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:
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. It is also important that the hand is mobilised gently and regularly, either by yourself or by a support person or therapist. Your therapist will be able to provide you education on how to do this, and you can look at the resources here.
Positioning post stroke is extremely important as it allows for muscles and joints to remain in there correct positions which helps with returning function and reducing impairments of joint changes and pain.
The New Zealand Stroke foundation has some excellent resources for positioning post stroke Find these here For left hemiplegia For right hemiplegia We have recently been discussing the importance of good sleep but for the many that can be difficult, for many different reasons. It may be that you have a neurological condition that impacts on your sleep, it maybe that you have developed insomnia over your life, like me you may have an interrupted sleep pattern due to small children or animals, it maybe that you feel you just don’t need that much sleep.
Well prioritising getting a good nights sleep can be one of the best things you can do for your health, in this post we are going to discuss the ways you can set your self up for a good nights sleep. Regularity – going to bed and waking up at the same time each day helps set your Circadian Rhythm (your body clock) to be working well and gives you the best chance to fall asleep well. Research shows adults need between 7-9 hours sleep so ideally getting into bed to give yourself an 8- 8.5 hour sleep opportunity is important. Embrace darkness – Not only is it important to have a dark bedroom by using eye masks or black out curtains in the bedroom. It is also important to watch your light exposure before bedtime. Cut the artificial lights down at night time, this will help allow melatonin levels to rise. Limit screens as the blue light from phones have been shown to disrupt your dream (REM) sleep when used as little as an hour before bed and this disruption has been shown to last for days afterwards. Body temperature – To fall asleep we need to have our core body temperature fall, keeping your bedroom around 18 degrees allows for this. Use appropriate bedding and sleepware can help too. Having a warm shower or bath before bed assists with this process and helps you fall asleep faster. However having cold hands and feel can stop your core body temperature dropping so using socks or something like a wheat bag can help warm them up to drop your core temperature. Watch what your drink - Both caffeine and alcohol will affect your overall quality of sleep, and have been shown to affect sleep in small doses even if you not aware of it. Caffeine, found in coffee, tea and soft drinks has a half life of 6 hours and a quarter life of 12 hours. Recommendations for sleep is to drink caffeine no later than midday. Even one glass of alcohol has been shown to disrupt dream sleep and the by products of the body processing alcohol are still present 8-9 hours after that drink. Alcohol affects the quality of sleep. Drinking too much fluid close to bed time can also increase nocturia (night time toileting) and can cause you to wake from sleep. Fluid intake and hydration is also important as dehydration also irritates the bladder and causes more toileting. Watch when you are eating – avoid eating three hours before bedtime as this can cause ongoing issues with reflux, and your body is undergoing digestion process so can not repair until this is finished. Bedtime routine – Having a consistent bedtime routine signals to your body that you are ready for sleep. Some ideas for a bed time routine are
Manage stress – The build up of stress chemicals such as the hormone cortisol can impact of getting and staying asleep. Understanding stress triggers and dealing with these can support good sleep. Meditation before bed has been shown to help people get a better nights sleep. An hour before bed taking some time to document any thoughts or stressors can also help. If you wake in the middle of the night, you can go and quietly write down any of the things that are keeping you awake. Can’t get out of bed, try deep breathing into your stomach in through your nose and out through your mouth or trick your brain to stop going through all those thoughts imagine your self taking a gentle walk in your favourite spot, or if you can try to walk yourself through a guided meditation, ideally avoiding the use of your phone. Keep the bedroom for sleep - The brain can be extremely associative it is recommended that if you are having difficulty with sleep that you use bedroom for only Sleep and sex. This is some of the reason why you can fall asleep on the sofa then try to go to bed you won’t be able to go to sleep. It is also why if you find yourself awake in bed for longer than 20 minutes it is recommended if safe that you get out of bed and do something quite until you feel sleepy and return to bed. Some people finding reading before bed can help and as long as this does not disrupt your sleep then this can be a good way to switch the brain off. A word about rest and naps We will cover fatigue management more at a later stage but if you find that you are needing to nap during the day and this is regular and dose not interfere with your night sleep then it it good to continue. Naps can affect a hormone call adensosisne which is needed to build up to help us sleep, when we nap we release some of the adenosine and that can impact out night sleep. If you have had a bad nights sleep it is better to wake up at the same time and then try to go to bed when sleepy in the evening to help with maintaining a good sleep pattern. If you do nap try not to nap too late in the afternoon before 3 pm is ideal. Happy sleeping How to set up the Zoom app on iPad or iPhone 1. Click on the App store icon on your phone or tablet 2. In the search bar enter ZOOM, select the one below 3. Click GET and wait 4. Then Click INSTALL 5. You may need to enter your Apple ID and password so have this ready 6. Then click OPEN How to reset your apple passwordHow to install zoom for android tablet and phones via google play store
2. In the search bar type ZOOM 3. Select the below Zoom app, and click INSTALL 4. Then click the GET button
5. You may need to use your google account ID so have this ready to use. (This is most commonly a gmail account eg: joebloggs@gmail.com) |
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