L7/8: Balance theory & assessment Flashcards
(148 cards)
1
Q
Why is balance so significant in the elderly?
A
35% of persons aged >65 yrs will fall in 1 year, with poor balance as a primary risk factor
Great risk of falling
- Poor balance is a risk factor for falls
2
Q
What does the dynamic system approach look like?
A
3
Q
What are the changes to these systems with age that are important to balance control & that we can change??
A
4
Q
What are the 4 effects of age on postural stability in quiet stance?
A
- increase in COP and COM motion with age (distance, velocity, frequency)
- decreased if co-contracting (sway less if co-contracting)
- Generally AP > ML
- More visually dependent (EC postural sway+)
5
Q
Balance declines much ______ (earlier/later), no just 65 years old (eg. 32 yrs vs 43 yrs)
A
6
Q
In a healthy older person, should be able to hold ____ stance with eyes ____ (open/closed) for 30 secs. There should be some deterioration and difficulty holding ____ stance with eyes ______(open/closed) for 30 secs.
A
tandem; open; tandem; closed
7
Q
What are the 3 impacts of age-related balance?
A
- Quiet stance
- Functional movement
- Reactive control
8
Q
What is the impact on quiet stance of age-related decreased somatosensation on balance?
A
Increased postural sway / COPE (reduced detection of COM position) particularly on foam / EC
9
Q
What is the impact on functional movement of age-related decreased somatosensation on balance?
A
> errors – e.g. catch toe & trip
10
Q
What is the impact on reactive movements of age-related decreased somatosensation on balance?
A
slower / less accurate / >overshoot
11
Q
Length of time able to hold a stance ____ (increased/declines) as we age
A
declines
12
Q
What is reactive control?
A
- Detect what movements are occurring
- How far travelling forward
- How to respond
13
Q
What are 3 somatosensory age-related pathology?
A
- LL osteoarthritis: decrease jt position sense, increase/ decrease COPE in stance – consider impact of which joint
- Peripheral neuropathy (eg. diabetes): COPE in stance
- Csp pathology – neck pain, whiplash: disruption to Csp proprio - decrease quiet stance time.
14
Q
What are 2 somatosensory interventions for balance issues?
A
- Retrain skill with practise:
- Cannot replace sensory organs if tissue is damaged (e.g. Peripheral neuropathy, scar tissue), but can retrain other LL somatosensors to compensate
- Compliant surfaces, particularly with EC
- Can improve in elderly
- Increase awareness of at risk situations, safety
15
Q
What is the impact on quiet stance of age-related decreased vision on balance?
A
Increased sway as > reliance on somatosensors & these are likely to be reduced
16
Q
What is the impact on functional movements of age-related decreased vision on balance?
A
> cautious (very tentative), errors, falls
17
Q
What is the impact on reactive control of age-related decreased vision on balance?
A
min direct effects
18
Q
What is contrast sensitivity?
A
Unable to see the step (vision affecting ability to balance)
19
Q
Why is having visual issues a problem on balance? What can be done to improve balance?
A
Once vision deteriorates, unable to improve.
Therefore, must train somatosensation
20
Q
What are 2 visual interventions for balance issues?
A
Minimal direct intervention
- Refer, raise awareness, practise at-risk situations
- Train somatosensory challenge safely
21
Q
What is the impact on quiet stance of age-related decreased vestibular on balance?
A
increased postural sway with sensory conflict – on foam + EC and with central & peripheral vestibular dysfunction
22
Q
What is the impact on functional movements of age-related decreased vestibular on balance?
A
overbalance during gait with head turns / brings on dizziness
23
Q
What is the impact on reactive control of age-related decreased vestibular on balance?
A
slowed detection of head mvt
24
Q
Several different intervention approaches depending on _____
A
deficit
25
What is an example of sensory conflict?
* Eg. stand on foam --\> challenge somatosensation • Shut eyes --\> no visual challenge other Rely on vestibular
26
What is the vestibular system?
* Detection of head movements
* If problem Slow detection of head movements
27
What are 5 impacts on quiet stance of age-related decreased cognitive functional on balance?
