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Home Exercises for Patients with Balance and Dizziness Issues

Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA

November 20, 2013

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Question

What kind of home exercise program would you give a balance and dizziness patient considering safety in the home?

 

Answer

Prescribing a home exercise program always comes down to three things.  What is the patient’s support structure in terms of ability of an individual to realistically help the patient follow the exercise program? Are they able to safely challenge their balance with someone standing by?  Secondly, what is this patient’s work ethic? Are they able to push themselves in an exercise program?  Next, think about the balance exercises and the fact that they should be progressed in such a manner that your stimulus causes about 30% loss of balance.  When you are looking at patients and you see their capabilities, you need to see that they actually are losing their balance about 30% of the time.  If it is greater than that, then they are probably at greater risk for being unsafe.  If it is less than that, then you are probably not challenging them enough.  

The exercise program could include walking up and down the hallway with the protective availability of the walls in the hallway on each side.  I may have them walk up and down while doing any one of the following:  head rotation side to side (with or without a walker), walking with head nodding, or trying to work on efforts such as bending down to pick up an object from the floor and putting it up onto a high shelf.  Ideally, they are going to have a chair or even a bed behind them when they are trying to work on something like that. Sitting down at the edge of the bed nodding five times followed by head rotation five times is another example.  For some patients, a great exercise is rolling from right to left or moving from sit up to stand up.  Obviously, the reverse would be true for other patients as well. Certainly doing the Brandt-Daroff exercise is a great home exercise program.  A lot of times when giving individuals the dynamic visual acuity efforts, they actually rotate their own head side to side in an effort to keep their eyes on a visual target that they are either holding out in front of the them or that is posted on a wall. At that point, the activity turns into a vestibulo-ocular reflex test.  If they have their eyes on a magazine that you are holding up and their head turns left, passes through the middle, and then turns right with their eyes staying on that magazine article, you have an exercise. There you have a few exercises that are all excellent options for these individuals.  

 


mike studer

Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA

Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA is the owner and lead therapist at Northwest Rehabilitation Associates, a Chamber member and active presence in the Salem community. He has been a PT since 1991 and a Clinical Specialist in Neurologic Physical Therapy since 1995. Mike is the only therapist in the nation to be awarded the Clinician of the Year by two different national academies of the American Physical Therapy Association, being awarded the Clinical Excellence Award in both Neurology and Geriatrics. He has authored over 30 journal articles, and contributed-to or primary authored 6 book chapters. He is a recognized national and international speaker on topics including aging, stroke, motor learning, motivation in rehabilitation, cognition, balance, dizziness, and Parkinson’s Disease, having presented in 48 states and 9 countries. In 2020, Mike presented a TED talk on neuroplasticity that has been viewed by thousands, and he was awarded the highest honor that can be bestowed on a physical therapist – one of only 250 therapists in the nation to be designated a Fellow of the American Physical Therapy Association for a lifetime and diverse contributions to the profession in clinical, research and educational fields.

 


Related Courses

The Science of Fall Prevention
Presented by Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA
Recorded Webinar

Presenter

Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA
Course: #2825Level: Intermediate2 Hours
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What is the difference between screening and testing? What is the science of imbalance? What are the differences between unsteadiness, imbalance, dizziness, lightheadedness, and vertigo? How do I document to prove my worth, my role, or this patient’s potential? What is the evidence for helping someone improve balance? What is the best method to select the most sensitive and responsive balance test for each patient? What psychological influences could be involved with this person? The answers to these questions and more are in this seminar intended for advanced dizziness management- differential diagnostics and treatment. Expect practical techniques, readily applied to the clinic, incorporating current evidence and revealing future advances in balance and dizziness rehabilitation. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.

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In this course, attendees should be prepared to extend their use of dual task repertoire and application from an approach that introduces distractions as a game or challenge, to a more sophisticated delivery of care in an effort to both habituate patients to distractions, and improve their reformatting of procedural memories, through automaticity. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Clinical Applications in Neurology: Parkinson's Disease and Parkinson's Plus
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This course intends to help the emerging neurologic-focused therapist move from intermediate to advanced, within the scope of their license. Neurology for the non-neurologist’s PD, PD+, and movement disorder focus aims to improve your clinical acumen, examination, education, and intervention skills, within this complex myriad of conditions…or at least as much as we can cover in 2 hours! This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

The Skill That Connects Us: PT, OT, SLP: The Latest Applications of Dual Task Testing and Training
Presented by Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA
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Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA
Course: #3183Level: Advanced2 Hours
  'Good information'   Read Reviews
Why are some movements "automatic", processed without direct and consistent conscious control, or even resistant to environmental distractions? How do movements become automatic in the unimpaired learner and begin again in those with brain injury or other impairment? In this course, we will review, APPLY, and ADVANCE the science of procedural learning (regaining automatic function) in gait, speech, ADL, athletics and more! We will review how the best applications of dual-task facilitate the transfer of experiences into procedural memories. Additionally, attendees will get a sneak peek into the emerging world of Dual Task Fitness, for the benefit of fall prevention, ADL, speech for those with fall risk, MCI, concussion, some PD, MS, ALS, and stroke.This course is appropriate for PT professionals, OT professionals and SLP professionals.

Why this test? Clinical Decision Making for Balance
Presented by Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA
Recorded Webinar

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Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST, FAPTA
Course: #3185Level: Advanced2 Hours
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When faced with limited time, resources, space, or information – how do clinicians decide the most optimal collection of balance tests for each patient? To make the best decision, therapists must consider many factors. Are you using the best decision-making process when examining a patient with imbalance? A short list of what will be covered in this advanced level course includes clinical decision-making for an imbalance examination, including factors such as: diagnosis, prognosis, personality and effect (low self efficacy, depression, agitation), cognitive impairment, reimbursement, fear of falling, and many more, Listen-in and learn how to choose the most optimal screening tools and tests for each patient!