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