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Neurologic Disorders -Assessment and Treatment of Balance

Updated: Oct 12, 2023


Part III - Rehabilitation Program with PhysioSensing





1. Balance and Stability – Sagittal


Goal: To improve postural control, while trying to distribute body weight equally on both feet to reach a stable (balance) position.


PhysioSensing Balance System. Balance and Stability exercise Interface
Balance and Stability - Sagittal Exercise Interface
PhysioSensing Balance System. Balance and Stability exercise
Balance and Stability - Sagittal Exercise Parameters













Definition of exercise’s parameters:

  • Tolerance: 15% - Tolerance is the weight percentage margin allowed so that the indicator remains green. To decrease exercise difficulty level, we can increase the tolerance value;

  • Maximum Time: 30 seconds – In the beginning of treatment is better to start with a lower exercise time;

  • Balance: Left – We understood that the patient has an asymmetric posture and movement in the medial lateral plane, showing a tendency towards the left side. In the beginning of treatment, we can adjust the central (balance) position to the left, considering the patient’s characteristics. We can progressively return to the “real” reference central position during the following sessions. This is a way we have to adjust the difficulty level to each patient;

  • Value: 10% - We adjust the central position of reference in 10% to the left;

  • Stance Position: Comfortable;

  • Unstable surface: No.



2. Figure and Paths – Square


Goal: To Improve postural control during movement and weight transfer while trying to reach all points withs the COP.


PhysioSensing Balance System. Figure and Paths exercise
Figure and Paths - Square Exercise Parameters
PhysioSensing Balance System. Figure and Paths Exercise Interface
Figure and Paths - Square Exercise Interface













Definition of exercise’s parameters:

  • Tolerance: 15% - Tolerance is the margin of weight percentage allowed for the patient to reach and validate the dot. To decrease exercise difficulty level, we can increase the tolerance value;

  • Limit: 30% - Analyzing the results from LOS protocol, we can see the maximum excursion values referent to movement to the right barely reached 30%. Therefore, choosing 30% of the theoretical limit of stability for the exercise is a good starting point;

  • Training Focus: All

  • Stance Position: Comfortable;

  • Unstable surface: No.



3. Random Points – Follow me


Goal: To improve dynamic postural control and motor control while moving the COP in different directions to reach aleatory points.




PhysioSensing Balance System. Random Points Exercise Parameters
Random Points - Follow me Exercise Parameters
PhysioSensing Balance System. Random Points Exercise Interface
Random Points - Follow me Exercise Interface











Definition of exercise’s parameters:

  • Tolerance: 15% - Tolerance is the margin of weight percentage allowed for the patient to reach and validate the dot. To decrease exercise difficulty level, we can increase the tolerance value;

  • Limit: 30% - Analyzing the results from LOS protocol, we can see the maximum excursion values referent to movement to the right quadrant barely reached 30%. Therefore, choosing 30% of the theoretical limit of stability for the exercise is a good starting point;

  • Time at the point: 2 seconds – Try to maintain balance in each point reached for 2 seconds, for increasing difficulty the patient can stay at the point for a longer time;

  • Training focus: Right – To stimulate weight transfer to the right we can set the training focus so the points will appear more on the right quadrants;

  • Stance Position: Comfortable;

  • Unstable surface: No.



4. Protocols Training – Limits of Stability


Goal: To improve limits of stability (how far can a patient displace their COP in 8 directions, without losing balance), proprioception, motor control, reaction time, muscle strength of the posterior muscle chain and ankle mobility.



PhysioSensing Balance System.  Limits of Stability Exercise Interface
Protocols Training - Limits of Stability Exercise Interface
PhysioSensing Balance System. Limits of Stability Exercise Parameters
Protocols Training - Limits of Stability Exercise Parameters












Definition of exercise’s parameters:

  • Tolerance: 15% - Tolerance is the margin of weight percentage allowed for the patient to reach and validate the dot. To decrease exercise difficulty level, we can increase the tolerance value;

  • Limit: 40% - Analyzing the results from LOS protocol, we can see the maximum excursion values referent to movement to the right quadrants barely reached 30%. For training the limits of stability we can choose 40% for every direction, to challenge and motivate the patient to improve;

  • Stance Position: Comfortable;

  • Unstable surface: No.



5. Load Charts – Load Distribution in Sagittal Plane while performing Sit to Stand.


Goal: To train equal load distribution during sit to stand movement facilitated by the visual biofeedback.