1. decreased perceived + real stability limits
* (They think they are worse than they are They think they are better than they are)
2. decreased ability to resolve sensory conflict
* Visual VS somatosensory VS vestibular
* Visual system tellling something contradictory compared to other systems (seen in periphery)
* On bus --\> get off bus --\> when bus moves again --\> older person falls --\> think they were on bus (movement of bus))
3. more frequent sense of self-motion
4. backward disequilibrium ( ○ Reduces limit of stability Think upright is further forward or backwards than normal)
5. altered perception of vertical &fall backwards.
28
What are cognitive functional interventions for balance issues (quiet stance)?
can improve LOS, sensory integ., sense upright, raise awareness
29
What are 3 impacts on quiet stance + functional movements of age-related decreased cognitive functional on balance?
1. attentional capacity decrease with age
2. ability to dual/multi-task when one is a postural task decrease with age / balance impairment
3. Restricted mvt due to fear of falling
30
What are cognitive functional interventions for balance issues (quiet stance/functional tasks)?
can change attention priority, improve dual tasking (Should train dual-tasking --\> can improve
Simpler tasks --\> complex tasks) when balancing / walking, improve confidence
31
What is attentional capacity?
Ability to do things more than once
32
What are 2 impacts on reactive control of age-related decreased cognitive function on balance?
1. Slower responses, especially if choice reaction time – longer time in response selection
2. Can improve with training
33
How to train reactive control?
Progress from simple to more complex
34
What is the impact on quiet stance of age-related decreased motor function on balance?
little impact
35
What is the impact on functional tasks of age-related decreased motor function on balance?
slower mvt with less power
36
What is the impact on reactive control of age-related decreased motor function on balance?
slower responses with smaller amplitude – because m activation timing delayed, altered co-ordination/patterning and amplitude reduced
37
What are 3 characteristics of steady-state control?
1. Ongoing control of body balance / motion
2. Most deficits here relate to detection &processing of sensory info, or determination of COM position
3. Minimal demands placed on body wrt timing, scaling of activity
38
What are 5 characteristics of anticipatory control?
1. Postural adjustments made in advance of voluntary movement to stabilize body
2. Internally generated control
3. Basal ganglia key role in mvt generation
4. Timing, scaling & co-ordination of muscle activity critical
5. Delayed onset of anticipatory activity:
* glut med in stepping
* hams in UL task
* ES in hip F
39
What are 2 features that increase the risk of falls?
1. longer CRT
2. delayed glut med in stepping
40
What are 2 ways we can influence risk of falls?
1. Alter muscle timing: Delayed muscle activation --\> increased risk of falls
2. Impacting scaling of activity
41
What are 3 characteristics of reactive control?
1. Rapid responses to external perturbation
2. Automatic postural responses – delayed &reversal of distal ®proximal patterns with age
3. Stereotypical strategies
* altered with age
* Timing, co-ordination & scaling of activity key to producing strategies
42
What are 3 strategies for balance perturbations?
1. Hip
2. Ankle
3. Step
43
What are 5 age changes in reactive control?
1. Delayed onset of automatic postural response
2. Reversal of distal --\> proximal patterns of activation
3. More frequent co-contraction
4. \> variability in onset times
5. More mixed postural response strategies
44
Usually, for perturbation strategies to regain balance, muscle activation occurs ____ (proximally/distally) to _____ (proximally/distally). However, during ageing, muscle activation occurs ____ (proximally/distally) to _____ (proximally/distally) and this \_\_\_\_\_(increases/decreases) risk of falls.
proximally; distally; distally; proximally; increases
45
What are 3 strategies of postural recovery?
1. Stereotypical patterns of body segment motion to reduce degrees of freedom
2. Relative to postural goals, the task, the environment
3. Four major strategies theorized from AP motion
46
What is the ankle strategy?
Inverted pendulum
47
What strategy is this patient using?
Hip strategy (most movement here)
48
What strategy is this patient using?
Step strategy
49
What strategy is this patient using?
Ankle (possibly) but she is using grasp
50
What are 3 ML (side) strategies?
1. Load/unload
2. Step
3. Crossover step
51
What is the ideal strategy for side ML perturbations?
Outwards step
52
What strategy do younger adults use for side ML perturbations? Why?
Able to detect the weight shift and take this outwards step
53
What strategy do older adults use for side ML perturbations? Why?
