As the inventor and avid user of the ADL Balance Trainer, I will spend the next couple of blog posts on treatment tips with the Trainer. While it was originally developed to provide balance challenges via reaching and placing tasks, I've found the Trainer to be very helpful in other areas too. One important area is helping patients learn to stand again. This post will highlight uses of the ADL Balance Trainer for patients struggling to stand again.
Tip 1: Remove the black platform, sit on a rolling stool in front of patient, and use your manual skills to spot, block, and facilitate. Being in front of patient allows you, as the therapist, to use your handling skills to block/control knee movements, extend hips, encourage weight shifting, and facilitate trunk extension, to name a few. Unlike parallel bars, the Trainer is wide enough to let you get your hands and arms around the side of patient without hitting against any bars.
Tip 2: Roll patients into Trainer in their wheelchair (WC). Once standing, the WC will be behind them, the Trainer around them, and you will be in front of them (same position as in tip 1). This set up reduces patients' feelings that they could fall. You've created a secure environment to help patients feel more comfortable about pushing past their comfort zone - which, at the moment, is sitting down.
Tip 3: Use the vertical poles for hand support. Holding the vertical poles naturally encourages the patient to look up, extend their trunk, tuck their hips, and stand taller. Holding the vertical poles also reduces the use of the hands and arms for weight bearing. Less use of the hands and arms to bear weight means increased use of the trunk and legs. Increasing the use of the trunk and legs for balance is a big step toward learning to stand again without the use of hand support.
Tip 4: Building on tips 1-3, use the available space inside the ADL Balance Trainer for weight shifting movements. Stay positioned in front of patient on rolling stool, keep WC behind patient, and have them hold the vertical bars while they learn to weight shift again. Unlike parallel bars, the Trainer is wide enough to allow the patient to weight shift, in all planes of movement, without needing to change the body position.
Tip 5: Use placing tasks to motivate your patients to learn to let go. Placing Games (1 of the 7 Balance Games that come with the Trainer) are great way to motivate patients to start using their hands again in standing. As a reminder, the object of Placing Games is to have the patient place an item, typically a ring or cone, on a platform of the same color (red, yellow, blue or green). In practice, I will hand the patient a ring or cone and ask them to place it on the platform it matches (to make the reaching and placing easier, I've already moved the platforms close to the patient). As the patient reaches for the ring or cone, they are no longer holding onto the Trainer with 2 hands. Though they may be holding with 1 hand, they are still learning to stand and balance with less support. To promote letting go with 2 hands, I give patients a stack of multi-colored cones and ask them to place them on the platforms that they match. Because they will need both hands to hold and pull apart cones from the stack, they cannot continue to hold onto the Trainer. Before they know it, they are standing and balancing without hand support.
The above 5 tips have proven invaluable to helping me work with patients to stand earlier and with better posture, confidence, steadiness, etc., than what I was able to achieve before we had the ADL Balance Trainer. Stay tuned to future blog posts for tips on using the Trainer to improve sitting balance, sit-to-stand transfers, reaching, and dynamic standing balance.