PhysioSensing Balance System. Laod  Charts - Load Distribution in Sagittal Plane while performing Sit to Stand Exercise Interface
Load Charts - Load Distribution in Sagittal Plane Exercise Interface

PhysioSensing Balance System. Load Charts - Load Distribution in Saggital Plane while performing Sit to Stand, Exercise Parameters
Load Charts - Load Distribution in Sagittal Plane Exercise Parameters














Definition of exercise’s parameters:

  • Stance Position: Comfortable;

  • Unstable surface: No – We can progress to adding a foam to stimulate proprioception.



6. Load Distribution – Global while performing heel raises and toe raises.


Goal: To improve balance in a more unstable stance, improve muscle strength on the plantar and dorsal flexors and to train equal load distribution in the mediolateral plane.


PhysioSensing Balance System. Load Distribution while performing heel raises and toe raises. Exercise Interface
Load Distribution - Global Exercise Interface















7. Balance and stability – Sagittal while squatting against a wall.


Goal: To train squatting, a functional movement used in daily activities, while trying to symmetrical distribute the weight on both legs.



PhysioSensing Balance System. Balance and Stability - Sagittal Exercise Parameters
Balance and Stability - Sagittal While Squatting Exercise Parameters
PhysioSensing Balance System. Balance and Stability Exercise Interface
Balance and Stability - Sagittal While Squatting Exercise Interface


















Definition of exercise’s parameters:

  • Tolerance: 15% - Tolerance is the weight percentage margin allowed so that the indicator remains green. To decrease exercise difficulty level, we can increase the tolerance value;

  • Maximum Time: 30 seconds – In the beginning of treatment is better to start with a lower exercise time, the goal is to try do the squatting repetitions correctly and not as many as the patient can do in 30 seconds;

  • Balance: Left – We understood that the patient has an asymmetric posture and movement in the medial lateral plane, showing a tendency towards the left side. In the beginning of treatment, we can adjust the central (balance) position to the left, considering the patient’s characteristics. We can progressively return to the “real” reference central position during the following sessions. This is a way we have to adjust the difficulty level to each patient;

  • Value: 10% - We adjust the central position of reference in 10% to the left;

  • Stance Position: Comfortable.



8. Load Transfer – Sagittal while grasping and reaching towards the right side.


Goal: To stimulate weight transfer to the right while maintaining balance.





PhysioSensing Balance System. Load Transfer Exercise Parameters
Load Transfer - Sagittal Exercise Parameters
PhysioSensing Balance System.  Load Transfer Exercise Interface
Load Transfer - Sagittal Exercise Interface












Definition of exercise’s parameters:

  • Stance Position: Comfortable;

  • Unstable surface: No – We can progress to adding a foam to stimulate proprioception.




Summary



Every time a patient completes an exercise or an assessment protocol, all data gets stored. For a clinical setting the reports generated are useful for analyzing the results from one session or the progression of several sessions, or even to explain to the patient the goal and meaning of each protocol or exercise results. It is a valuable tool for the clinical assessment of balance disorders, mainly due to the objectivity and reliability of the parameters measured.



PhysioSensing Balance System. Clinical Report - Limits of Stability Assessment
Clinical Report - Limits of Stability Assessment
PhysioSensing Balance System. Progress Report - Limits of Stability Assessment
Progress Report - Limits of Stability Assessment



















Another interesting feature of Balance Software is the 7 games available. Each game gathers a set of exercises that allow load transfer in several planes and balance training, appropriate for a high variety of therapeutic situations. Allied with physical stimulation, visual biofeedback has been considered a very efficient way to improve rehabilitation results. Additionally, associating a ludic component to a rehabilitation process has also shown to increase motivation and adherence to the process (Gil-Gómez et al., 2011).



PhysioSensing Balance System - Balance Software Game
PhysioSensing Balance Software - 2D Games
PhysioSensing Balance System - Balance Software Game
PhysioSensing Balance Software - Bart Game









PhysioSensing Balance System - Balance Software Game
PhysioSensing Balance Software - Slime Pong Game
PhysioSensing Balance System - Balance Software Game
PhysioSensing Balance Software - Slime Run Game












Do you have questions about this topic? Or want to know more about balance system?

Schedule a 15 minute talk with me!



Ana Souto

Meet Ana, a physiotherapist with a master's degree in human physiology, currently specializing in neurobiology. Her professional journey has led her to gain extensive expertise in both neurology and sports physiotherapy.

Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Leveraging her strong foundation in scientific research and evidence-based practices, Ana creates customized assessment and training plans. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care.

In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.





References


Gil-Gómez, J.-A., Lloréns, R., Alcañiz, M., & Colomer, C. (2011). Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: A pilot randomized clinical trial in patients with acquired brain injury. Journal of NeuroEngineering and Rehabilitation, 8(1), 30. https://doi.org/10.1186/1743-0003-8-30


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