At the heart of improving balance is building stronger and faster balance reactions, including ankle, hip, knee, and stepping strategies. If balance reactions are not evident during training, meaningful balance gains aren't likely. Without losses of balance and quick recoveries, therapy sessions may be doing more to improve standing posture or standing tolerance than building balance.
As therapists, we ask patients to work beyond their limits of stability while also encouraging them not to focus too much on the possibility of falling. The irony is that a fall is often the very reason they are participating in balance training. This is where a harness becomes valuable. A harness prevents a fall while allowing patients to challenge their balance safely.
By eliminating the risk of injury, patients are often more willing to move beyond their limits of stability and improve the speed, strength, and coordination of their balance reactions.
The rub is that a harness can also interfere with balance training. If the harness steadies the patient before balance reactions have a chance to occur, or if it provides so much security that the patient relies on the harness to catch them rather than on their own balance strategies, it can adversely impact the development of better balance.
This is harness abuse, and it should be avoided. When the harness provides too much support or security, it can reduce a patient's ability to develop better balance.
To help avoid harness abuse, consider the following strategies:
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Remove unnecessary offloading. Harnesses are often used with systems that provide body-weight support. While offloading can help patients feel secure during standing and walking activities, it can also dampen balance reactions. As appropriate, eliminate offloading to create an environment in which the patient has the opportunity to engage and strengthen balance reactions.
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Add slack to the harness. Harness straps can be loosened to allow patients to lean, reach, step, and bend without being immediately pulled back toward center. Freedom of movement is essential for developing effective balance strategies. Add enough slack to permit natural movement, but not so much that the patient could contact the floor if a fall occurs.
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Be mindful of movement limits. Even when offloading is removed and slack is added, the harness can still negatively impact balance training. For example, a patient may be able to take a small to moderate step without harness interference. However, if a large step or multiple recovery steps are taken, the available slack will be taken up, and the harness will interfere with the exercise. Select activities that maximize balance reactions while avoiding harness interference.
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Set expectations that the harness is temporary. For patients working to improve balance and independence, explain that the harness is a temporary training tool. The goal is to progressively reduce reliance on the harness as balance improves and confidence grows. Avoid fostering dependence on a harness.
When used appropriately, a harness can be an effective tool for helping patients regain balance and mobility. By removing the fear of falling, patients are often more willing to challenge their limits of stability and develop stronger balance reactions. However, if the harness begins to interfere with movement or balance recovery, make adjustments. The harness should enhance balance training, not make it less effective.
About the Author: Shane Haas serves as the Director of Clinical Informatics at Ernest Health, a leading provider of inpatient and outpatient rehabilitation. He enjoys learning and sharing leadership and management principles. His backgrounds in Physical Therapy (UF ’96) and Industrial Engineering (TTU ’02) provide a balanced heart and head perspective that shapes the Healthcare Managers' Playbook.
