​When we are working on balance in the clinic we are always trying to get someone to challenge their balance to make change. 

In fact we know that to really improve your balance fast you need to be off balance about 50% of the time.  When we are working on balance the aim for us is not to always make you still. 

We often are trying to get you practising recovering your balance or integrating your sensors to makes sure all the systems are working well together. 

Here Belinda describes how she has been challenging her balance.  

"Decided to mix up my daily walk a few days ago (in sunnier times) and challenge my brain and body to do something more novel and out of my normal comfort zone.

It’s amazing how many systems were at play to help me negotiate these rocks safely. Our brains are remarkable, integrating all the information and sensory inputs in order to give an efficient and appropriate output = BALANCE
.... vestibular, vision, depth perception, balance reactions, postural adjustments, proprioception, motor control, coordination, planning, concentration... just to name a few.

Some conscious and many subconsciously working

I was definitely loosing my balance 50% of the time which was putting me in an ideal training zone for balance retraining.

The best part was that this was fun.

If you want to have better balance you need to train all the systems. Train the inputs to improve the output.

When ever we train balance however we do weigh up safety and confidence. But remember no challenge no change. 

When talking about Vestibular rehab (the fancy name for retraining balance and reducing dizziness and vertigo caused by the inner ear and related systems).

We loosely break it down into two broad categories – Peripheral (coming from the inner ear itself) or Central (coming from the brain or neurological pathways)

Examples of Peripheral conditions are:

• Benign Paroxysmal Positional Vertigo (BPPV) what most people refer to as vertigo
• Labyrinthitis or Vestibular Neuritis (Ear infection)
• Meniere’s Disease
• Bilateral Vestibular loss
• Semi Circular canal dehiscence

Examples of Central conditions are:

• Concussion or Head Injury
• Migraine
• Multiple Sclerosis
• Parkinson's Disease
• Cerebellar conditions
• CANVAS
• Stroke

(note: These lists are not a complete list of conditions)

Symptoms can be very similar between central and peripheral conditions and it is not uncommon to see some present with more than one vestibular issue. For example traumatic BPPV post concussion or BPPV with Parkinson's, Migraine triggered by BPPV.  This is why a full assessment is important to see where symptoms are stemming from and treat them appropriately 

A Physiotherapist trained in Vestibular rehab has the skills and knowledge to be able to distinguish between the two categories in testing and there are treatments for both central and peripheral conditions and then treat these effectively with positional manoeuvres, gaze stability and balance exercises to provide a well rounded program for recovery. 

Having dizziness and balance issues checked are important as they can be treated effectively and leaving them untreated increases a persons falls risk, not to mention reduced participation in the activities they enjoy doing because of ongoing symptoms and avoidance due to fear of causing their symptoms. Don't let dizziness hold you back, get it looked at today. 

We have been talking around the importance of high intensity exercise for neuroplasticity in the brain for a while. It is widely accepted that it helps improve function in Parkinson's when people regularly (more than 3 days a week) exercise at between 60-80% heart rate max.  It is also regularly discussed how cardio exercise is good for overall health including for the heart and lungs.  

Research is now showing that it can also improve walking speed and distance in people who have had stroke, traumatic brain injury and spinal cord injury over six months ago.  The research has shown that the same effort levels are required so getting heart rate up to 60-80% Maximum is needed to make these changes. With improving locomotion/walking/gait.  Functional practice is best, which means training improved walking with walking.  

So what does the exercise prescription look like to make these changes, again it is recommended a minimum of 3 x a week, we know the ACSM recommends all adults get a minimum of 150 minutes moderate intensity exercise a week. 

If we took 70 year old female client the prescription may look like this for someone who is confidently walking over ground.  Four times a week walk outdoors or on a treadmill with 30 seconds walking as hard as they can aiming to get their heart rate over 89 BPM (89-118 BPM = 60-80% HR max), then with slower 1.5 min walks in-between for 30 minutes.  Ideally the higher the heart rate the better but we need to start slowly and build up if fitness levels are lower. 

To measure heart rate you can count the number of beats by feeling your pulse at your wrist or neck and count the beats for 60 seconds or for 20 seconds and times by three. There are also a number of wearable devices such as watches and heart rate monitors that can give you real time information on your heart rate which maybe a beneficial investment if you want to see how your heart rate more regularly. 

This advice is a general guideline and it is always recommended that you seek medical advice before starting a new exercise program.  

Many people with a Neurological disorder or Chronic health condition, find that they can no longer do all the activities in a day that they wish.  When working with clients we get them to appreciate that they need to pace their activities (Something that over my rehab period I have also had to do). 

What is Pacing?
“a way of increasing your activity level without stirring up your fatigue/pain or other symptoms such as dizziness too much”

Aim: to maintain an even level of activity throughout the day instead of doing as much as possible in the morning and then resting all afternoon.
When we don't do this we can get in to a cycle which is unproductive which we call the BOOM/BUST cycle. 

Setting goals can be one of the best ways to drive your performance and rehab forward. 
Here is a great little booklet we put together to help you out. 
DOWNLOAD - HNR goal setting ebook.