In the previous post "The Business Case for Better Balance," I wrote that the best practitioners of balance “are very knowledgeable, e.g., information experts, about balance." In this post I will expand on 5 aspects of balance that you must master to be the best.
- Balance systems. Systems are comprised of inputs, process centers, and outputs. In respect to balance, the basic system inputs include eyesight, inner ear sensors, and sensors in the legs/feet. These 3 areas work together to supply the brain with important information about balance, including orientation in space, pressure distributions, positional changes, etc. The brain functions as the process center. It receives the inputs and instantaneously compares it to prior sensory information, formulating plans for movements and adjustments (to prevent loss of balance). It sends these movement plans out via neurons. Neurons transmit the outputs to muscles in the eyes (to fix gaze) and body to make adjustments needed to keep steady. These adjustments occur in patterns commonly referred to as balance strategies. The following are common balance strategies: ankle, hip, arm/reaching, stepping, and knee. The best balance practitioners not only understand balance systems, they also teach their patients about them.
- Types of balance. There are 2 basic types of balance: balance when you are standing still (static) and balance when you are moving around (dynamic). Static balance includes reaching, standing on unsteady surfaces, weight shifting, etc. Dynamic balance includes walking, stairs, stepping over obstacles, sidestepping, etc. Both types of balance are important to activities of daily living and should be incorporated into balance training. The best balance training programs incorporate a variety of static and dynamic exercises.
- Balance testing. Balance is affected by surface (hard, soft, unstable, etc.), stance (normal, narrow, single-leg, etc.), and movement (head, arm, trunk, etc.). Having a clear understanding of how these variables affect balance will lead to better treatment plans. There are a variety of surveys, standardized assessments, and high-tech tools to help identify areas of balance deficiency. The best programs use and repeat balance tests to identify and track balance problems and program outcomes.
- Training parameters. Until recently there were no specific training parameters for balance. According to review of literature by Lesinski et al. (2016) the following training parameters are recommended for balance training: frequency of 3 x week; training time of 11-15 minutes per session; variety of 4 or more exercises/session; exercise duration of 2 sets of 21-40 seconds each exercise; and a treatment duration of 11-12 weeks (or 16-19 training sessions). Having specific training parameters in place will help your balance training efforts become the best.
- Ideal training intensity. Based on the principles of overloading, we know balance exercises need to challenge one’s ability to remain “steady.” Steady is defined as not significantly relying on knee, hip, stepping, or reaching strategies (no use of external support) to maintain balance. Finding the ideal level of challenge requires skill. If exercises are too easy, the patient is under challenged and will not make patients appropriate functional gains. Conversely, if exercises are too hard, the patient will become frustrated and/or fearful of falling, ultimately giving up on balance training. The goal is to find an ideal level of challenge. A target training intensity of 50-90% steadiness is suggested. If the patient is unsteady more than 50% of exercise time, then it is too difficult. If the patient is steady more than 90% of the exercise time, then it is too easy. In order to train patients at an ideal intensity, the best therapists continually monitor and adjust balance exercises.
If you would like to increase your balance knowledge in the above areas visit www.ADLbalance.com.