Can you discuss a clinical example you perform to challenge the sensory system and improve balance confidence?
Answer
I take a pair of safety googles and I wrap the plastic wrap around those safety goggles. I purposely have it so that it is an obscuring object to look through. If you do this and have a patient wear the goggles, they will be able to see through it depending on how many times you wrap it with plastic. The patient can see through it, but they are getting distorted information. I am giving a challenge to their sensory system by providing them with an altered visual field rather than a clear visual field. If I have a patient that is having issues ambulating and negotiating in an environment, this is one of the activities I may do to try to make it more challenging when walking across a room. This is an activity that I do with the lights on. I want to have good lighting, but then I take away some of the clearness of what they can see with the plastic wrap. This is a way to provide a distorted visual field, which is another type of challenge for the person. If I have a patient who has low balance confidence, this is something that is extremely difficult to have them agree to do. I would have them stand in place. I would say, “Mrs. Smith, I want you to stand in place. I am going to put the goggles on you. I want you to keep your eyes open and I want you to try to maintain your balance while you are standing in place.” We practice that and it seems to work well, so we move on. I say, “I would like you to put your feet in a semi-tandem position or tandem position. Can you put one foot in front of the other? Can you stand on one leg?” I will start to change the input, making it more challenging, and then I will take away the glasses and see how they walk without the glasses. This is an activity that I do to improve balance confidence. They are afraid of falling. Putting the goggles on makes them more afraid, but taking them off may show them that their balance is not as poor as they feel it may be.
Kenneth L. Miller, PT, DPT, GCS, CEEAA
Dr. Kenneth L. Miller is a board-certified geriatric clinical specialist, advanced credentialed exercise expert for aging adults, and credentialed clinical instructor from the APTA. He has over 26 years of clinical experience with the older adult population. Dr. Miller is an assistant professor at the University of North Texas Science Center with dual appointments in the Department of Physical Therapy in the School of Health Professions and in the Department of Internal Medicine and Geriatrics in the Texas College of Osteopathic Medicine.
His clinical focus is on best practices for use with the older adult population. He has spoken nationally and internationally on topics of gerontology including primary prevention, fragility, outcome measures, and pharmacology.
He serves on editorial boards related to geriatric care and physical therapy education including Topics in Geriatric Rehabilitation where he was guest editor for a thematic issue dedicated to pharmacology and nutrition. He also serves the physical therapy profession as director of practice for the Academy of Geriatric Physical Therapy and on several Academy Task Forces. Most recently, he has helped to develop the best practice guidelines for the Academy that describe best practices for the care of older adults. Dr. Miller is also a co-editor of the Ciccone's Pharmacology in Rehabilitation 5th edition textbook update.
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