Based on principles of overloading, we know patients need to be challenged when exercising in order to make improvements. If exercises are too easy, there will be no positive training effects. Below is a list of 4 areas that can be manipulated to help overload balance exercises.
- Movement is arc of motion in which an exercise is being performed. Movements can be increased or decreased in size to challenge balance. At one extreme is asking patient not to move at all, e.g. statue standing, while trying to keep balanced on foam or a rocker board. The other extreme is asking patients to move through their full range of motion. Reaches (up, down, across midline), head turns/tilts, and weight shifting exercises are all more challenging when the ranges of motion are increased.
- Base is the position of the feet on the ground. In general the smaller the base, the harder it is to keep balanced. The following list of stances is in increasing order of difficulty: wide, normal, heels together, split, tandem, and single-leg. Tighten up the base of support to make balancing more of a challenge.
- Surface is what the patient is standing on or walking over. The more unstable the surface, the bigger the balance challenge. Example challenges to standing surfaces include: soft/foam, wobble/rocker board, BOSU, hip sticks, etc. A 2015 article by Hirase, et al, showed earlier improvements in balance when training on foam versus only stable surfaces Ramps, curbs, stairs, and door thresholds are examples of surface obstacles that can be used to challenge walking steadiness.
- Speed can either be slowed down or sped up to challenge balance. Slowing movements emphasis stability and control, while faster speeds highlight agility. Examples of slow movement challenges include weight shifting at a slower speed with emphasis on technique and control. Adding a pause at the end of high stepping motions is another example of slowing down speed to increase difficulty. Conversely, speeding up movements over or around obstacles is an example of emphasizing agility as a balance challenge.