Something like this should be available in every hospital/clinic. Objective evaluation of your walking and falling practice. Remember to ask your therapist to perturb your walking.
http://www.ctvnews.ca/health/clinic-helps-stroke-patients-recover-balance-avoid-future-falls-1.1298336
Janet Raymond leans forward, her upper body supported by a vest-like
harness suspended from the ceiling. She's waiting for the apparatus to
deliver the jolt she knows is coming, its goal is to test how steady she
is on her feet.
There's an abrupt release of tension on the harness and Raymond lurches
forward, her face betraying a touch of uneasiness, despite having gone
through this manoeuvre many times before.
But she's kept her footing and hasn't fallen -- and that means she's making progress.
About eight months ago, Raymond was about to board a Toronto streetcar
after a night out with friends, when her legs suddenly felt too weak to
mount the vehicle's stairs.
It turned out she had suffered a mild stroke, which affected her right
leg and part of her hand. After a stay in hospital, Raymond was
transferred to the stroke unit at Toronto Rehab, where therapists took
over her recovery.
"When I first arrived, I couldn't walk at all," says Raymond, 62. "I
was in a wheelchair. I was quite upset and I wondered what was going to
happen, if I'd be in a wheelchair all my life."
Her goal was to walk again, to go back to work as a delivery driver and to return to everyday activities with her husband.
That's when staff at the Balance, Falls and Mobility clinic at Toronto Rehab kicked into high gear.
The recently created program is designed to assess patients' balance
and walking ability using state-of-the-art computerized technology.
"We have developed a clinic where individuals come from the stroke unit
or from our brain injury in-patient unit and they get a very
sophisticated assessment based on some of the research that we're
doing," says Dr. Mark Bayley, medical director of the brain and spinal
rehab program.
"And we provide them with a treatment plan based on that assessment."
One of those assessment tools, and indeed recovery tools, involves
having patients "fall" or go off balance while wearing a protective
harness.
Strapped into the gear, the patient stands on pressure-sensitive force
plates that transmit data to a computer, which maps how their footing
changes in response to the controlled fall -- a "perturbation" in
rehab-speak.
"We look at their reactions to that perturbation and try to improve that through training them," says Bayley.
Another piece of the assessment-training equipment is a
pressure-sensitive gait mat, which records a patient's steps as they
walk, transferring their footfalls in real time to a computer screen.
"The person walks on the mat and it's able to pick up footfalls and
give us a whole bunch of information, quantitative information, about
how that person is walking -- how quickly, what their stride length is,
how variable they are in their walking," explains clinic leader Liz
Inness.
"And again, we might be able to compare how they walk with their cane,
without their cane, with or without an orthotic, under different
conditions, so we can tailor our therapies."
Inness says using these more technological assessments goes beyond what
therapists can glean about a patient's mobility strictly through
observation.
Seeing how a patient's feet land can reveal underlying issues that
might be affecting balance control or gait, so that therapy can be more
specifically targeted.
"Balance and mobility issues are a huge problem after someone has a
stroke or a brain injury," she says. "It can affect their risk for falls
when they return to the community. It can also affect their day-to-day
life.
"When we're out in the community, we are experiencing countless
perturbations to our balance just to be able to walk, negotiating
crowds, walking on the sidewalk.
"And this allows us to assess underlying issues we need to address in
therapies to help people become more mobile and return to the community
in a safe and independent way."
Toronto Rehab is also developing portable tools using such game-based
devices as Nintendo Wii balance boards, which could be used in clinical
settings outside the hospital.
"We're working to see if we can use those to provide the same
measurements as in the clinic," says mobility team leader William
McIlroy.
"Our bigger plan, our bigger initiative, is to transform not just the
Toronto Rehab and not just in southern Ontario, but around the world
about how people diagnose and treat balance and mobility challenges."
For Raymond, the program has meant a return to independence.
"You don't feel the same after you have a stroke," she says. "I had to
learn how to walk all over again ... Eventually, I couldn't believe it,
but I could walk. Every day was better.
"It gave me hope that I'm not going to be stuck in a wheelchair. I'm going to be walking and normal."
National Stroke Association’s Stroke Center Network is a community of hundreds of hospitals, rehabilitation centers and healthcare
professionals working together to ensure you or your loved ones are receiving the best stroke care possible.