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How do does a physical therapist help survivors to improve their balance?

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Physical Therapist

Answer transcribed from Brightway's interview with physical therapist Susan Little:

I think balance is so interesting. Let me start by saying that it is a tremendously complex system and network that controls our balance as human beings. That's good and bad. It's bad because with any brain injury, regardless of the location of the injury, balance seems involved in some bit. The good side is that because it is such an extensive network, there's lots of room for improvement that if one part of that network is even very severely damaged, you have other systems that can compensate. 


With that said, balance rehab is not unlike any other kind of exercise or strengthening. If we want our muscles to get stronger, we all know you lift a challenging heavy weight and that muscle gets stronger. With balance, you need to do the same. You need to challenge your balance system and it will get better. Those gymnasts in the Olympic events aren't born that way. They practice, practice, and practice and their balance gets better.

Brains are the same. Your brain is the same even if you've had a brain injury. You have that capability for that balance to improve, but you have to challenge your balance. Although you can safely lift a weight that is challenging and make your muscles stronger, it's sometimes harder to challenge your balance in a safe manner. I always say that you need to find something that is challenging but doable and find a way to do that safely and not fall. One technique is obviously to have a therapist or a family member guard you while you're doing these difficult but doable exercises. Another way that I often give to my patients is to have them position themselves standing in a corner where their back is to the corner and they're not touching the wall but they're as close as they can be to that wall without touching it. They also place a sturdy chair in front of them so they have guide rails all around them. Then, they work on their balance exercises at a very basic level.


If you walk with a walker, that might be simply letting go of the walker for ten or five seconds, whatever is difficult but doable. As you progress, that may progress up to balancing on one leg. Again, if you lose your balance, you have that wall beside you and behind you, as well as that chair in front of you so that you can catch your balance and be safe. You can progress through a variety of balance exercises from balancing on one foot to balancing on one foot with eyes closed or with eyes open. Turning your head also has a surprising impact on your ability to balance and is often very affected after brain injury. So by incorporating just head turns while you maintain your balance, you can strengthen those balance reactions by challenging them. I think that's the exciting part for me because I know our brain has that capability to improve if we give it the right kind of challenge. 


Again, you sure don't want to fall and hit your head again or do some other type of injuries. So if you have an acting therapist, I would certainly check in with them regarding the balance exercises. If you don't, perhaps again a family member standing by is always the best way to start. Having a steady family member who can support you if you lose your balance can keep you safe. Now, understand that if you are wheelchair-bound or if you're even struggling with just your sitting balance, you may want to begin with working on your sitting balance. Again, I would similarly suggest that you sit on the edge of a bed or something soft so that if you lose your balance to your side or backward, you have a landing zone that is safe. In front of you, have again a sturdy chair or a caregiver to provide you that support and guarding that you may need if you're really not ready to be doing the standing kind of balance.


It’s hard to answer in specifics because everyone's balance level is different, but I think you can try some of those and see. Keep the general thought that I need to challenge my balance in a safe way and find a way to do that. Make sure that those challenges are difficult but doable. There’s no point in doing them if they're not difficult because that does not drive change and improvement in our brain and our balance system.