There are a wide variety of ways to challenge balance, including different stances (feet together, tandem, single leg, etc.), surfaces (foam, hip sticks, rocker boards, etc.), and movements (head turns, reaching up, stooping, etc.), to name a few. With so many options available, how do we choose what to do first? Should we progress a patient by standing them on foam or should we narrow their stance? Do we introduce reaching challenges or do we have them stand on a rocker board?
Unable to find any existing studies that compared balance challenges, we collected data from patients while they completed different balance exercises. Using a Biodex Balance System, we compared postural sway data under different balance conditions. Below is a table summarizing the comparative levels of difficulty (as measured by postural sway):
The results showed that surface challenges results in larger amounts of sway than stance or movement challenges. This information is helps make better choices when progressing balance exercises. It is easier for the patient to progress initially by adding/changing movements or stances. Then, as bigger balance challenges are needed, progress can be made to unstable surfaces. Additionally, the use of visual feedback (tracers) resulted in 30% less sway. Because tracers are not widely available, use a mirror for visual feedback when more help is needing for standing posture and balance (see blog post Want Better Balance? Look in the Mirror for more information). Balance Training is full of choices, use the above information to help make the right choice.
For more information on balance training consider pre-ordering The Haas Balance Book: 100+ Exercises for PT's and OT's. Release date is March 2019 - order now for discounted price and special offers!