Balance problems are a common experience for people

following a stroke. Insufficient co-ordination and stability can

make people feel unsteady and lead to falls and lack of
confidence. Thankfully, there are exercises that can help
stroke sufferers regain balance.
The impact of stroke on balance can be complex, but we
know that the brain sends signals to the muscles through the
nerves to make them move and that a stroke can damage
the brain, thus affecting these signals. Balance problems can
involve various parts of the body, such as the eyes, ears,
muscles, and joints. It is common for a whole side of the
body to be weak following a stroke, yet in some cases, a
person may only experience weakness in one arm or one
leg. The muscle weakness can be mild or severe. Severe
cases may even involve paralysis.
Something called drop foot – which causes your toes to
catch on the ground when you take steps, problems with
stamina, and stiffness or tightness in the muscles – can also
impact movement for those who have had a stroke.

Causes of balance problems after stroke

Balance problems can have a negative impact on quality of
life if they last for a long time. Regaining balance after stroke
is therefore important, but it is helpful to understand the
cause of the balance issues. You are more likely to have
balance problems when a stroke has affected the left side of
your body. Let’s take a look at some causes of balance
problems.
Weakness. Most stroke patients feel some kind of weakness,
at least on one side. They may have difficulty sitting up,
straightening legs, and standing, or they may be okay with
walking, but experience drop foot. There is also a chance
that they could feel disoriented in crowds or on uneven
surfaces.
Loss of sensation. This can happen on the affected side,
especially in the leg. It is like you can’t feel where your leg
and foot are. This increases the risk of falling since it is very
hard to feel the ground when you try to stand and walk.
Injury to brain. Sometimes, stroke occurs in the areas of the
brain that control balance (brain stem). This could give you
the sensation that you are moving when, in fact, you are not.
Lack of concentration. Moving around and trying to keep
balance after a stroke requires a lot of concentration and,
therefore, can be tiresome. This is why many stroke patients
will not talk when they are moving – it is just too hard for
them to concentrate on two tasks at once.

Other common problems that affect your

balance after stroke
There are other problems that can affect balance after a
person suffers a stroke. For example, some people
experience perceptual problems. Often associated with the
right side of the brain, perception issues make it hard for a
person to interpret their surroundings. When the world
around you doesn’t make sense, it makes it very difficult to
move, as you can imagine. Below is a list of other common
problems.
Vision problems. Focusing can be quite difficult after stroke.
Or, patients can have double vision, eye movement
problems, or blind patches. This can easily throw balance
off.
Dizziness. A feeling like the world is spinning is common after
a stroke. Some stroke victims even experience vertigo.
Ataxia. This is a condition that causes clumsy,
uncoordinated movements. It normally occurs with strokes
affecting the back of the brain.
Medication side effects. Certain medications for treating
stroke can cause side effects, including dizziness or
weakness.

