Impairments that may alter balance
- Muscle strength / power/ endurance
- Coordination
- Joint range of motion
- Somatosensation
- Vision
- Vestibular
- Cognitive
- Emotional factors e.g. fear of falling
- Pain
Strength / Resistance Training
- Reduced muscle strength is an important risk factor for falls
However - - Strength training alone does not prevent fall
- Resistance exercise in combination with balance and functional exercise may reduce falls in older people living in the community
Sensory Training
Minimal research on effectiveness of direct sensory retraining to improve postural stability
Treatment could include:
* Practice at-risk situations –e.g. uneven surfaces
* Raise client’s awareness of impairment
* Attempt to incorporate awareness raising into intervention
Postural alignment in sitting
Essential Components
- Head balanced on level shoulders
- Upper body erect - trunk and neck in neutral
- Shoulders over the hips
- Feet and knees a few cm apart
- Weight evenly distributed
Visual System training
Raise client’s awareness of impairment
Practice at-risk situations
Postural alignment in standing
Essential Components
- Even weight-bearing
- Head balanced on level shoulders
- Upper body erect - trunk and neck
in neutral - Shoulders over the hips
- Feet and knees approx. 10cm
apart - Weight evenly distributed
In sagittal plane
Greater trochanter anterior to
lateral malleolus
how to challenge balance training
- Increase challenge by decreasing BoS
- Practice moving CoM within BoS and controlling body position
FITT balance training
freq- 2-3x/ week
intensity- degree of challenge to the balance control system relative to the capacity of the individual to maintain
balance
time- Total weekly dose 3+ hours include balance & functional exercise –
reduce rate of falls// Minimum 50 hours to protect older adults against fall
Reduced base of support training ideas
feet together, strained stance, tandem stance
Training controlled movement of the centre of mass
- Head movements
- Rotate body to (R) / (L)
- Ability to shift weight in different directions
- Laterally
- Forward
- Backwar
Training proactive balance in standing:
A / P weight shift examples
Example: Shifting weight forward – e.g.
sway meter as visual cue
Example: Shifting weight forward – e.g.
scales as feedback
Anticipatory
Reaching in all direction
Reaching inside then outside
base of support,
forward, backwards, laterally
Reach and cross midline
Bend down to touch floor or pick
up object
Reach overhead
Training in walking
- Walking over a thick mat
- Walking outside over uneven surfaces
- Walking over/around obstacles
- Head turns
- Walking with narrow base / balance beam
- Opening a door (both pushing away and pulling towards themselves)
- Turn 360o to the left and right
- Dual-task balance training
Training in high level mobility tasks
- Hopping
- Jumping
- Skipping
- Running
- Complex functional tasks – start – stop
- Velocity
- Change of direction
- Decision making
- Reaction time
3 Dimensional Exercise
constant movement in a controlled repetitive way through all three spatial planes eg dance
Practice to induce neural change requires
- Task specificity
- Individualization
- Variability
- Intensity - finding the Challenge Point
- Progressive overload
