L2 Balance Treatment Flashcards
Categories of PT interventions addressed by balance
Patient or Client Instruction
Assistive Tech
Functional Training
Motor Function Training
Therapeutic Exercise
Patient education to reduce fall risk addresses
vision related constraints
dynamic stability constraints
biomechanical constraints
medications
Vision related constraints
optimize lighting
recommend eye exam
avoid progressive lenses while walking
improve contrast of objects w/tape
Dynamic stability constraints
-decrease clutter
-place commonly used objects at eye level
-secure electrical cords
-bath mats
-secure edges of rugs
-grab bars in bathroom
-handrails
Biomechanical constraints
-BOS–> footwear
-Strength–chairs w/higher floor to seat height
-firm surfaces instead of soft cushions
-LOS = grab bars and ADs
Medications
recommend MD analysis of current meds
assess meds to see if they impact balance
ensure they are taking meds as prescribed
Six Tips to Help Prevent Falls
-Talk with HCP about medication side effects
-Do strength and balance exercises
-Get your vision and hearing checked regularly
-Make your home safer with lights, grab bars, and securing rugs
-Use walker or cane
-stand up slowly to avoid dizziness
Purpose of AD for Gait
- to increase BOS to increase the patient’s stability
- to offload a limb with weight bearing precautions or pain
Considerations with ADs
-energy resources of patient
-patient’s cognitive abulities and safety judgement
-environment where it will be used
-proper fit of the device
-patient’s willingness to use the device
Selection of AD
Balance measures
Observation
Trial
Safety
Space in home
Efficiency
Documenting gait with AD
Include distance ambulated, AD used, amount of assistance
Steps to creating therapeutic activity/exercise for balance
- Identify constraints and impairments that might be causing the constraints
- Activity should address both the balance constraint and the underlying impairments
- Tie it back to an activity of interest, employ motor learning principles
At home safety
-educate the patient to STAY ACTIVE but know the signs of fatigue
-signs of fatigue means you should use an AD
-choose a corner for static movements
-difficulty should be lower than at the clinic
-focus on low-risk impairment-based exercises
During PT session safety
use a gait belt, harness system, etc
select activities that are moderately difficult
How to make task easier/harder
- manipulate the task
- manipulate the environment
- manipulate the individual’s balance resources/constraints
Neuroplasticity principles to use with exercises
Feedback
Practice
Exercise variables (intensity)
Reactive balance training is reliant on
feedback motor control
Anticipatory balance training is reliant on
feedforward motor control
Reactive Balance Training
–PT intentionally exposes patient to a perturbation with increasing challenge over time
–includes wearing a harness for safety
-SR suggests that RBT can reduce falls by 46-48%
Anticipatory Balance Training
-training to activate postural muscles in a feedforward manner before voluntary movement begins
-includes tasks where patient is made aware of task and knows the desired movement
-no external perturbations
Training for anticipatory balance should include
variable magnitude and direction of movement
predictability
the activity that causes the pts fear of falling
Activities for dynamic constraints
think about strength AND power
controlling small movements of COM progressing to larger movements of COM
Considerations for Cognitive Constraints
Task needs to be relevant to the pt
Task complexity varies by patient
Perform baseline assement of several tasks
