The primary goal for patients in In-Patient Rehab (IPR) and Skilled Nursing Facilities (SNF) is to discharge home. For this to occur in a safe and effective manner, patients need to demonstrate sufficient balance in two basic areas: walking and reaching.
- Balance while walking. The most common patient goal in IPR and SNF is "to be able to walk again." To help ensure a safe return home, patients need to be able to more than just walk. They need to walk in and around their homes and communities safely - with or without a walking aide (walker, cane, etc.). Because these environments are not all smooth & flat (like the floors in rehab facilities), consider the following needs when training gait: uneven sidewalks, steps, ramps, door thresholds, narrow doors, tubs, showers, cords, pets, and variations in floor covering (carpet, tile, wood, rugs, etc.). Patient will also need to safely walk while moving in different directions (sideways, backwards, etc.), at different speeds, holding/carrying different objects, and looking in different directions (up, down, sideways, etc.) - all while in different environmental conditions (dark, light, wet, dry, crowded, etc.). As therapists, we need to safely progress gait beyond walking with walker on flat, smooth flooring, moving straight ahead, looking straight ahead, and at a slow speed.
- Balance while reaching. Less obvious than walking goals, patients need to be able to stay balance while reaching. Walking is important to get from place to place, but reaching safely is important to getting things done. Reaches are a big part of ADLs. Observational studies show 95% of ADLs involve movements of the trunk and arms. We reach up high to get cups or dishes out of cupboards. We reach low to pick up shoes up off the closet floor. We reach out far away from out bodies to retrieve items at the back of the fridge or pantry, etc. Reaching and body movements happen together. For example, reaching low occurs with whole body postures of stooping or squatting and weight shifting forward. Reaching high occurs with head/back extension and weight shifting backward. Reaching across midline occurs with trunk rotation and weight shifting side to the ipsilateral side. As therapists, we need to challenge balance through reaching (high, low, far, and across midline) to better prepare our patients for a safe return home.
Patients that can walk and reach with steadiness and confidence are better prepared to discharge (and stay) at home safely!