I noted in last blog post (The Body's 4 Natural Defenses Against Falls) that hip strategies are key to recovering from medium-level balance disruptions. I also stated that patient's often skip over using their hips for balance recovery, and, as therapists, this is one area we can really help patients. Below are practical tips to improving patients' use of hip strategies. It should be noted that before patient can effectively work on hip strategies, they need to be able to stand without hand support (if unable, see 5 Steps for Learning to Stand Without Hand Support for ideas on helping patients to stand without hands).
- Educate patients on components of basic balance systems, e.g., inputs and actions. Inputs include balance information from the eyes, inner ears, and legs. The brain makes sense of this information and sends actions to the muscles to keep the body balanced. These actions include movements at the ankles, hips/arms, stepping, and grabbing. Helping patients better understand balance is the first step in helping them improve their balance.
- Emphasize use of hips by cuing and facilitating hip movements. Help patients feel the movement of hips for regaining balance. Manually cue them to move hips forward when losing balance backward ("limbo"motion), and to move hips backward when losing balance forward ("bow" motion).
- Set up "safe" environment. I work in inpatient rehab and, when working on early balance interventions, prefer to keep wheelchair behind patient, ADL Balance Trainer around patient, and me in front of patient (to help spot and facilitate movements). Because patient is surrounded by support, their fear of falling is greatly reduced or eliminated. Similar safe set-ups can be achieved in parallel bars (for outpatient) or with sturdy chair backs (home health), instead of using Trainer.
- Introduce "moderate" balance challenges. If challenges are too small, patient will recover balance using ankle strategy. Conversely, if challenges are too large, patient will rely on stepping or grabbing strategies. Although moderate challenges are relative, I recommend the following exercises (listed in increasing order of difficulty) for working on hip strategies. Be ready to spot patient and facilitate hip movements as needed.
- Head turns (side-side) and tilts (up-down). Movement at inner ear and visual fields increase balance challenges.
- Extended reaching in forward direction. The farther the reach, the more challenging it is to stay balanced.
- Narrow stances. The narrower the stance, the more challenging it is to keep balanced.
- Nudges. Nudge forward to work on "bow" recovery motion at hips; nudge backward for "limbo" motion.
- Unstable surfaces. Unstable surfaces, such as the ADL Hip Stick or foam, put ankles at a disadvantage and shift the emphasis to the hips for balance.
- Combinations of above challenges. Combined challenges make it more difficult to stay balanced. For example, combine head turns and narrow stance or nudges when standing on foam. The goal is to challenge patient, as they naturally improve, to continue to effectively use their hips for balance recovery.
Shane Haas, PT, MSIE, CPE will be in Dallas, TX on February 24th 2018 teaching Balance Training by ADL. If you are interested in joining use for a great course, please visit www.ADLbalance.com for details.