Physiotherapy Balancing and Coordination Exercises (In Standing & Walking)
STANDING ACTIVITIES:
Once the patient has a good head and trunk control one needs to work on thecontrol of the lower limb in order to make the patient stand successfully.Activities like unilateral bridging, crawling, kneeling and half kneeling helps in developing good pelvic and leg control.
These exercises are progressed from supported position to unsupported position.Sitting to standing can be practiced by making the patient sit on a chair or cot such that the feet are in proper contact with the ground. The patient is advised to lean slightly such that the centre of gravity is brought between the feet, the therapist should stabilize the knee and support the pelvis there after the patient is encouraged to assume standing posture.
Repetition of this task is essential till the patient masters the activity. The patient may be also taught standing by pulling on to the wall bar or parallel bar but for this the upper limb should be strong, nevertheless in the initial stages the support and assurance by the therapist is very important. Once the patient learns to stand,balance and weight transfer is taught.
Posturography machine provides the important feedback to the patient which helps in improving the standing balance and control. Approximation given to the pelvis or to the shoulder also helps infacilitating stability in standing. In case the patient has tremor then ankle weights, a weighted belt or theraband can help in reducing them.
Once the patient is stable in double support phase, weight transfer is practiced. Lastly in standing the patient is made to make a step with either limb in forward,backward and outward direction as a prerequisite to ambulation.
GAIT TRAINING
Gait training may be initially given in a parallel bar with foot marks. Footmarks are essential to reduce the tendency of the patient to walk with wide base of support. He needs constant verbal feedback regarding the step length,body rotation, accessory movements and trunk positions if the functional activity does not present itself as a whole procedural program.
When the patient has to be progressed to walk outside a parallel bar, the therapist decides whether the patient needs to be given an assistive device, which is based upon the balance of the patient. Although walking aids do provide support to the patient, they also possess a problem because the patient will now need to control the position and movement of the device as well as themselves.Walker or cane may be used depending upon the patient’s comfort.
Various coordination tests were used as assessment tools for incoordination are also used as exercises to improve incoordination. The patient is asked to repeat each activity about 10 to 12 times during each session.
The patient maybe given these exercises as even home exercise program. At home patient can have multiple sessions with good rest in between them to avoid fatigue.Proximal fixation can be improved by using PNF techniques like rhythmic stabilization and approximation.