Balance Problems After Stroke: How Physiotherapy Can Help

Why stroke affects balance

Balance relies on the brain combining information from the eyes, inner ear and body sensors, and then controlling muscles to make corrections. A stroke can disrupt any part of this:

• weakness on one side makes corrections harder
• reduced sensation means less information about foot position
• vision changes or neglect of one side affect awareness
• slower reactions delay corrections
• people often lean towards or away from the affected side

Assessment

A physiotherapist assesses balance in different positions and tasks: sitting, standing with feet apart and together, reaching, turning, walking and stepping. Standardised balance tests help measure the problem and track improvement.

Early balance training

Balance training often starts in sitting: reaching in different directions, shifting weight and correcting posture. It progresses to standing: weight shifting, standing with feet closer together and reaching.

Progressing balance

As steadiness improves, challenges increase:

• stepping in different directions
• standing on the affected leg
• walking with turns and obstacles
• balance while doing another task, like talking or carrying

Our article on balance training after a stroke goes into the training itself in more detail.

Safety during training

Balance practice always happens with appropriate support nearby, such as a physiotherapist, a rail or a counter. The goal is to challenge balance without falling.

Fear of falling

Many stroke survivors develop fear of falling, which can limit activity. Gradual, supported practice builds confidence.

Pusher syndrome and leaning

A small group of stroke survivors actively push towards the weak side and resist being moved back to the middle. It's called pusher syndrome, and it can be confusing for families because the harder you try to straighten the person, the harder they push. Physiotherapists treat it with visual cues, such as a vertical door frame, and by having the person reach towards the stronger side, rather than by force.

More commonly, people lean slightly towards one side without realising it. Their sense of upright has shifted. A mirror, a physiotherapist's feedback and practice in sitting and standing tall gradually reset it.

Neglect is another hidden factor. Some people pay less attention to one side of space after a stroke, bumping into door frames or missing obstacles on that side. Balance training for them includes scanning practice: deliberately turning the head to check the neglected side before moving. Families can help by placing things of interest on that side to encourage turning.

Home safety

Home changes such as grab rails, removing rugs and good lighting reduce fall risk while balance improves.

Our balance training guide shows the main exercises.