Balance exercises

 Static Balance Control

 Activities to promote static balance control include having
the patient maintain sitting, half-kneeling, tall kneeling, and standing
postures on a firm surface.
 More challenging activities include practice in the tandem and single-
leg stance and squat positions.
 Progress these activities by working on soft surfaces (e.g., foam, sand,
grass), narrowing the base of support, moving the arms, or closing the
eyes.
 Provide resistance via handheld weights or elastic resistance.
Balance during single leg stance
Balance while standing with arm abducting and
holding a weight.
Have the patient maintain equal weight distribution
and
upright trunk postural alignment while on moving
surfaces,
such as sitting on a therapeutic ball, standing on
wobble boards
Balance while standing on wobble boards.
Vary the position of the arms.
 Practice stepping exercises starting with small steps, then mini-lunges,
to full lunges.
 Progress the exercise program to include hopping, skipping, rope
jumping, and hopping down from small stool while maintaining
balance.
 Have the patient perform arm and leg exercises while standing with
normal stance, tandem stance, and single leg stance.
 Anticipatory Balance Control
 Have the patient practice anticipatory balance control by performing
the following.
 Reach in all directions to touch or grasp objects, catching a ball, or
kicking a ball.
 Use different postures for variation (e.g., sitting, standing, kneeling)
and throwing or rolling the ball at different speeds and heights.
 To emphasize the stepping strategy, have the patient practice stepping
up onto a stool or stepping with legs crossed in front or behind other
leg.
 Use functional tasks For example, have the patient lift boxes that are
identical in appearance but of different weights; throw and catch balls
of different weights and sizes; or while on a treadmill, suddenly
stop/start the belt or increase/decrease the speed.
Balance when standing while reaching and
catching the ball overhead.
Exercises While Sitting in a Chair
 Set 1 (for the lower extremities)
 Extend leg up then back down
 Raise up and down on toes then heels
 March in place
 Bring leg out to the side then back to the middle
 Bring leg back toward the chair then forward again
 Set 2 (for the upper extremities)
 Bend arms towards shoulders then back down again
 Push arms out away from chest then back again
 Push arms up from shoulders then back down again
 Raise shoulders up toward ears then back down again
 Roll shoulders forward then backward
 Raise arm to shoulder level and extend forearm upward
 toward ceiling then back down again
 Bring elbows in then back out from chest
Standing Exercises for Balance
 Bring leg in toward the middle then back out again
 Rise up and down on heels and then toes
 March in place
 Keeping the trunk and hip straight, bend leg toward buttocks then back
down
 Squat down by bending at the knees and keeping back straight
 Kick leg straight back behind body while not bending the knee
 Kick leg in front of body while not bending the knee
 Practice of Walking
 Variation in step length
 Variation in speed
 Tandem walking
 Figure-of-eight walking
 Side stepping
 Crossover stepping
 Stepping over obstacles

 Perturbation Training
 Therapist pushes patient (reactions)
 Patient pushes therapist (anticipatory)

 Level of challenge increased in above activities with

 Eyes closed
 Foam surface under base of support
Tai Chi for Balance Training
Tai Chi has become a popular form of exercise for
balance training.
 Tai Chi is a traditional Chinese exercise program
consisting of a sequence of whole-body movements
that are performed in a slow, relaxed manner with an
emphasis on awareness of posture alignment and
synchronized breathing.
The emphasis on maintaining a vertical posture
enhances postural alignment and perception
 Balance Exercise Program Incorporating Strengthening, Walking, and
Functional Activities

 Week 1
 Flexibility exercises (5 repetitions, 15-second hold)
 Hamstring stretch, Gluteus maximus and hip flexor stretch, Gastrocnemius and
soleus stretch.

 Strengthening exercises
 preferred elastic-band strengths for lower limb exercises
 Lower limb muscles (elastic band: 1 set of 8–10 repetitions for each leg)
 Quadriceps (sitting and straight-leg raises)
 Hamstrings
 Gluteus maximus
 Gluteus medius
 Upper limb muscles (5–10 repetitions)
 Push-ups
 Abdominal muscles (5 repetitions)
 Curl-ups with arms behind head

 Instruction in body mechanics for

 Standing, Sitting, Lying
 Lifting, Reaching
 Carrying
 Arising from floor
 Ascending/descending stairs
 Week 2
 Flexibility exercises (as above)

 Strengthening exercises: lower limb muscles (elastic band: 1 set of 10 repetitions,

each leg), upper limb muscles (10 repetitions), abdominal muscles (5–10
repetitions)

 Coordination exercises
 Reciprocal leg movements (10 repetitions, eyes closed)
 Bridging (10 repetitions)
 Sitting/standing (5 repetitions)
 Braiding exercises (2 repetitions)
 Reciprocal ankle motion (10 repetitions)
 ladder: forward stepping (2 repetitions)
 “Survival” maneuvers
 Floor recovery exercises—“how to get up if you should fall”
 Week 3

 Flexibility exercises (5 repetitions, 20-second hold)

 Strengthening exercises: lower limb (2 sets of 10 repetitions),

 upper limb (push-ups, 10–15 repetitions), abdominals
 (curl-ups, 10–15 repetitions)

 Postural exercises (15 repetitions, 10-second hold)

 Coordination exercises (repetitions increased)
 Survival maneuvers: practice (floor recovery/stairs)

 Endurance walking (0–6 minutes, comfortable pace)

 Week 4

 Flexibility exercises (5 repetitions, 25-second hold)

 Strengthening exercises: lower limb (2–3 sets of 10 repetitions),
 upper limb (push-ups, 15 repetitions), abdominals
 (curl-ups, 15 repetitions)

 Postural exercises (20 repetitions, 10-second hold)

 Coordination exercises (repetitions increased)

 Reciprocal legs (eyes closed)
 Braiding (no holding, eyes open)
 Rung ladder (forward, side, and backward stepping)
 Survival maneuvers: practice (floor recovery/stairs)
 Endurance walking (3–8 minutes, comfortable pace)
 Week 5

 Flexibility exercises (5 repetitions, 30-second hold)

 Strengthening exercises: lower limb (3 sets of 10 repetitions),

 upper limb (push-ups, 15–20 repetitions), abdominals
 (curl-ups, 15–20 repetitions)

 Postural exercises (25 repetitions, 10-second hold)

 Coordination exercises: as above with increased repetitions,
 Braiding (no holding, eyes closed)
 Reciprocal ankle dorsi/plantar flexion (25 repetitions)
 Survival maneuvers: practice (floor recovery/stairs)
 Endurance walking (6–10 minutes, comfortable pace)
 Week 6

 Flexibility exercises (5 repetitions, 30-second hold)

 Strengthening exercises: lower limb (3 sets of 10 repetitions),

 upper limb (push-ups, 20 repetitions), abdominals
 (curl-ups, 15–20 repetitions)

 Postural exercises (25 repetitions, 10-second hold)

 Coordination exercises (as above with increased repetitions)
 Endurance walking (8–12 minutes, comfortable pace)
 Survival maneuvers: practice (floor recovery/stairs)
Thank You