Gait and Balance Essentials Part 2

Feeling unsteady on the feet? Lacking confidence in the ability to stand and balance?

Gait and Balance Essentials: Part 2 -  

How do you treat gait and balance impairments in physical therapy?  

Gait and balance training in physical therapy involves a comprehensive approach to create positive adaptation. In the human body, multiple sensory systems and the neuromusculoskeletal system must be effectively challenged to promote gait and balance improvements. This is an essential component of any physical therapy program aiming to maintain balance and ensure stable gait. A thorough physical therapy evaluation by a skilled physical therapist is recommended before beginning any gait and balance training program. The evaluation is a very important step of the process, as this will identify key areas and body systems to focus on when creating an individualized treatment program.

Our team at ProMotion designs a series of progressive exercises and activities that are tailored to train each individual sensory system involved in maintaining balance and gait. In the previous edition of Gait and Balance Essentials, it was discussed that proprioception, vision, and vestibular function are three key systems involved in gait and balance performance. To train proprioception, we begin with balance activities by standing on a flat and solid surface, and over time begin shifting to more challenging surfaces like a soft foam pad or folded up towel on the ground. This requires greater sensory input to maintain stability on these surfaces! To train vestibular function, vestibulo-ocular reflex (VOR) exercises are implemented while in a seated or standing position. For example, holding the thumb straight in front of the nose, then rotating the head from side to side while maintaining your gaze on the thumbnail. Often there can be an overreliance on the visual system to maintain balance. Balance exercises can be progressed by closing the eyes while standing with the feet together or feet in front of each other, placing greater demand on the visual or vestibular systems to maintain stability.

I have issues going out into the community due to my balance. How can I fix this?

Going out into the community involves completing a variety of functional tasks. Ambulation in the community often includes navigating up and down stairs, curbs, and even crossing over various surfaces or terrains. A key component of any physical therapy program is the integration of functional movements of everyday life. Stair training is a common activity in any comprehensive physical therapy program. This includes working to gain strength, control, and confidence in the ability to navigate both up and down stairs. Many other common functional movements of everyday life trained in physical therapy include:

• Sit to stand transfers – being able to stand up and sit down from various seat heights
• Navigating up and down a curb – using an assistive device or railing when needed
• Entering and exiting a vehicle
• Ascending or descending a curb or ramp outside of a building

Can I use an assistive device to improve my balance?

Assistive devices can be a great option to assist with gait and balance abilities and fall prevention when appropriate. Our providers at ProMotion conduct gait and balance assessments to determine fall risk and then use this information to judge if an assistive device is appropriate or not. There are a wide variety of assistive device options that can be used to assist with gait and balance. It is important that the assistive device that is selected for use is the most appropriate option for the patient. Factors such as strength, balance, vision, accessibility, cognitive function, and ease of use are all components to keep in mind when deciding on an assistive device.

A comprehensive physical therapy plan includes proper instruction on assistive device sizing and set up, making sure that the heights for handles and seats (if applicable) are appropriate for each individual patient. Once the selected assistive device has been accurately fit for safe and effective use, proper assistive device training in physical therapy is necessary! This includes walking practice with the assistive device, using proper cadence and mechanics under the skilled guidance of our physical therapy team. Navigating up and down stairs or curbs, ascending or descending ramps, and performing safe sit to stand transfers are other common activities covered when practicing safe assistive device usage. Ensuring that the patient and the family or caregivers (if applicable) is essential to ensure confidence when using the assistive device outside of physical therapy.

Our goal at ProMotion is to help you maintain your strength and confidence in your everyday abilities and your goals. We want you to be able to move better, live better, and ultimately BE better!

If you or a loved one are experiencing gait and balance difficulties, we would love to help! Give us a call to schedule your initial evaluation to determine the cause of your gait and balance difficulties and to create an individualized plan to regain your strength and confidence today!