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Physical deficits

11) Effects of stroke which may make balancing and regaining mobility difficult.

Here are some of the effects of stroke which may make balancing and regaining mobility difficult.

Muscular Physiological Psychological
  • Loss of muscle control – muscles are required to move the body around and keep balance.
  • Weak muscles – muscles need to be strong enough to support the body against gravity and propel you forward.
  • Ataxia – this is where the muscles are working but the movements are poorly timed and co-ordinated. This is often seen when a person has damage to the cerebellum (At the back of the brain). This part of the brain being needed for balance, muscle tone and coordination of movement. The person can move their arm and leg but the movement may look out of control and make doing simple tasks difficult. This may make walking difficult.
  • Increased muscle tone(stiffness )or low muscle tone (floppy) – reduces the movement and the automatic responses of muscles.
  • Dyspraxia – the inability to coordinate, perform or carry out specific movements.
  • Reduced or changed sensation/feeling down the affected side of the body – not feeling the leg can make it hard to feel confident when standing on it, this makes walking more difficult.
  • Inattention or neglect of part of the body – if somebody is not aware of their leg they may not remember to move it during walking. If able to walk they may walk into things on one side.
  • Pain – discomfort can reduce balance and mobility.
  • Vision problems – eyesight is vital for balance and safe mobility as feedback from the eyes gives you information not only about what’s in front of you (uneven ground, tables etc) but also if you are upright.
  • Fatigue/tiredness – this can impact not only on the ability to participate in therapy but also the amount of walking/activities that someone is able to do.
  • Dizziness – some people experience dizziness which affects their balance and mobility.
  • Side effects of medicine – some people experience side effects from medicine (fatigue, dizziness when standing) which might affect balance and mobility.
  • Poor concentration or easily distracted – this may make someone unsafe when walking.
  • Anxiety/fear of falling – fear can reduce confidence to do things this may impact on walking.
  • Lack of insight – the person may not realise they cannot walk but will still attempt to do so.
  • Motivation – if the person is not motivated for whatever reason, they are less likely to participate in therapy. For example if they are depressed.

Many stroke patients have a combination of these problems which is why a full physiotherapy assessment is essential. Each stroke patient is different. On the following pages you will see the main problems which the therapist will work on.

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