Exercises to help regain balance after

stroke
Stroke balance exercises can be very helpful as a person is
going through the recovery process. Physical therapists do
caution that balance exercises for stroke patients should
begin at a basic level and work towards a more advanced
routine. Basic level exercises might seem simple at first.
However, to work properly, they do require strong brain
connections.
Here are some basic level exercises stroke patients can
consider:
 Heel raises – These require holding onto a sturdy chair
or countertop, and rising yourself up on your tiptoes,
while keeping knees and upper body straight.
 Side stepping – Hold onto a counter or ledge, place
tape on the floor, and step sideway to cross the line,
placing one leg across the front of the other. Reverse
the motion, returning to the starting point, but this time
crossing the leg behind.
Once a person feels comfortable and steady with the basic
balance exercises, they can safely move on to intermediate,
such as the exercises outlined below.
  Heel raises – Similar to the basic level, only you don’t
hold onto anything (no counter or chair for support).
 Side stepping – Perform the side step, crossing your
legs across each other as you move across the straight
line, but don’t hold onto a counter or ledge.
 Heel to toe walking – Set up a straight tape line for side
stepping and walk forward placing the heel of your foot
directly in front of the toe of the other foot as you walk.
Go to the end of the tape, turn around, and repeat the
process.
 Gym ball squats – Put an exercise ball between your
back and a wall, as you stand tall, slowly lower into a
squatting position, then roll back up to the standing
position. Repeat this several times.
When stroke sufferers are really dedicated to balance
exercises, they are often surprised at how quickly they can
progress to the next level. It is different for everyone, so if
you have suffered a stroke and are participating in exercises,
there is no need to rush it. If and when you are ready, you
can move on to high-level balance exercises for stroke, such
as those suggested here.
 Single leg standing – This involves placing both feet flat
on the floor and slowly lifting one leg so that you are
balancing on the other leg. You hold it for at least 10
seconds and then alternate legs.
 Backwards walking – Find a room that is free from
obstacles and walk backwards slowly. It is best to try
this with someone close by the first time just as a
precaution.
 Weighted ball pass – Take a weighted exercise ball and
slowly pass the ball from hand to hand as you circle it
around your body, while you are standing. Do it
clockwise and then counterclockwise.
Aside from these specific balance routines, physical therapy
exercises for stroke patients are also commonly used to help
people regain strength and stability. In some situations,
standing up right after a stroke is very difficult, so sitting
balance exercises for stroke patients can be the first step
towards recovery. These exercises can include sitting on a
sturdy bench and shifting your weight from side to side, so
that your hip lifts off the surface, shifting back and forth as
you arch and round your lower back, as well as leaning
down on your elbows side to side or reaching out as if you
want to touch something with your weak side.
Without good balance, it is not only difficult to stand and
walk, it can make it hard to get dressed, take a bath, or use
the toilet. Investing time and whatever energy you can to
complete balancing exercises following a stroke is well worth
it. Studies show that rehabilitation that includes balancing
exercises provides stroke sufferers with the best possible
outcome in the end.

5 Outstanding Treatments to
Improve Balance After Stroke
October 22, 2018
Balance problems after stroke can be reversed with effective stroke
treatment — but which one is right for you?

To help you find the best way to improve your balance after stroke, we
rounded up the best data-driven treatments.

After we explain the top 5, we will help you estimate how long it will take
you to regain your balance after stroke.

Let’s dig in.

What Causes Balance Problems after Stroke?

A stroke on one side of the brain affects the opposite side of the body.

For example, a left side stroke will impair the right side of the body,
creating all sorts of imbalance issues.

When one side of the body isn’t cooperating as much as the other, it
can affect your gait (manner of walking), balance, and coordination.

Luckily, as with most stroke side effects, it’s absolutely treatable

through repetitive practice.

How Repetitive Practice Helps Stroke Survivors

Regain Balance After Stroke
Repetitive practice is fairly straightforward:

It simply involves practicing a task you want to get better at in a

repetitive fashion.

This is the key to stroke rehabilitation because repetition helps the brain
rewire itself and form new neural connections.

This happens through neuroplasticity, the mechanism that your brain

uses to lay new neural pathways and reinforce existing ones.

The more you rewire your brain, the more your balance will improve.

The key is to practice the right thing.

We’ll dig into that next.

How to Treat Balance Problems After Stroke

There are various causes of balance problems, so the best treatment for
you will depend up on your stroke side effects.

To help you navigate these treatments, we have labeled who each

treatment is best suited for.

1. Rehabilitation Exercise

The most common cause of poor balance after stroke is impaired

muscle coordination in the legs and core.

If you can rewire the brain and improve coordination in your legs and
core, then your balance will improve too.

Treatment:

To improve balance after stroke, start practicing rehab exercises that

focus on 3 areas:

 Strengthening balance rehabilitation exercises

 Leg rehabilitation exercises
 Core rehabilitation exercises
The more you rewire the brain through practice, the more your balance
will improve.

Who is this for?

Individuals with hemiparesis (weakness on one side of the body) or

hemiplegia (paralysis on one side of the body) can benefit from
rehabilitation exercise.

2. Foot Drop Exercises

Foot drop is a condition that impairs your ability to lift the front of your
foot, which can cause it to drag on the floor when you walk.

This is a dangerous stroke side effect because it impairs your balance

and increases the likelihood of falling.

Treatment:

Foot drop exercises can help you regain mobility in your foot when
practiced with regularity.

Who is this for?

