To improve balance, individuals need to be challenged at an appropriate level. Such a level achieves a healthy mix of steadiness AND unsteadiness. This mix fosters confidence, reduces frustration, and builds balance. Unlike speed on a treadmill or weights on a bar, steadiness is not a constant when performing balance exercises. Because it can fluctuate, it takes SKILL to establish proper balance challenges. Below are 3 points to consider for balance intensity:
- Balance is TOO EASY – To keep balance exercises from being too easy, Individuals should be “unsteady” at least 20% of exercise time. UNSTEADINESS is defined as the presence of unwanted or unexpected movements including postural reactions (swaying, rocking, bobbing, reaching, stepping, etc.), slow movements (muted reaches, delayed steps, pauses in head turns, etc.), and/or use of supports (gait belt help, grabbing handrails, touching tabletops, etc.). Watch your patients when they exercise. If you do not see any signs of unsteadiness, the exercise is too easy and positive training effects will be minimal.
- Exercise is TOO HARD – To keep exercises from being too difficult or challenging, individuals need to be able to demonstrate “steadiness” at least 20% of the time. STEADINESS is defined as the ability to maintain a posture, or perform an exercise, without any obvious postural reactions, slow movements, or need for supports. If the individual is noted unsteady over 80% of exercise time, the balance exercise is too hard. Exercises that are too hard often lead to feelings of vulnerability, uncertainty, and frustration.
- Exercise is JUST RIGHT – For balance exercise intensity to be “just right,” individuals should be able to work in and out of periods of steadiness and unsteadiness. The presence of postural reactions, slow movements, and/or need for supports range from 20% to 80% of the exercise time. Signs of unsteadiness while exercising are good. Ideal balance exercises intensity balances between steadiness and unsteadiness. Too much, or too little, of one or the other, results in a sub-optimal exercise experience. Individuals need to feel challenged, but not frustrated or unsafe. Exercises shouldn’t be too easy or too hard. Exercises need to be "just right" with a ratio of 20% steadiness and 20% unsteadiness.
To help achieve this 20% ratio with steadiness and unsteadiness, exercises need to be continually monitored and adjusted. It takes SKILL to set and progress balance exercises. I hope this post helps you hone your skill and improve the balance exercise you do with your patients.
About the Author: Shane Haas is a Physical Therapist with 20+ years of experience in the area of balance rehabilitation. He is also President and co-founder of ADL 365 Inc. (www.ADLbalance.com), a company that makes innovative products for building better strength, balance, and function. Shane can be reached at shane@adlbalance.com.