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Balance Training by Challenging the Sensory System using a Household Item

Kenneth L. Miller, PT, DPT, GCS, CEEAA

January 12, 2015

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Question

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

Kenneth L. Miller, PT, DPT, GCS, CEEAA

Dr. Ken Miller, PT, DPT, is a board-certified geriatric clinical specialist and advanced credentialed exercise expert for aging adults. Dr. Miller is an assistant professor at the Medical University of South Carolina in the Division of Physical Therapy and serves as the founding director of the USC Geriatric Residency Program. His clinical focus is on best practices for use with the older adult population. Dr. Miller is the Director overseeing Practice for the Academy of Geriatric Physical Therapy. He has spoken nationally and internationally on topics of gerontology, including pharmacology, primary prevention, frailty, outcome measures, best practices, and pain management for the older adult.  Dr. Miller has over 20 years of clinical expertise in risk mitigation and error prevention and is currently researching well-being, mental health, and burnout in physical therapists.  

 


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