* Take too long to detect weight shift
* No longer able to unload the leg
* End up taking a cross overstep
54
What are 4 changes with age and pathology with musculo-skeletal system?
1. decreased muscle strength, power / rate of torque development
2. decreased muscle endurance
3. decreased muscle length
4. decreased joint ROM
55
What are the 6 reasons why we need to assess balance?
1. determine functional limitations & impairments
2. document functional level
3. identify strategies used to achieve function
4. prediction:
* eg falls risk, rehab outcome
5. direct treatment
6. patient feedback
56
What are the levels of assessment?
There is no one test that can record all information at all levels need to be perform multiple tests
57
What are 6 features of functional ability that are specific to balance tests?
1. steady state
2. anticipatory / ongoing control
3. reactive control
4. sensory system manipulation
5. cognitive demand
6. combination test batteries
58
There is no one test that can record all information at all levels need to be perform _____ tests
multiple
59
What are 4 ways to decide what tests to be used for balance level?
1. Patient’s age, fxal level, impairments, limitations
2. Resources available: time, equipment, assistance
3. Function of the test
4. Tests should be reliable, valid and sensitive
60
What are 6 ways to get the most of the assessment?
1. Written assessment forms to prompt & guide
2. Comprehensive, but not exhausting
3. Complete quickly
4. Assess in most appropriate times.eg PD ‘on’
5. \* tests for reassessment
6. Yours & pts goals utmost in mind
61
What are 6 balance assessment tools?
1. Steady state
2. Anticipatory / ongoing control
3. Reactive control
4. Sensory manipulation
5. Cognitive demand
6. Combination test batteries
62
What are 6 characteristics of the steady state in the clinic?
1. Ability to hold a position – length of time without overbalancing, sway
2. Romberg (1853) – feet together, 30s, EO & EC, sway estimate
3. Romberg quotient – EO/EC time
4. Sharpened Romberg – tandem stance, 30s, EO &EC, timed
5. Reduce size ML base Bilat --\> together --\> step --\> tandem --\> one
6. Normative values available (\>30s HOA)
63
What are the 3 issues in the steady state in clinic?
1. footwear
2. arm position
3. best/worst
(Make sure to make it repeatable (eg. footwear..etc))
64
What are the 3 pros in the steady state in clinic?
1. quick
2. easy
3. high level
65
What are the 2 cons in the steady state in clinic?
1. ceiling effect if lim to 30s
2. sway subjective
66
What are 4 characteristics of the steady state in the lab?
1. COP (force plates)
2. COM (3D- Motor analysis and Balance Master)
67
What is the Balance Master?
Estimates COM based on the person's height
68
What are the 4 pros in the steady state in clinic?
1. reliable
2. ultimate validity
3. known measures
4. adaptable
69
What are the 3 cons in the steady state in clinic?
1. expensive
2. need expertise
3. unless give norms difficult to interpret
70
What happens if the timed balance is poor?
Challenge at the level of assx
71
What are 4 characteristics to increase challenging the timed balance?
1. Hold for longer
2. Reduce size BOS (feet together, step st, stride)
3. Internal perturbations (head, UL, LL)
4. ↑ proprioceptive demand (system most used in quiet st) by
* Alter surface - ↑ compliance & instability – foam mats of ↑ thickness (red large mat, square)
* Reduce / remove vision to force to use proprioception – EC
72
What are 5 examples of exergaming for assessment and treatment?
1. Konami’s Dance Dance Revolution
2. Nintendo Wii + Wii Fit
3. X-box Kinect
4. Playstation Move
5. iDANCE2
73
What are 3 customised devices or programs?
1. Stepping task
2. Reaching-LOS
3. VR training
74
What are assessment for exergaming?
customised software for assessment – excellent
75
What are treatment for exergaming?
generally not different from usual physiotherapy intervention (studies with low n), but provides variety, feedback, novelty
76
What can a Wii balance board do?
* As close as force plates (use)
* Can be used as assessment and treatment
* Another customised software for assessment (free)
77
How can gaming be used for assessment?
Wii balance board only valid with additional programming
78
What are 4 interventions for gaming?
