Prescribing exercises to improve balance can itself be a balancing act. Push too hard and your patient loses their balance too often and can feel insecure and discouraged with exercise. On the other hand, if you don’t push hard enough, your patient will not make significant improvements in steadiness and balance. Below are 3 points to “balance” when prescribing balance exercises:
- Stance. Stance is the position of the feet when standing. Example stances include (listed in order of increasing difficulty): feet apart, feet together, split stance (one foot forward and one back), tandem stance (one foot directly in front of the other), and single-leg stance. In general, the narrower the stance, the more challenging the exercise. Select a stance that challenges your patient at an appropriate level.
- Movements. Adding movements with the head, arms, and body will further challenge balance. Head turns and tilts involve the vestibular and ocular systems, both play a significant role in maintaining balance. Reaches (high, far, low, or across midline) help simulate daily living tasks and require more control to keep balanced. Moving the body while keeping the feet fixed (either forward and back or side to side) also requires more control from your patient to keep steady. TIP: Use cones, rings, clips, or other objects to further engage patients in reaching movements.
- Surface. The surface on which your patient stands also factors in to exercise difficulty. Hard, steady surfaces give better feedback to the touch sensors in feet (needed for good balance). Soft, unsteady surfaces, in contrast, provide limited feedback and make exercises more difficult. To increase the intensity of balance exercises, replace hard, steady flooring with foam or rocker-bottom boards.
While there are other factors to consider when prescribing balance exercises, learning to balance these 3 factors will help you on your way to providing safe and effective balance exercises for