Balance training is a critical component for anyone with ataxia. This is due to the fact that ataxia negatively impacts the balance system and is one of the leading causes of disability. Ataxia is caused by damage to the cerebellum. The cerebellum plays a MAJOR role in:
- Coordinating arm and leg movement
- Fine motor movements
The cerebellum also plays a major role in controlling eye movements. This allows the brain to “lock in” on an object and keep it in focus. This is similar to setting your video camera on autofocus. With a camera, autofocus allows the subject and/or camera to move and keep objects/subjects in focus.
When either the object or the body are moving, the eyes need to perform fine movements to keep the object (in the environment) in focus. Without this feature (on a camera), moving objects may look blurry or distorted. Now imagine that visual going on in the brain. Yikes! Enter the cerebellum……objects remain clear and in focus……..and all is right with the world.
All that being said, when this “autofocus” component of the cerebellum is not working properly, all is NOT right with the world. Quite literally. When the eyes can’t lock in on objects and keep them in focus, it creates several balance problems including:
- The feeling of falling backward
- Over correcting or “under-correcting” when a loss of balance occurs
- Loss of balance with head and/or eye movement
- Keeping in mind the role the cerebellum has as it relates to eye movements and “autofocus”, damage to this area can cause:
- Balance problems with head movements,
- Balance problems with eye movements,
- Balance problems when objects are moving (in the surrounding environment
Balance Training for Ataxia
Balance training has 2 big picture components. First, it involves retraining the “motor” components. In a healthy brain, there are “built in” balance strategies. Balance strategies are small hip, knee, and ankle movements that adjust or counteract when the body (center of mass) is disrupted. These small movements are quick and automatic.
Second, balance training (due to damage to the cerebellum) also involves retraining the brain’s “autofocus”. Keeping objects clear and in focus gives the brain reference points in the environment. These (clear and in focus) reference points allow the brain to keep the body in a vertical position relative to the ground.
Training the Balance Strategies
Retraining the balance strategies is possible regardless of where you are at in the recovery process. The best way to retrain the brain to make the necessary hip, knee, and ankle movements (mentioned above) is to stand. Yup, thats right. Just stand. Our brains are pretty cool, in that, if you provide the right environment, it will automatically go into “learning mode”. Start by standing with the feet wide and as the balance strategies improve, narrow the base of support by bringing the feet closer and closer together.
How does standing improve walking?
Walking, at its core, is standing on one leg. With this in mind, the goals with moving the feet closer and closer together is to ultimately get them so close together that you could lift one leg and progress to single leg standing. That would be the most advanced component of a standing progression.
For safety, start by using a corner for support. As your balance improves, you can start moving further and further away from the corner until you no longer feel you need that security. The corner is also helpful because it provides defined boundaries.
Training the “vision” (autofocus) with ataxia
The most important aspect of a balance training program (due to damage to the cerebellum) is to retrain the “autofocus”. Meaning that most likely head and eye movement causes objects to be distorted and is one of several reasons someone might have difficulty staying balanced (if they have damage to the cerebellum). This involves a three step process.
1.Static standing with eyes fixated on a stationary object
2. Static standing with eyes fixated on a moving target without moving the head
3. Static standing with eyes fixated on a stationary target with head movement. For any of these exercises, as you become more advanced start bringing the feet closer together. In this video I show the feet in tandem position.