1. Programs (e.g. Just dance, Wii sports)
2. Games = tasks
3. Think of what you want the person to achieve
4. Safety – on & off board, speed of mvt
79
What are 4 characteristics of the Timed Up and Go Test in anticipatory/ongoing in clinic?
1. time to st from chair, wlk 3m, turn, return, sit
2. Speed of performance during functionally relevant tasks that might threaten balance
3. excellent reliability, validity
4. able to discriminate fallers & nonfallers (\>13.5 sec predictive of fallers)
80
What are 4 pros for the Timed Up and Go Test in anticipatory/ongoing in clinic?
**EXAM QUESTION**
well-used & researched, global indicator, quick, predictive
81
What are 4 cons for the Timed Up and Go Test in anticipatory/ongoing in clinic?
**EXAM QUESTION**
limited evaluative capacity
82
What are 6 issues with anticipatory/ongoing control?
1. Speed: 2 versions of the test (1) comfy pace or (2) as quick as you safely can
2. Usually do 1-3 reps – if multiple - take the best time usually (when worst / average time)
3. Aids – can use aids, but not physical assistance
4. Sit-st default is hands on lap. If needed, can use armrests – but record this
5. Footwear – usual footwear
6. Practice try? Usually no, original paper pts walked it first with the PT 2 versions
* Always start as comfy pace first (for older persons)
* Do 1-3 reps
* (Ideally) In the interest of time, can I do one (in exam)
* Sometimes don’t do 3 --\> fatigue
* Need to record aids (next time, might have slower time but not using aid)
* Must demonstrate
83
What are 2 things to do if TUG is slow?
1. Determine what aspect of the TUG is contributing to the slowing
* Assess &address these issues – E.g. slow sit - stand
2. Analyze movement – why slow?
* Feet back, lean fwds, slow stand - weak Q – strengthen, tentative - ↑ confidence – Slow gait, \> steps to turn, st - sit
84
It is important to use a ____ belt and to be close to the patient in the TUG.
walk
85
What are the 3 reach tests (anticipatory/ongoing in clinic)?
1. Functional reach
2. Lateral reach
3. Multidirectional reach test
Measures self-generated movement to limits of stability in different directions
86
What are 3 characteristics of the functional reach (anticipatory//ongoing in clinic)?
1. Anterior distance reached beyond arm’s length
2. excellent reliability, valid when c/w gait speed &one-leg stance time
3. predictor of falls
87
What are 2 pros for the Functional Reach in anticipatory/ongoing in clinic?
1. well-used & researched
2. quick
88
What are 2 cons for the Functional Reach in anticipatory/ongoing in clinic?
uni-planar but posterior being
89
What are 6 steps in the method of the functional reach?
1. Tape measure or ruler at acromial height on wall, start line marked on floor, feet comfy position facing parallel to wall
2. Close to wall, but don’t touch it, raise arm closest to wall & hold – sh square – measure
3. Reach as far fwds as possible without taking a step, touching the wall, overbalancing, rising on toes
4. Assessor marks the same part of the hand (3rd MCP or 3rd fingertip)
5. Reaching arm up so that hand stays at ruler ht
6. Must return to start position
* Measure distance
* Make sure that patients don’t cheat
90
What are normative values in the functional reach?
**EXAM QUESTION**
* Poor ≤ 15cm
* Fair \>15cm and ≤ 25cm
* Good \>25cm
91
What are 2 things to do if FR (functional reach) is short?
1. Determine why – ability to move COM, strength, confidence/fear, pain, flexibility
2. Assess & address these issues
* E.g. Can improve balance confidence by
* Agility & strength training (50 2xwk 13wks)
* Education & low resistance training (1hr 1xwk 8wks) able to improve balance confidence - not related to functional gains
* Systematic review of 30 studies shows exercise can probably reduce fear of falling immediately post exercise
92
What is the outcome measure for functional reach?
Distance able to reach
93
When can wii boxing be helpful for training functional reach?
If done slowly and emphasise on the reach
94
What are 2 characteristics of the lateral reach?
1. lateral distance reached beyond arm’s length
2. good reliability, valid when c/w BBS & one-leg stance time
95
What is the use of the lateral reach? (i.e when is it used)
those with ML weightshift problems
96
What are 3 pros for the lateral reach in anticipatory/ongoing in clinic?
