Balance re education

Question 1

What is the rationale behind using this treatment (Pain/Increase ROM/Strengthen etc)?

Answer 1

improve balance

limit risk of falls

Question 2

What are the physiological effects of the treatment?

Answer 2

activation of muscles involved in postural control and stability

depending on how vigorous the balance testing is the pt may have an increase in heart rate, blood pressure and respiratory rate

activation of the nervous system as balance testing involves sensory input from the visual, vestibular and proprioceptive system

pt will be getting proprioceptive feedback through the balance testing on things such as joint position, movement and orientation which can help maintain awareness of body position

Question 3

What structures are affected by the technique?

Question 4

What principles are used in carrying out the technique?

Answer 4

safety is the main focus when testing peoples balance, so make sure that another physio is present to help support, or catch during a fall

observe righting reactions, how he moves around the base of support and how stable he is.

make treatment setting creative (use balls, things to change stability of walking surface)

Question 5

Precautions and contraindications?

Answer 5

precautions-pregnancy, experience changes in balance that can increase the risk of falls

those with cognitive impairment such as dementia may have difficulty understanding instructions

severe intolerable pain

recent surgery

recent injury

fractures

Question 6

How should balance treatment start?

Answer 6

start them in a postural set with lots of stability (could be sat down with feet on the floor)

then observe postural alignment whilst getting them to touch you hand out of their BOS

then compare this to the other side

then get them to use their opposite hands and get them going through different planes of mvmnt

Question 7

How should this treatment then be progressed?

Answer 7

get patient to sit on a blue wobble cushion with their feet raised off the plinth

then get them to touch your hands again, looking at righting reactions

can then get them to catching a ball, faster etc, getting rotation, but make sure a physio is present behind

then get them standing doing the same thing, making their BOS smaller and larger

can then bring in balls again etc

can have them on one leg etc

do all the opposite to regress

can have them shutting their eyes