Time to Pull the Plug (on Balance)?
WARNING: This blog post is largely opinionated, read with caution. Technology should exist to help our patients, not just because it is visually appealing, looks sophisticated, or can produce tons of data and reports. In the area of balance, I see examples of bad technology. Is a $200 tilt board worth 5 to 10 thousand dollars or more just because it is connected to a load cell and a computer? Is reaching any better with motion-sensor gloves and a computer screen, when I can do the same movements with a cone and a shelf? What good is seeing a screen with a tracer of a patient's center of mass, when I can just look and see with my own eyes how the patient is moving? There is more to balance training than standing still and trying to minimize movement (a common exercise on computerized tilt boards). What is the value of a virtual target on a screen when we live in the "real" world? Balance is functional - life is not about trying to stand as still as possible. Real life is standing AND reaching, stooping, twisting, walking, climbing, etc. As such, balance needs to be trained in a wide-variety of ways: static, dynamic, reactionary, weight shifting, etc. Computerized tilt-boards tend to focus on training balance by minimizing movements. Improving one's ability to stand like a statue does not carry over to reaching up, stooping down, walking or stepping up a curb, to name a few. Proponents of the computerized tilt boards will argue the value of specifically and numerically testing balance. To this point, I question whether the value is real or perceived? How "valuable" is a data that just quantifies what we can easily see? It is easy to see that a patient swaying back and forth when standing is unstable - no matter the numbers. That being said, I do realize that we need to test patients. Testing is helpful to identify areas of balance deficiencies, as well as, proving effectiveness of our treatments. There are, however, a number of published balance assessments (Berg, Tinetti, DGI, etc.) that provide information on static and dynamic balance, and they are all FREE! Not all technology is bad, but the technology we see in some areas of balance does not, in my opinion, justify the steep price tag it comes with. In these instances, it might be time to consider pulling the plug!