Balance training is one of the physiotherapeutic procedures and is an important component of fall prevention, especially for elderly patients. In addition to age-related frailty and an inadequate training condition caused by sitting and lying down too much, a number of medical conditions can cause balance disorders. These include, above all, neurological diseases as well as diseases of the ENT area (ear, nose and throat). Balance training can also support the healing process after operations on the extremities, e.g. after implantation of a hip or knee prosthesis, as part of the rehabilitation process. Balance is controlled by the central nervous system (CNS). In this process, the CNS receives information from the vestibular organ (organ of balance), the visual system (eyes) and from proprioception (sense of touch or depth sensitivity). If one of these senses is disturbed or if there is damage to the CNS, this can lead to balance disorders.
Indications (areas of application)
Balance training is used, among other things, as or for:
- Diseases or damage to the vestibular organ – Z. E.g. after TBI (traumatic brain injury).
- Gait insecurity
- Infantile cerebral palsy – Cerebral movement disorder whose cause is early childhood brain damage.
- Multiple sclerosis (MS) – Chronic inflammatory disease of the central nervous system.
- Peripheral neuropathy – Damage to the peripheral nerves, especially in the legs, which are responsible, among other things, for depth sensitivity and register the position of the body in space.
- Rehabilitation – eg after surgery in the area of the extremities.
- Fall prophylaxis – Especially in elderly patients or osteoporosis (bone loss), fracture prophylaxis (prevention of fractures) is indicated.
- Training therapy for physical fitness in old age
- Vertigo (dizziness)
- Condition n. Apoplexy (stroke)
Contraindications
In principle, there are no specific contraindications to balance training. However, contraindications should be noted regarding the ability to perform physical training. These include increased risk of bleeding, acute infections with fever, circulatory insufficiency, and physical disability that prohibits physical exertion.
Before training
A physical examination and an assessment of the patient’s exercise status should be performed before training to design an optimal treatment plan.
The procedure
Balance training should address both static and dynamic balance. In addition, combinations with strength and gait training are useful as part of fall prevention. Start with simple exercises that can be increased as you progress and supplemented with motor and cognitive enhancements (multitasking). Since balance training in a sitting or lying position is ineffective, exercises in a standing or walking position are preferred. Furthermore, the training must be perceived as difficult by the patient, as this is the only way to adequately train balance or to increase it. A training session should last about 25 minutes, individual exercises should be performed for 10-30 seconds. After each exercise, the legs should be shaken out and the body loosened. A gradual increase in the level of difficulty is recommended:
- Reduction of the standing area – for example, with the help of the one-leg stand.
- Limitation of sensory information – Z. E.g. by closing eyes, wobbly or soft base or head rotation.
- Additional tasks – E.g. throwing a ball in a one-legged stand.
- Disturbance of balance – e.g., light pushing by the therapist.
Important are the possibility of intervention by the therapist, as well as the interruption of an exercise as soon as the patient loses his grip. If an exercise level is perceived by the patient as easy, it is possible to move on to the next. For balance training in vestibular disorders, there are training programs based on balance exercises according to Cowthorne and Cooksey. The goal is to centrally compensate for vestibular function loss through exercises performed in an ascending manner while lying, sitting, and standing.
After the workout
No special measures are needed after training.
Possible complications
No complications are expected if the indication is correct and balance training is performed adequately.