Anyone who struggle with dorsiflexion (lifting the front part of their foot
upward) can benefit from foot drop exercises.

3. Vision Deprivation Therapy

Some stroke patients suffer from impaired vision after stroke, and for
once, it may be a good thing.

In this study, stroke patients were deprived of visual cues during balance
rehabilitation programs.

Surprisingly, stroke patients who were deprived of visual cues improve

their balance more than the control group.

The study suggests that overuse of visual cues may be a compensatory

strategy for coping with balance problems after stroke.

Treatment:
Present the study to your therapist and ask if visual deprivation balance
training might be a good fit for you.

If they say yes, be sure to practice under the supervision of your

therapist or caregiver!

Who is this for?

If you don’t have a heightened fear of falling, then visual deprivation

balance rehabilitation may be a good fit for you.

But be sure to check with your therapist because it could be a very

dangerous activity without proper care.

4. Cognitive Training Exercises

Some balance issues are actually a cognitive problem, like impaired

concentration and hemineglect(failing to notice the environment on your
affected side).

When stroke affects your ability to concentrate or notice your

environment, it can result in poor balance.

For example, you may slip on a step, not because your legs are weak,
but because you simply did not notice the step.

Therefore, improving your attention can help with regaining balance

after stroke.

Luckily, studies show you can improve your attention after stroke through
attention process training.

Treatment:

Attention process training, such as cognitive training exercises, can help

improve concentration and attention after stroke.

Just like you can rewire the brain to improve leg coordination, you can
also improve cognitive function.

It’s all about repetitive practice!

5. Modified Yoga Therapy

If you enjoy yoga, then you’ll be pleased to know that modified yoga has
been shown to help improve balance after stroke.

After doing yoga twice a week for 8 weeks, stroke patients improved in
the following balance-related areas:

 Improved activities-specific balance confidence

 Reduced fear of falling
 Improve quality of life

Treatment:

Try participating in modified yoga sessions twice a week with a trained

therapist, if you can. It’s important to work with a therapist familiar with
stroke so that (s)he can modify each pose correctly.

Who is this for?

Anyone interested in improve their balance and quality of life!

How Long Does It Take to Get Your Balance Back

After a Stroke?
According to our data-driven stroke recovery timeline, many stroke
survivors improve their balance after about 6 months.

That’s roughly how long it takes to improve your gait (manner of

walking) and other stroke side effectsthat affect balance.

Your recovery time may be shorter or longer depending upon the size
and location of your stroke.

Every stroke is different, therefore every recovery takes different

amounts of time.

The good news is that when you participate in rehabilitation

consistently, your balance will start to improve.

Although it happens at different rates for everyone, you can regain

balance after stroke with correct, consistent treatment.

Summary: Regaining Balance After Stroke

Balance problems after stroke are the result of various side effects such
as hemiplegia, hemiparesis, and foot drop.

The best treatments involve repetitive practice. By repeating

therapeutic stroke rehabilitation exercises, you can rewire the brain and
improve balance after stroke.

Complimentary treatments like modified yoga and vision deprivation

therapy may prove useful when practiced under a trained professional.

Overall, rest assured that balance problems will improve after stroke as
long as you’re participating in regular therapy.

ore Exercises for Stroke Patients

to Improve Stability
November 14, 2016
Core exercises for stroke patients are essential for reducing your risk of
falling, stabilizing your balance, and improving your gait (manner of
walking).

The following stroke exercises are arranged from easiest to hardest. Each
features a picture of our physical therapist Cassie.

Video: Core Exercises for Stroke Patients with PT

Cassie
Before we get started, here’s a video that walks you some easy core
exercises for stroke patients.

It’s a great warm-up, and you’ll get to meet Cassie!

Core Exercises for Stroke Patients from a Physical

Therapist
Below, you will find 5 more core exercises for stroke recovery with
written instruction.

The first 2 exercises came from the video above. The other 3 core
exercises are more difficult variations.

Bonus: Download our free Stroke Rehab Exercises ebook. (Link will open a
pop-up that will not interrupt your reading.)

1. Trunk Rotation (Twists)

From a seated position, place your right hand on the outside of your left
thigh.

With your back straight, use your arm to help twist your torso to the left.

