Balance Interventions
Selecting interventions is based on the PT plan of care. Activities to restore and improve balance function should be directly related to a documented impairment, functional limitation, or disability. Conversely, impairments observed and/or measured by the PTA which are not included in the evaluation findings should be communicated to the supervising therapist for consideration and review.
Stretching
Upright posture and postural adaptations plays a significant role in fall recovery and balance strategy selection. Flexibility in the spine, hip, and ankle play a direct role in sensorimotor function.
Strengthening
Similarly, strengthening exercises for the postural and lower body muscles can improve balance and decrease risk for falls. Task-oriented approaches to strengthening enhance motor learning and functional recovery specific to the patient's functional short and long term goals. Therapists may integrate multidirectional resistance or perturbations to increase strength in muscles recruited during hip and ankle strategies. Balance and/or frequency of falls are impacted by the increased endurance which results from a strengthening and conditioning (cardiovascular) program.
Sensory Training
Activities which specifically challenge the visual, vestibular, and proprioceptive systems are included as interventions for sensory retraining. Interventions are targeted to effect a change in underutilized sensory inputs in order to integrate these multiple systems into an effective fall prevention strategy. Pain after joint injury alters proprioception, so interventions for recovering normal joint function typically include proprioceptive activities.
Interventions may also include providing adaptive strategies to compensate for compromised sensory systems. Large print, ergonomic modifications to prevent end-range activities (forward bending, overhead reaching), enhanced lighting/visual contrasts are examples of strategies to use in the home and community environments to prevent falls due to impaired sensation.
Perception training
Examples of activities which integrate sensorimotor training principles include eyes open/closed, variable surface consistencies, balance boards, performing a functional activity while on stable/unstable surfaces, enhanced feedback (e.g., knowledge of results using visual or auditory feedback).
Postural Awareness Training
Examples of interventions include progressive weight shifting and standing activities in double-limb and single-limb support. The intended outcome is that the patient can anticipate, assume, and maintain weight shifts in multiple planes without loss of balance. Strengthening of postural muscles and lower body stabilizers are requisites for postural awareness training.
Dynamic Gait
Interventions for dynamic gait should include environmental constraints for which walking is functional. For example, curb training, visual scanning/trunk rotation with walking (e.g., safely crossing streets), and maneuvering around obstacles are activities which may influence decisions about level of independence in community.
Vestibular Exercises
Vestibular exercises are specifically selected to enhance coordination and agreement between the visual and vestibular systems. When input from vision conflicts with vestibular input, then symptoms of vertigo (dizziness, nausea, altered gaze, disorientation) may result.
Examples of vestibular exercises include eyes fixed-head moving, and eyes moving-head fixed while tracking an object through multiple and variable directions of motion. These can be performed in sitting and standing, statically and dynamically.