balance and balance training exercises for alderfly

balance training

1. BALANCE

2. BALANCE Balance refers to an individuals ability to maintain their line of gravity within their Base of support (BOS). It can also be described as the ability to maintain equilibrium, where equilibrium can be defined as any condition in which all acting forces are cancelled by each other resulting in a stable balanced system.

3. BALANCE SYSTEMS The following systems provides input regarding the body's equilibrium and thus maintains balance. Somatosensory / Proprioceptive System Vestibular System Visual System The Central Nervous System receives feedback about the body orientation from these three main sensory systems and integrates this sensory feedback and subsequently generates a corrective, stabilizing torque by selectively activating muscles. In normal condition, healthy subjects rely 70% on somatosensory information and 20% Vestibular & 10% on Vision on firm surface but change to 60% vestibular information, 30% Vision & 10% somatosensory on unstable surface.

4. SOMATOSENSORY SYSTEM Proprioceptive information from spino- cerebellar pathways, processed unconsciously in the cerebellum, are required to control postural balance. Proprioceptive information has the shortest time delays, with monosynaptic pathways that can process information as quickly as 40–50 ms and hence the major contributor for postural control in normal conditions.

5. VESTIBULAR SYSTEM The vestibular system generates compensatory responses to head motion via: Postural responses (Vestibulo- Spinal Reflex) - keep the body upright and prevent falls when the body is unexpectedly knocked off balance. Ocular- motor responses (Vestibulo- Ocular Reflex) - allows the eyes to remain steadily focused while the head is in motion. Visceral responses (Vestibulo- Colic Reflex) - help keep the head and neck centred, steady, and upright on the shoulders.

6. VISUAL SYSTEM For non- impaired individuals, under normal conditions the contribution of visual system to postural control is partially redundant as the visual information has longer time delays as long as 150- 200 ms. Friedrich et al. observed that adults with visual disorders were able to adapt peripheral, vestibular, somatosensory perception and cerebellar processing to compensate for their visual information deficit and to provide good postural control. In addition, Peterka found that adults with bilateral vestibular deficits can enhance their visual and proprioceptive information even more than healthy adults in order to reach effective postural stability. The influence of moving visual fields on postural stability depends on the characteristics of the visual environment, and of the support surface, including the size of the base of support, its rigidity or compliance.

7. TYPES OF BALANCE Balance can be classified in to : Static Balance: It is the ability to maintain the body in some fixed posture. Static balance is the ability to maintain postural stability and orientation with centre of mass over the base of support and body at rest. Dynamic Balance: Defining dynamic postural stability is more challenging, Dynamic balance is the ability to transfer the vertical projection of the centre of gravity around the supporting base of support. Dynamic balance is the ability to maintain postural stability and orientation with centre of mass over the base of support while the body parts are in motion.

8. THE MECHANISMS INVOLVED IN STATIC BALANCE Sufficient power in the muscles of the lower limbs and trunk to maintain the body erect. Normal postural sensibility to convey information concerning position. Normal impulses from the vestibular labyrinth concerning position. A central coordinating mechanism, the chief part of which is the vermis of the cerebellum. The activity of higher centers concerned in the willed maintenance of posture.

9. THE MECHANISMS INVOLVED IN DYNAMIC BALANCE Sufficient power in the muscles of the body to maintain movement and stability. Normal postural sensibility to convey information regarding movement. Normal impulses from the vestibular system and visual system concerning movement and environment. Central coordinating mechanism including cerebellum and basal ganglia The activity of higher centers concerned in the willed/ involuntary maintenance of movement and stability.

10. CORRELATION BETWEEN STATIC AND DYNAMIC BALANCE Maintenance of postural stability during both dynamic and static conditions involves establishing an equilibrium between destabilizing and stabilizing forces and requires sensory information derived from vision, the vestibular systems, and somatosensory feedback.

11. BALANCE TRAINING

12. Balance training involves doing exercises that strengthen the muscles that help keep upright, including muscles of legs and core. These kinds of exercises can improve stability and help prevent falls. Balance training programs aim to: Strengthen balance control in everyday activities leading to improved fall- related self- efficacy, reduced fear of falling and increased walking speed Improve physical function Improve quality of life

13. Examples of balance exercises include: Standing with weight on one leg and raising the other leg to the side or behind, Putting heel right in front of your toe, like tandem walking, Standing up and sitting down from a chair without using hands, Walking while alternating knee lifts with each step, Doing tai chi or yoga, Using equipment, like a Bosu, which has an inflatable dome on top of a circular platform, which challenges your balance.

14. Over time, the balance training can improve balance with these exercises by: Holding the position for a longer amount of time Adding movement to a pose Closing eyes Letting go of chair or other support Balance exercises can be done as often as we like, even every day. Adding in two days a week of strength training, which also helps improve balance by working the muscles that keep stable.