And if you can’t move your right hand, then you can use your left hand
to assist it.

Be sure to keep your spine straight and don’t twist to the point of pain.

Aim to engage your core and get a good core exercise in.
Repeat on each side 15 times.

2. Lateral Trunk Flexion (Oblique Crunches)

From a seated position, dip your left shoulder down towards your left
hip.

Then, return to an upright position by focusing on using your core to pull

yourself up.

If you can’t fully complete this exercise yet, then you can use your arm
to push yourself back up.

Repeat on each side 15 times.

3. Forward Punches

Clasp your hands together, then punch forward while keeping your arms
parallel to the floor.

Use your back muscles to come back up. You should really feel this in
your core.

Repeat 10 times. But if you feel any pain in your back, stop immediately.

4. Knee to Chest

From a comfortable lying position, hug your knees into your chest.

Then, hold on to left leg with your left arm and then extend your right leg
onto the floor. This is your starting position.

From your starting position, bring you right leg back into your chest.

Try not to use your leg muscles to achieve this movement. Focus
specifically on engaging your core and using your core muscles to lift
your leg up.

Once your leg is back in your chest, give your core muscles a good
squeeze, then release your leg back down.

Perform 10 repetitions with each leg.

5. Toe Taps

While lying on your back, lift your legs up and bend your knees at a 90
degree angle.

Your shins should be parallel to the floor and your thighs should be
perpendicular. Your core should be fully engaged.

This is your starting position, which is also referred to as tabletop

position.

From tabletop position, bring your left leg down and gently tap the floor
with your left foot.

Then, bring your leg back up by using your core muscles. Maintain a 90
degree bend in your knee the entire time.

Repeat on the other leg, all while keeping your core as tight as possible.
This completes one set.

Perform 10 sets total.

Benefits of Core Exercises for Stroke Patients

By using these rehabilitation exercises to strengthen your core, you will
improve your stability, balance, gait, and even your posture.

Strengthening your core has a ripple effect into your other extremities,
like your arms and legs, because you need a strong core to practice
other rehab exercises.

So be sure to include core work in your full-body stroke exercise regimen

at home!

Physical Therapy Leg Exercises for Stroke Patients

Exercising with high repetition (i.e. massed practice) is the best method
for motor recovery after stroke.

So be sure to get all your reps in.

Below are our best leg exercises for stroke patients.

Bonus: Download our free Stroke Rehab Exercises ebook. (Link will
open a pop-up that will not interrupt your reading.)

1. Hip Flexion with Hold

Use your hands to lift your affected leg up into your chest, and hold
there for a second before slowly letting your leg back down. Repeat on
the other leg.

Try your best to keep a straight back and tight core.

Repeat both sides 10 times each.

How to make it harder:

Don’t use your hands.

2. Knee Extension

From a seated position, extend your left leg out in front of you parallel to
the floor. Avoid locking your knee. Then, slowly bring your foot back
down to the floor.

This will feel like a kicking motion.

Then repeat with your right leg, alternating back and forth between your
right and left legs for a total of 20 repetitions (10 on each leg).

How to make it harder:

Pause for a second at the top of each extension.

3. Hip External/Internal Rotation

You may need an optional towel for this exercise.

For this exercise, you can place a towel underneath your affected foot to
help make it easier.

From a seated position, use your hands to assist your affected leg and
slide your foot towards your midline. Then, push your leg outwards,
using your hands for assistance if necessary.
Repeat 10 times.

How to make it harder:

Ditch the towel and don’t use your hands.

4. Seated Marching

From a seated position, lift your affected leg up into your chest, and
then place it back down onto the floor. Keep your back straight and
maintain a controlled movement. Then repeat on the other leg,
alternating back and forth for a total of 10 repetitions.

How to make it harder:

Pause at the top for a second or two. And, if you have the control to do
this safely, slightly push down on your quads to add a bit of resistance.

5. Hip Adductions

For this exercise, sit in a chair and lift your affected leg slightly off the
floor. Your leg should remain bent at 90 degrees, but your foot should
hover over the floor.

Then, kick your leg outward like you’re kicking a ball to the side. Then,
kick your leg inward toward your midline. Repeat 10 times.

How to make it harder:

Pause after each kick.

