. This leads to


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Visible Consequences

With new role to follow the good side and allow thegood side to lead; the exchange of role between two sidesof the body when normal before stroke, becomes ahistory and a past making Normally abnormal, to beNormal for stroke subject.

Paretic intrinsic foot muscles and ankle muscles thoughweak and paretic begins its efforts to maintain the gripwith the floor by clawing the toes or hooking it to theground and ankle joint goes in planter flexion tomaintain contact with the support surface for balance,

being the last segment of the multi link of lower limbwhich is constantly following the good limb and isconnected to the good side at the pelvis; the basin.


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What to do for hooking of the toes?

To get rid of the clawing and hooking of the toes tothe ground, one needs to restore balance of head armand trunk over the paretic hip of the paretic lowerlimb to begin with in different postures like Buddha,Side sitting, and Namaz.


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Side sitting posture.

Try to destabilize the side sitting posture as under.

Make the stroke subject to sit as shown in fig 1, thenask him to move his good limb ( his paretic limb must not move)

as shown in fig 2


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Buddha and Namaz posture

Buddha posture for good mechanical stability.

Namaz posture for mechanical stability.


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Forward-backward

Standing on the paretic lower limb when the goodlimb moves forward and backward.

Dear shreyas here can we..

Can we show the film in media envelop titled Bharatand Manoj leg forward backward?


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Balance thro paretic side

As you succeed to restore balance and COM controlwith paretic trunk and limbs hooking of toes,clawing of toes and other segmental changes in theupper limb and lower limb and trunk segments willdisappear automatically.


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Conclusion

Self organizing brain is responsible for safety of balance with goodside but

It is also responsible why the paretic lower limb gets incapacitatedto reload the limb and to control and to restore COM, thereforetherapeutics must speak the same language of self-organized brainand that is controlling COM from within and not from outside withparetic limbs.

All manmade efforts to retrain balance with externally inducedtherapeutics and with high tech manmade machines will fall shortand remains dwarf in comparison to overpower the decision of theselforganized brain and therefore will only lead to compensationand compromise with vision and touch.

Somatosensory touch on the wall, touch on the furniture, canecrutch or help from therapists for balance is like laying an inroad tohabit and adaptation making it very difficult to restore sensorymotor control for stroke subject .

how to restore balance following stroke?

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