Ah yes, time to go to the parallel bars and do some balance training. As we all know, because we are super nerds, Balance is made up of a few major sensory components. The visual system (just written about by Spencer, here) proprioception from the joints, GTOs and such, touch sensation from your feet and other contact body parts and the vestibular system.
We put the patient in a compromised position (eyes closed, on foam, tandem, etc) and ask them to balance while they make minor/major adjustments with their hands on the bar, as needed, for a time duration.
But what is the end result? What do we really want our patient to accomplish? We want them to be able to loose their balance (normal) and adjust (normal) like you and I. And how do we do that regularly? With the stepping-strategy.
If knocked off balance, we simply pick up our feet after the appropriate weight-shift and widen our base of support by stepping to catch ourselves. This is an instinct, kind of. It is also something you can teach and learn. (Read: Motor Control!). What are we teaching someone now? Well, if you look at the principles of motor control, we are teaching them that if they loose their balance they should tap wildly with either hand for the parallel bars that (won’t) be there in order to steady themselves from a loss of balance. Of course this Upper Extremity strategy does not work in a wide aisle at Walmart.
In my estimation, we should be training the stepping-response with our patients so that they can instinctively react with a step to widen their base in the event of a loss of balance. Let’s take them out of the parallel bars, since we are already standing next to them, and actually guard them and let them learn to catch themselves with their feet… just like you and I. Specificity of training.
Yes, this requires prerequisite criterion to attempt; the ability to weight shift, for example, but we need to get the patient out in the open and stepping. They learn what we teach. I am worried about what habits we are reinforcing.
Please give me your input on this. This treatment is so prevalent that I know I must be missing something and am curious as to other’s thoughts.
“I never half step ’cause I’m not a half stepper” – Phife Dawg; A Tribe Called Quest