Balance training

Question 1

What is balance?

Answer 1

The ability to maintain the body’s position in equilibrium

Question 2

What is centre of gravity

Answer 2

point where the body’s mass appears to be concentrated and from which gravity appears to act

Question 3

Where is CoG in anatomical position?

Answer 3

slightly anterior to S2

Question 4

What affects CoG?

Answer 4

body shape, weight distribution and position

Question 5

What is base of support?

Answer 5

the perimeter of the contact area between the body and it’s support surface.

Question 6

What alters base of support?

Answer 6

Foot placement and postural stability

Question 7

What are corrective strategies and examples?

Answer 7

When someone is destabilised, corrective strategies are required to return CoG over BoS and prevent falling
- ankle strategy
- hip strategy
- stepping strategy

Question 8

What are the three sensory inputs for balance?

Answer 8

• visual system
• Vestibular system (receptors in inner ear)
• somatosensory system (mechanoreceptors and proprioeception)

Question 9

How does the ankle strategy work

Answer 9

In posterior displacement, dorsiflexion and in anterior displacement plantarflexion

Question 10

Which muscles contract in the posterior displacement ankle strategy?

Answer 10

dorsiflexors, abdominals and quads

Question 11

Which muscles contract in the anterior displacement ankle strategy?

Answer 11

plantar flexors, hamstrings and trunk extensors

Question 12

How does the hip strategy work?

Answer 12

Pelvis moves rapidly in opposite direction to sway

Question 13

Which muscles contract in the backward hip strategy?

Answer 13

hamstrings, glutes and spinal extensors

Question 14

Which muscles contract in the forward hip strategy?

Answer 14

abdominals and quadriceps

Question 15

How does the stepping strategy work?

Answer 15

Forwards or backwards step used to increase the base of support when displacement is too great for ankle or hip strategy

Question 16

What are some causes of impaired balance?

Answer 16

• Amputation
• Inner ear problems
• Nerve damage
• Head injury- affecting vestibular system
• Alcohol
• Neurological conditions e.g. Parkinson’s, MS
• Visual impairments
• Lower limb injury e.g. ACL sprain, ankle sprain
• Spinal pathology e.g. low back pain
• Brain injury e.g. stroke, tumour
• Ageing

Question 17

What is balance training?

Answer 17

Exercise programme requiring patient to maintain balance. Gets progressively more difficult within a safe balance. Can be static or dynamic activities.

Question 18

How is balance training progressed?

Answer 18

• Supported or unsupported- hold onto something stable to make it easier.
• Bilateral or unilateral stance.
• Large base of support or small base of support.
• Partial or fully weight bearing.
• Stable or unstable surface.
• Visual input or no visual input (close eyes).
• Static or dynamic.
• No head/limb movement or head/limb movement.
• Distraction or no distraction.
• Staying within or reaching outside of base of support.
• Perturbation or no perturbation (stress or bother)

Question 19

Balance training dosage

Answer 19

At least 2-3 days a week and 20-30 minutes per session in healthy adults.

Question 20

Balance training safety

Answer 20

• Begin with simple and safe exercises.
• If there is risk of falling, stay close to patient, perform exercise in parallel bars or next to a stable object they can hold. Two people for very unstable patients.
• Place mats under wobble boards.
• Remove obstacles and unsafe objects

Question 21

Contraindications fo balance training?

Answer 21

• Patients who are inherently unsafe in balance challenged positions e.g. cognitive impairments.
• When it will disrupt healing process.
• When it increases pain.
• When it increases inflammation.

Question 22

What adaptations occur as a result of balance training?

Answer 22

• Decreased cortical brain activity.
• Increased sub-cortical activity.
• Decreased excitability spinal reflexes.
• Decreased unwanted joint reflex oscillations- improved movement control.