What Are the Symptoms of a Stroke? – How to Improve Balance

What are the symptoms of a stroke? During a stroke, balance may be affected but may not initially be associated with it.

Consequently, it is imperative that other symptoms of a stroke should be quickly checked so as not to treat the balancing impairment in isolation because a stroke can be deadly.

What is Balance?

The phenomenon of balance is associated with sensory input from the eyes, the correct functioning of the balance system of the inner ear, and the sense of position and movement in the feet, legs, and arms.

The inner ear balance system works with the eyes, muscles, and joints to maintain orientation or balance and is necessary to prevent falls.

Visual signals are sent to the brain about the body’s position in relation to its surroundings.

The signals are processed by the brain and compared to information from the inner ear and the skeletal systems.

Within the inner ear, a complex series of tubes, fluids, and sensitive hairs work to help the brain detect our body’s movement and position.

This includes perceptions of up and down, side to side, and circular movements.

Falls among the elderly are a leading cause of debilitating injury (such as hip fractures) and a serious risk factor for premature death.

By preventing balance problems and working to improve remaining ability, seniors can improve their quality of life and reduce crippling injuries.

Balance impairment can be the side effect of certain medications, medical complications, or serious disorders.

What is a Stroke?

A stroke happens when a blood clot blocks blood flow to the brain. This causes brain tissue to become damaged, burst or die.

A stroke can cause lasting brain damage, long-term disability, or even death. To work properly, your brain needs oxygen.

Your arteries deliver oxygen-rich blood to all parts of your brain. If something happens to block the flow of blood, brain cells start to die within minutes, because they can’t get oxygen. This causes a stroke.

There are two types of stroke:

• Ischemic stroke – caused by a clot and this is the nature of most strokes
• Hemorrhagic stroke – caused by burst or leaking arteries.

A transient ischemic attack (TIA) is sometimes called a “mini-stroke.” It is a warning sign of a future stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.

Symptoms of Acute Ischemic Stroke

Acute ischemic stroke patients require time-critical treatment, so rapid identification of stroke symptoms and a quick reaction time are critical.

The FAST technique is popular for identifying acute stroke symptoms.

FAST stands for Face drooping, Arm weakness, Speech difficulty, Time to call emergency.

When looking for stroke signs, asymmetry is important.

FACE: Facial weakness due to acute stroke will cause one side of the face to droop and often, the smile is uneven or lopsided, or the person may be drooling from one side of the mouth.

ARM: When asked to raise both arms, if only one arm is mobile, or one arm is weaker, numb or drifting downward, a stroke may be suspected.

SPEECH: Slurred or incoherent speech and or the inability to understand or repeat simple sentences are usually a sign of stroke.

TIME: If any of the above signs are present and sudden in onset, an ambulance must be called immediately to take the person to the hospital as quickly as possible to prevent damage to the brain.

Additional Symptoms of Stroke

• Weakness or numbness in the face and extremities (arm, leg, face; especially on one side)
• Confusion or trouble understanding other people
• Problems in vision with one or both eyes
• Sudden severe headache
• Difficulty in coordination (walking, etc.)
• Dizziness
• Loss of balance
• Difficulty in swallowing

Furthermore vertigo, nausea and vomiting may occur when a patient suffers from “posterior circulation stroke” that occurs in the back part of the brain.

The Five Most Common Balance Disorders in Seniors

Always consult your doctor for accurate diagnosis

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is one of the most common types of balance disorders. In seniors over 60, its primary symptom is intense vertigo when moving the head and this can occur even by rolling over in bed.

It is an inner ear disorder that could be caused by a head injury, an ear infection, or natural aging.

Ménière’s Disease

One sign of this common disease is a ‘full’ feeling in the ear. People with Ménière’s Disease also may experience vertigo, ringing in the ears, and sporadic hearing loss. Hearing loss can affect balance and increase the risk of falls.

Labyrinthitis

When the inner ear becomes infected and inflamed, the result can be balance problems. Labyrinthitis is an inner ear infection often linked to a case of the flu.

Ramsay Hunt Syndrome

Older adults may be more prone to shingles’, a skin condition caused by a virus. In some cases, the shingles’ virus can affect facial nerves near the ear resulting in a condition called Ramsay Hunt Syndrome.

A symptom is vertigo often accompanied by ear pain and loss of the ability to hear.

Chronic Conditions

Conditions such as eye problems, arthritis, heart problems and long-term medical conditions such as Parkinson’s disease, Alzheimer’s disease, and Multiple Sclerosis that affect the nervous system can affect contribute to unsteadiness.

Symptoms of A Balance Disorder

When balance is impaired, an individual has difficulty maintaining orientation, cannot walk without staggering, or may not even be able to stand up from a sitting position. Symptoms that may be experienced include:

• Dizziness
• Vertigo (spinning)
• Falling or a feeling of falling
• Light-headedness or feeling woozy
• Visual blurring
• Disorientation

In some individuals, it is also not uncommon to experience nausea and vomiting, diarrhea, faintness, changes in heart rate and blood pressure, fear, anxiety, or panic for varying periods of time.