Extra Seated Leg Exercises for Stroke Patients

Whether you’re back at work of eager to try more leg exercises at home,
the following moves can also be practiced from any comfortable seated
position.

6. Ankle Rolls

Sit comfortably in your seat and start to make big circles with your
ankles to warm up your ankle joint. Try doing 20 ankle rolls and if it feels
good, do two sets.
7. Hamstring Stretch

To stretch out your hamstrings, reach for your toes while staying seated
in your chair. Make sure to bend at your hips and not at your low back.
As long as there is no pain, hold the stretch for 20 seconds and then
come up slowly.

8. Inner Thigh Squeezes

To continue working your adductors, or inner thigh muscles, make two

fists and place your fists side by side between your knees. Then,
squeeze your knees and fists together with everything you’ve got and
hold the squeeze for 8 seconds.

9. ‘L’ Taps

Start in a comfortable seated position with your feet below your knees.
Then, bring your right foot out to your 3 o’clock position and tap your
foot. Then, bring it back to center and move it up to your 12 o’clock
position and tap, returning to center after. This will make an “L” shape.
Repeat on the other leg.

10. Inverse Half Squat

This is a difficult strengthening exercise. We recommend practicing in

front of a table or desk that you can hold for support.

Start with your legs out a little wider than normal, and secure yourself in
a strong stance. Then, stand halfway up – but only halfway – and then
sit back down. You will start to feel this in your quadriceps and, well,
your entire lower body.

Try doing these half stands 10 times and you’ll really start to feel your
muscles working.

How to Get Back to Walking with Stroke Exercises for

Legs
As you practice these 10 leg exercises, your coordination and mobility
will improve. This should help improve your gait (manner of walking)
and balance.
When it’s safe to do so, you can continue to improve your gait by
practicing walking. We know this sounds obvious, but walking really is
the best way to get better at walking!

Walking is a form of weight-bearing exercise, which will help with

your strength as well as your mobility.

Also, if foot drop is making walking difficult, be sure to practice foot drop
exercises too.

These leg exercises will help support your recovery, and when you can
get back on your feet, try to walk as much as you can.

Easy Balance Exercises for Stroke Patients

We’ll start with the simplest balance stroke rehabilitation exercises and
work our way to the most advanced exercises.

Then we’ll share a couple of our favorite tai chi movements at the end,
because tai chi helps safely improve balance during stroke recovery.

1. Elbow Lean

Sit in an upright position with your hands out to your sides. Then, lean to
the right side by putting your weight onto your right forearm. Return to
center and repeat on the other side, making 10 reps total.

If this is too difficult, grab those yoga blocks or books and lean onto
them to decrease the distance that you have to move.

How to make it harder:

Do this exercise from a lying position as if you’re getting out of bed. This
will put even more weight into your affected side, which will help build
balance and coordination.

2. Seated Cat-Cows

In a comfortable seated position, place your hands on your knees and

gently push away, rounding your back and tilting your chin down. This is
the ‘cat’ position. Then, reverse the movement by pulling yourself
forward and arching your back. This is the ‘cow’ position.
Alternate between cat and cow 10 times.

How to make it harder:

Try this in a quadruped position (which simply means on your hands

and knees) like the original yoga pose.

3. Flamingo Stands

Do you know what a flamingo looks like when it’s standing on one leg?
That’s what you’ll need to look like during this exercise.

Practice standing on one leg for about 30 seconds and then switch to
the other foot, holding on to a chair, counter top, or table for extra
stability.

How to make it harder:

Ditch any assistive furniture and practice this exercise solo. Then, for
even more of a challenge, you can continuously increase the duration of
your exercise until a 2-minute stand feels like a piece of cake.

Intermediate Balance Exercises for Stroke Patients

If you have some mobility in your body, then you might be ready to try
some moderately difficult balance exercises for stroke recovery.

4. Calf Raises

From a standing position, raise yourself up onto your tiptoes while

holding onto the back of a chair or table for support. Hold for 2 seconds,
then release. Repeat 10 times.

How to make it harder:

Once you’ve developed some balance and coordination, try doing this
without holding onto something. Only attempt this when you’re ready as
to avoid a devastating fall, and be sure to have a caregiver nearby.

