Balance exercises challenge one’s ability to remain “steady.” Steady being defined as no significant reliance on knee, hip, or stepping strategies; and no use of external support (touching with hand) to maintain balance. Basic examples of balance exercises include standing with heels together or shifting weight side to side.
We know that exercises must challenge patients in order to have a positive effect on balance and falls. As therapists, we need to balance making exercises too easy (under-training) or too hard (dangerous). In relation to balance exercises, Steady for Life promotes a training intensity for balance exercises of “50-90% steadiness.” At 50% steady your balance is maintained for half of the exercise time. And at 90% steady, balance is kept for 90% of the exercise time. If a patient or client is unable to keep steady greater than 50% of the time, then the exercise is too hard and needs to be made easier. Conversely, if they can keep steady more than 90% of the exercise time, the exercise is too easy and will not result in the hoped for improvements in steadiness.
If balance exercises are not challenging your patients/clients, they will not be as effective in reducing falls. The following tips can help you progress your balance exercises so you can better help your patients become steady for life!
Static Balance Progression Tips (standing in place):
1. Sand with feet closer together (shrink base of support) by standing heels/insteps touching or in heel-toe stance (if patient is really steady, then try to stand on one foot).
2. Stand on a soft surface such as dense foam, pillows, etc.
3. Add movements – move head side to side and/or up and down – the faster and farther the movement, the harder it is to keep steady.
4. Add arm movements – reach high, reach low, reach out, etc.
5. Add light pushes or perturbations.
6. Add “dual tasks,” e.g., conversing, simple math, pouring water in cup, tossing ball, etc..
Dynamic Balance Progression Tips (moving about):
1. Move at a slower speed, step with “softer” feet (pretend you are trying to sneak around, shouldn’t hear feet at all).
2. Lift foot off ground in slow, controlled heel-toe pattern, set foot down with slow, controlled toe-heel pattern.
3. Pause movements with one foot off the ground.
4. Add dual tasks, such as, carry cup of water, pass ball from left to right hand and back, simple math, conversing, crowded rooms, etc..