The red highlighted text illustrates the overlap of some symptoms as they occur in both balance disorders and stroke patients.

The FAST test is the main differentiating factor between the two conditions. A medical diagnosis is needed to confirm the right condition.

The type of stroke affects the treatment and recovery and restoring good balance is essential for the patient.

Improving Balance

Because balance in standing and walking is at least partly a skill that can be learned and is dependent on good general physical condition, sound nutritional and health habits.

This includes including regular exercise like walking or playing sports can go a long way toward recuperating from balance problems.

Before beginning a program complete a medical review of medications, a musculoskeletal check for any abnormalities, and blood tests to determine cholesterol and glucose levels

Seniors can improve their overall health, fitness, and balance, by participating in low-impact sports, such as aerobics, yoga, Tai chi, Pilates, or water aerobics.

Other more active sports such as tennis, biking, walking, weight training, or bowling can also improve balance by strengthening muscles and joints and improving posture.

Ballroom dancing requires good body awareness and hand-eye coordination so it is good exercise.

Specific Exercises For improving Balance

Any exercise program should build gradually to avoid burnout, boredom, or injuries. Most studies have shown that exercise properly done presents a low risk of serious injury.

The American Senior Fitness Association and the Ohio State University Extension recommend

1. Knee lifts to improve balance. Attempt to lift the knee as high as the hip using a secure object to assist in maintaining balance in the beginning. As strength increases, decrease the tendency to lean on a support, and try holding the leg up for 3 seconds or longer. Never close the eyes while doing these exercises due to difficulties with maintaining balance.
2. Calf stretches, toe-tapping, point and flex exercises, leg lifts to the side and exercises which bend and straighten the knee. The sit-to-stand exercise is highly specific; when necessary, use the chair for support when standing and again when returning to a sitting position. Try to gradually decrease use of the arms as the legs get stronger.

Exercises That can be Done at Home

1. Hold onto a wall, chair, or the kitchen sink, raise yourself up and down on tiptoes, repeatedly. As strength improves, go higher up on toes and eventually try it on one foot at a time. This exercise strengthens the calf muscles.

2. Lean your back against a wall with your heels placed seven to eight inches away from the wall. Lift the toes of both feet off the ground as high as possible. This exercise strengthens the shin muscles.

3. Take extra trips up and down the stairs. Hold onto the stair rail with one hand and press the other hand against the wall for safety. This exercise strengthens the hips and thighs.

4. Strengthen the same muscles by getting up out of a chair repeatedly if fearful about falling down the stairs. Grip the arms of the chair if you need to, but you’ll get more benefit from the exercise if you don’t push with your hands.

Refer to a previous article – Poor Balance in Seniors for more exercises

Conclusion – What Are the Symptoms of a Stroke?

When younger, good balance is mostly a matter of keeping your core muscles strong, but as we age, other factors come into play. Weakened muscles, poor vision or use of certain medication can compromise the ability to remain steady on the feet.

Balance problems can be caused by a specific injury, disorder, or disease. It is also one of the side effects of having a stroke. The good news is that there are several exercises that can improve balancing

References

American Stroke Association | A Division of the American Heart Association.2019 www.strokeassociation.org. Available at: https://www.strokeassociation.org/en.

Powers WJ., et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018;49:e46–e110.

Summers D., et al. 2009. Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: a scientific statement from the American Heart Association. Stroke 2009;40:2911–2944.

Hosseininezhad M., et al. 2017 Stroke mimics in patients with clinical signs of stroke. Casp J Intern Med 2017;8:213–216.

CDC – Centers for Disease Control and Prevention. 2022, Stroke https://www.cdc.gov/stroke/about.htm

Stroke Forum 2022. Acute ischemic stroke symptoms and mimics https://www.strokeforum.com/overview/acute-ischemic-stroke-symptoms-and-mimics?gclid=EAIaIQobChMIj8y3-5ew9wIVUAqtBh0BUAAXEAAYASAAEgLanvD_BwE

Sunrise Senior Living 2017. 5 most common balance problems seniors experience https://www.sunriseseniorliving.com/blog/september-2017/5-most-common-balance-problems-seniors-experience.aspx

Vestibular Disorders Association, 2022. Discover a Life Rebalanced http://www.vestibular.org

Ohio State University Extension. 2017. Improve Balance: Prevent Falls http://ohioline.osu.edu/ss-fact/0170.html

University of Connecticut Health Center. Keep Your Balance: Exercises Can Improve Balance, Help Elderly Reduce Falls http://www.uchc.edu/ocomm/newsreleases02/feb02/balance.html