5. Knees Side-to-Side
Lie down on the floor with your knees bent at 90 degrees. Then, let you
knees fall to the right and stretch your torso. Bring your knees back up
and twist to the left. Repeat this core-strengthening balance exercise 16
times (8 on each side).

How to make it harder:

Instead of passively letting your legs fall to the side, use your core
muscles to actively move them even farther – without stretching to the
point of pain.

For an even more advanced move, don’t’ let your feet touch the ground.
Instead, hover your legs just inches from the ground for some serious
balance-building core work.

6. Side Leg Raises

From a standing position, lift your leg out to your side about 45 degrees
(or as much as you can do) and hold it there for a couple seconds.

To ensure safety, use furniture to maintain your balance and

coordination.

Bring your foot back down to the floor and complete 10 repetitions on
each leg.

How to make it harder:

For extra difficulty, try closing your eyes during this exercise. It might
seem easy in theory, but once you try it you’ll really feel the challenge.
Just be extra careful, please! Make sure that there’s someone around to
ensure your safety.

7. Dynamic Weight Shifts

Sit on a bench (or at the edge of your bed) with your arms at your sides.
Then, shift your weight to the right, using you right arm for stability.

Then return to center and repeat on your left side. Complete this
alternating exercise 10 times.

Advanced Balance Exercises for Stroke Patients

If your mobility is pretty good but you want to work on your core
strength, then you’re ready to try some advanced physical therapy
balance exercises.

8. Bicycle Crunches

Do a typical crunch, but alternate between touching your right elbow to

your left knee and then your left elbow to your right knee.

How to make it harder:

Try these crunches on top of an exercise ball for extra range of motion
that will make your muscles work harder.

9. Sit-to-Stand / Box Squats

A box squat involves sitting down onto a box (or chair) and then
standing back up. This is considered a partial squat because you get to
rest at the bottom instead of holding your weight in the lowest position.
Do 10 reps, or more.

How to make it harder:

Try doing full squats when you’re ready. Be sure to pay extra attention
to proper squat form by keeping your back straight to avoid injury.

10. Staggered Stance

Walk across your kitchen by taking baby steps, using the counter for
support.

To perform these baby steps, place your right foot firmly on the ground
beneath you and then place your left heel right up against your right
toes.

Your feet should be perfectly in line with one right in front of the other.
Then, practice walking while keeping constant heel to toe connection,
placing your right heel to left toe and left heel to right toe and so forth.

How to make it harder:

Try this balance and coordination exercise without the counter for
support (but only when you’re ready!). For an even greater challenge,
you can try it on an uneven surface like a grassy hill or sandy beach.
The uneven terrain will make you work harder and improve your
balance even more!

11. Backwards Walking

Try taking 10 steps backwards in your kitchen while holding onto the
counter for support. If your kitchen isn’t big enough, so this along a wall
in the living room.

Make sure that there are no obstacles in the way before you begin the
exercise.

Tai Chi Balance and Coordination Exercises for

Stroke Recovery
Did you know that tai chi is beneficial for stroke patients who want to
improve balance and coordination?

The following tai chi exercises were created by our physical therapist,
Barbara. You might feel silly in some of the poses, but they’re great for
improving balance after stroke.

In tai chi, there is a focus on energy and visualization. If you’re not into
that – great! Ignore those parts and just do the movements.

But if you’re into that sort of thing, enjoy the full experience.

12. Standing Tai Chi Warm Up

Start in a standing position with your legs hip width apart and knees
slightly bent.

Then, with your arms shoulder width apart, palms down, and hands 3-6
inches apart, float your hands up and down in front of your body.

As you do this, visualize yourself moving a ball of energy up and down

with your hands.

13. Infinity Twist

Then, visualize yourself carrying that big ball of energy right in front of
your torso.

While using your arms to carry that ball of energy, pivot your torso to
move the ball around in front of you in the shape of an infinity sign (a
sideways figure 8).

As you move the imaginary ball to your right, pivot your torso to the right
as well. Then repeat on the left side. Keep in mind that this exercise
involves your core and entire body, not just your arms.

Move slowly and intentionally as you swirl this energy around the front-
side of your body.