1. well-used
2. quick
3. lateral measure
97
What are 2 cons for the lateral reach in anticipatory/ongoing in clinic?
1. earlier stages of research
2. uniplanar
98
What are 3 characteristics of the test?
1. # steps with 1 leg on 7.5 or 15cm block in 15 sec
2. Ability to weightshift at speed
3. reliable, valid c/w gait speed, stride length, functional reach
99
What is the outcome measure for the step test? How does this differ from the functional reach?
* Rapid weight shift (unloading and loading legs)
* Looks at distance able to reach
100
What population is the step test designed for?
CVA population
101
What are 2 pros for the step test in anticipatory/ongoing in clinic?
1. assessment of rapid ws
2. quick
102
What are 3 cons for the step test in anticipatory/ongoing in clinic?
1. early stages of research
2. dependent on strength
3. speed
103
What are the 7 steps to follow in performing a step test?
1. Comfy stance 5cm behind step (7.5cm or 15cm)
2. Stand beside pt with a foot on the block to steady
3. Instruct- step on & off as many times as possible from when I say go to stop
4. Demonstrate the task, whole foot on
5. No assistance given
6. You count the no. of steps. With up+down = 1
7. If overbalance - ?stop recording or continue
104
What are 2 things to do if the patient can only manage a few steps in the step test?
1. Determine why – strength+ (where?), pain, confidence /fear, ability to move COM ML, range
2. Assess & address these issues
* Eg poor hip abd muscle strength
* Resistance tr can improve hip abd strength
* Visual feedback – computerised balance training of weightshift effective in ↑ speed, precision in stroke
105
What are 4 machines that are used in the lab to test balance?
1. Force plates
2. EMG
3. motion analysis
4. Balance master
106
What can the balance master assess?
Assess reaction time, accurate in rhythmic weight shift and how far you can more
107
What are 2 reactive tests to do in clinic?
1. Marsden External Pull Test
2. Hold and release test
108
What is done in the Marsdern External Pull Test?
posterior pull to shoulders
109
What are the 5 scales (outcome measure) for the Marsden External Pull Test
0 = Normal remains upright without stepping
1 = Normal takes 1 step, regains own bal
2 = Normal takes \>1 step, regains own bal
3 = Abnormal takes \>1 step, needs to be caught
4 = Abnormal falls without stepping
110
What is assessed in the Marsden External Pull Test?
Short, sharp pull --\> how they regain their balance
111
What are 4 characteristics of the Hold and release test?
1. Patient leans back into your hands until their COM is outside their base of support - You release
2. Rates ability to recover balance after a perturbation / disturbance
3. Rate response as per Marsden (5pt scale)
4. More reliable therapist pressure and responses than pull test
112
How can reactive control be tested in the lab in terms of perturbations?
underfoot, pull
113
What are 3 characteristics of the reactive control training for voluntary stepping?
1. All directions – which needs training most?
2. Concentrate on a single large step
3. Increase speed, less predictable
114
What should be done to train reactive control?
* Voluntary stepping
* All directions – which needs training most?
* Concentrate on a single large step
* Increase speed, less predictable
* Add small perturbation (pull)
115
\_\_\_\_\_\_ step practice can improve reaction time stepping, but need to add ______ for best results
Voluntary; perturbation
116
What are 4 characteristics of the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
1. determines what system person is most reliant on for sensory information
2. determines ability to resolve sensory conflict
3. 6 stance conditions, timed for 30 sec max
4. manipulate visual / support condition / surround
117
What is condition 2 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
remove vision and swaying a lot --\> means you are vision dependent
Poor use of somatosensory system
118
What is condition 3 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
* Lose information that tells them that they are swaying
* Dome --\> visual (not swaying)
* Somatosensory (swaying) Sensory conflict
119
What is condition 4 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
* Sway a lot
* On thick foam
* Not using vision
* Rely on somatosensory
120
What is the interpretation of condition 2 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
visually dependent / poor use of somatosens
121
What is the interpretation of condition 3 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
difficult resolving visual conflict / ignoring visual information
122
What is the interpretation of condition 4 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
somatosens dependent / poor use of vision
123
What is the interpretation of condition 5 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
vestibular problems
124
What is the interpretation of condition 5 in the clinical test for sensory integration of balance(CTSIB) and sensory organisation test (SOT) for sensory manipulation?
difficulty resolving conflicting info / reliant on visual input even if inaccurate
125
Young adults and healthy older adults don’t show much change until sway in conditions ____ and ____ in sensory system manipulation.
