Balance problems after stroke

When you are moving around, your brain needs to coordinate information from your eyes and the balance system in your inner ear, as well as controlling your muscles and joints.

A stroke can change the way your brain controls balance, and you could feel unsteady or uncoordinated. There are some other causes of balance problems, and treating an underlying condition can help improve your balance.

How can your balance be affected by stroke?

Weakness on one side of your body

A stroke often causes weakness on one side of your body, which can make it difficult to balance. At worst, you may find it difficult to sit up safely, or you may have difficulty standing. You may be able to walk but find that you can’t lift your toes quickly enough to stop them catching on the ground when you step. This is known as foot drop, and it can make you feel unsteady or more likely to trip. Or you may find that you have less energy so that you tire easily and then become unsteady.

Loss of sensation

The second main factor affecting balance is the loss of sensation in your affected side, particularly your legs. If you cannot feel where your leg and foot are, it is very difficult to know how to move. You will automatically use your vision to compensate for the lack of feeling, which takes a lot of concentration and is tiring. It also means that you may be less aware of your surroundings. All of this increases your risk of having slips, trips and falls.

Concentration problems

After a stroke, moving around and keeping your balance may require more concentration, which is hard work. Dealing with any situation which needs concentration could affect your balance. Many people who fall report that they were not paying attention, were thinking of other things or doing several things at the same time when they fell.

Vision problems

Vision is an important aspect of balance. Vision problems are quite common after stroke, including difficulty focusing, double vision and eye movement problems. If you have hemianopia (missing part of your field of vision), you might not see things in your way.

Neglect

Spatial neglect, or inattention, means that your brain is not processing sensory information from one side. You might not be aware of one side of your body, and the space to that side. People with neglect may try to move but forget to move their weak leg, causing loss of balance. They might bump into or trip over objects they can’t see on that side of their body, causing a fall.

Ataxia

People with ataxia have difficulty controlling smooth movements. Movements of your limbs and body tend to be shaky, and arms or legs can miss their target. This can make balance difficult when sitting and standing.

Perceptual problems

Some strokes can affect your ability to interpret your surroundings. It can be difficult to maintain your balance and plan how to move if you are unsure of your own position in relation to the space around you.

Vertigo

If a stroke happens in your cerebellum or brainstem, the areas that control balance in the brain, you may be left with vertigo. This means having a feeling that you or the world around you are moving or spinning. You can feel dizzy or lose your balance.

Side-effects of medication

Some medicines commonly prescribed after stroke can cause dizziness or weakness, including some high blood pressure medication. Withdrawal from antidepressants can cause dizziness. Interactions between different medicines can also affect your balance.

Talk to your doctor or pharmacist if you have any concerns about the medicine you are taking, as you may be able to try new drugs or a different combination of drugs. Never stop taking any medication without speaking to your doctor first.

Other causes of balance problems

A range of other conditions not directly related to stroke can also cause dizziness and loss of balance. These include inner ear infections, migraines and confusion due to a urinary tract infection.

What help is there for balance problems?

Physiotherapy

A physiotherapist can assess you and recommend therapy or exercises that may help you to recover. You should see a physiotherapist while you are in hospital. If you have left hospital, your GP can refer you for physiotherapy. Private physiotherapists and some NHS services will accept a self-referral where you can go to them directly to request assessment and treatment. For more information, see our guide ‘Physiotherapy after stroke’.

Equipment to help with balance problems

A simple walking stick or four-point cane can improve your stability and improve your confidence, especially when walking outside. Even if you do not need to lean on the stick for support, people will often give you a little more time and space. It is important that any equipment is the correct size for you, so get professional help when choosing.

I'm worried about falling, is there any help available?

Most areas offer services to support people at risk of a fall. In some areas this is called a falls service or a falls prevention service. The way services run varies, but they all offer rehabilitation for people who have been injured in a fall and advice on how to prevent falls and injuries in the first place.

If you have fallen or you feel worried about falling, ask your GP to refer you for help, such as your local falls service. A physiotherapist can give you individual advice.

Information guide

• Download the Balance problems after stroke guide (PDF)

Where to get help and information from the Stroke Association

Helpline
Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Email: helpline@stroke.org.uk
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Other sources of help and information

Age UK
Helpline: 0800 055 612
Specialist information for older people including guidance on avoiding falls, plus wellbeing and tips on strength and balance.

Chartered Society of Physiotherapists (CSP)
Helpline: 020 7306 6666
Offers a search facility for finding a qualified, private physiotherapist.

Online strength and fitness tools
Before you follow advice and exercises online, check with your physiotherapist or GP to make sure it's safe for you.

nhs.uk/falls
This NHS page gives practical tips for reducing falls and links to home exercise videos and exercises.

Mystrokeguide.com
My Stroke Guide has a 12-step video programme to help you be more active. It’s tailored to people with different levels of mobility so you can choose the right activities for you.

Disclaimer: The Stroke Association provides the details of other organisations for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.