15. AREAS IT TARGETS Core: Yes. We need strong core muscles for good balance. Many stability exercises will work with abs and other core muscles. Arms: No. Most balance exercises are about balancing on feet. So unless we are doing moves that involve our arms, or holding weights, we don’t work for arms. Legs: Yes. Exercises in which we balance on one leg and then squat or bend forward also work the leg muscles. Glutes: Yes. The same balance exercises that work the legs also tone the glutes. Back: Yes. Our core muscles include some of our back muscles.

16. TYPE Flexibility : No. Balance training is more about strengthening muscles and improving stability than gaining flexibility. Aerobic: It can be, but often is not. It depends on how intense the activity is. If it involves moving fast, then it may be aerobic. Slower balance exercises do not make breathe faster or make heart pump harder. Strength: Yes. Many of these exercises will work on the muscles, especially the muscles of legs and core. Some moves may also use chest and shoulder muscles, like the plank position.

17. MANAGEMENT OF BALANCE IN SPECIFIC CONDITIONS Parkinson’s disease: Physiotherapy for Parkinson’s disease focuses on: transfers, posture, upper limb function, balance, gait, and physical capacity. The therapist uses cueing strategies, cognitive movement strategies and exercise to maintain or increase independence, safety, and quality of life. Sensory cueing strategies such as auditory, tactile, and visual cues have often been used to help walking in PD.

18. COGNITIVE MOVEMENT STRATEGIES Cognitive movement strategies are used to improve transfers. Complex and automatic activities are divided into separate elements consisting of relatively simple movement components. By doing this, the person has to think consciously about his movements. Try to avoid dual tasking during complex automatic ADL. Furthermore, the movement or activity will be practiced and rehearsed in the mind. It is important that movements are not performed automatically; performance has to be consciously controlled.

19. EXAMPLE: Sit to stand Hands on chair Place feet correctly Move forward Flex trunk Rise up from chair

20. Cueing strategies The performance of automatic and repetitive movements of is disturbed in some patients as a result of fundamental problems of internal control. That’s why cues are used to complete or replace this reduced internal control. Cues can be generated internally or externally. Rhythmical recurring cues are given as a continuous rhythmical stimulus, which can serve as a control mechanism for walking. Auditory (moves on music, singing, counting,...) Visual (patient follows another person, walks over stripes on the floor, he projects himself with a laser pen,...) Tactile(patient taps his hip or leg)

21. THE PHYSICAL THERAPEUTIC INTERVENTION GOALS APPLY TO THE PHASE ADDRESSED: Early phase - patients have no or little limitations. Goals of the therapeutic intervention are: Prevention of inactivity Prevention of fear to move/to fall Preserving/ improving physical capacity

22. Mid phase - more severe symptoms; performance of activities become restricted, problems with balance and an increased risk of falls. Problems: Body Transfers posture Reaching and grasping Balance Gait

23. Late phase - patients are confined to a wheelchair or bed. The treatment goal in this phase is to preserve vital functions and to prevent complications, such as pressure sores and contractures.

24. BALANCE TRAINING IN ELDERLY Balance training can also be used in the elderly. Risk of Falls in elderly, is very common due to poor balance. For this reason, the use of balance training might be very helpful to them. The training includes: Gait pattern Balance control Co- ordination and functional tasks Strengthening exercise Computerized balance programs or vibration plates.

25. To keep the therapy adherence up it is best to look for an approach with a ‘fun factor’. Some examples: Music- based multitask exercise program - basic exercises consisted of walking in time to the music and responding to changes in the music’s rhythmic patterns. Exercises involved a wide range of movements and challenged the multidirectional balance weight control system mainly by requiring shifting, walk-and-turn sequences, and exaggerated upper body movements when walking and standing. Tai chi has been proven to be an economic and effective way for training balance in older people.

26. To ameliorate balance in the elderly it isn’t enough to just follow a conventional exercise intervention (including muscle strengthening, stretching and aerobic exercises, and health education). It is better to also include static, and dynamic balance exercises. Static balance exercises: squats, two- leg stance and one- leg stance. Dynamic exercises: jogging end to end, sideways walking or running with crossovers, forward walking or running in a zigzag line, backward walking, or running in zigzag line. Use of Balance Boards. Core strength training: Nevertheless to improve balance core strength training is an important element. The benefit is this therapy can be both given in a group setting or in individual fall preventive interventions

27. OUTCOME MEASURES Many exists some commonly used test are: 4 Stage Balance Test Berg Balance Scale to evaluate static and dynamic balance, the Falls risk assessment tool Timed Up and Go Test to assess a patient's mobility The Balance Outcome Measure for Elder Rehabilitation Functional Reach

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