5; 6
126
What is the use of sensory system manipulation?
evaluative
127
What are 2 pros for the lateral reach sensory ssem manipulation in clinic?
1. gives indication of sensory system reliance
2. integration ability
128
What are 2 cons for the lateral reach in anticipatory/ongoing in clinic?
1. foam
2. sway-referencing
129
How can you improve sensory system manipulation?
Can improve with training
130
What are 3 ways to test cognitive demands?
1. Ability to walk and perform added task safely
2. Stops walking while talking – stopping walking to talk predicted what demented NH elders would fall (Lundin-Olsson, 00)
3. Dual task - timed up & go – do TUG test, repeat while holding full cup H20 – repeat while counting bwds x 3’s starting \>50 – reliability + validity (Shumway-Cook, 01) – adds in cognitive & motor second tasks
131
What is an example of adding a motor task while doing the TUG?
holding a cup of hot water at the same time as walking
132
What is an example of adding a motor task while doing the TUG?
counting backwards by threes at the same times as walking
133
TUGmanual ≥ _______ secs predicts – 87% Fallers & 93% NonFallers
**EXAM QUESTION**
14.5
134
TUGcognitive ≥ _____ secs predicts – 80% Fallers & 93% NonFallers
**EXAM QUESTION**
15
135
What is the Berg's Balance Scale? What are 4 characteristics?
1. 14 functional items scaled 0-4 (/56)
2. points given on timed scores, distances reached, # steps, supervision required
3. \< 45 = high risk of falling
4. well researched, commonly used, reliable, valid, strongly correlated with fear of falling & other balance tests
136
What is the BOOMER?
Step test, TUG, FR and QSEC converted to score Used in QLD health
137
What are 6 characteristics of the BESTest?
1. functional items scaled 0-4 (/56)
2. points given on timed scores, distances reached, # steps, supervision required
3. Includes most of what we have discussed today
4. tries to combine all aspects of postural control in one test
5. Time consuming, newer
6. Mini-best-test (shorter version)
138
What is the purpose of the BESTest?
Takes away some of the thinking required (clinical reasoning)
* Are there biomechanical issues?
139
What are 6 test batteries?
1. Tinetti Balance Sub-scale
2. Fugl-Meyer Balance Sub-item
3. Dynamic Gait Index
4. Modified Elderly Mobility Scale
5. Duke Mobility Skills Protocol
6. Gait Assessment Rating Scale
140
What are 2 tests to assess the fear of falling?
1. Fear of falling questionnaire
2. Activity-specific balance confidence (ABC) scale
141
What is the fear of falling questionnaire?
Falls Efficacy Scale (FES, FES-1)
142
What are 3 characteristics of the Activity-specific balance confidence (ABC) scale?
1. \< 50 : low fxal level (NH clients)
2. 50 – 80: mod fxal level (retirement home, chronic illness)
3. \> 80: high fxal level (physically active OA)
143
What is the difference between the fear of falling questionnaire and the Activity-specific balance confidence (ABC) scale?
Fear of falling questionnaire: simpler tasks
ABC: high level tasks
144
What are 3 specific treatment plan approaches for balance?
1. One-on- one
2. Functional task practice (e.g. Stepping)
3. Address identified impairments (e.g. Strength, proprio)
145
What are 4 general treatment plan approaches for balance?
General
1. Balance classes
2. Home program
3. Gaming
4. Yoga / tai chi
146
What are 2 important features in regards to exercise to improve balance?
1. Use same principles as per other body systems
2. Retrain the task you are interested in, in the manner the person needs to balance – eg holding a position, maintaining balance whilst moving
147
What are 6 principles do I consider when prescribing an exercise?
148
What are the guidelines which have shown improvements for balance?
Guidelines which have shown improvements
* 2-3 times/wk
* 1 hr
* Over a year
* Lasting 2.5 months
* Long term commitment
* Tai Chi, Dance classes (engage people)
* Walking won't help balance
