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Evidence-Based Balance Rehabilitation and Fall Prevention: Summary
Case Example: The Patient with Ataxia • Flexibility : May be excessive due to locking/hyperextending joints for stability • Strength : Focus on isometric and eccentric training verses concentric • Vertical orientation : Recalibration for lateropulsion (if cerebellar/brainstem lesion) • Balance reactions : PBT training when appropriate (will need support) • Sensory reweighting : Increase reliance on visual and somatosensory • Processing : Encourage slowing down; break down tasks when possible • Compensatory strategies : Bracing and assistive device to limit degrees of freedom, teach distal or proximal stabilization and limit limb movement during tasks when possible
Case Example: The Patient with Stroke Who Pushes
• Flexibility : Monitor ankle and hip flexibility (especially if spastic) • Strength : Address hemiparesis (especially weightbearing muscles) • Vertical orientation : Contraversive pushing—use strategy as outlined • Balance reactions : Will be skewed by perception, so will be exaggerated to the nonparetic side and delayed to the paretic side: ○ PBT only after vertical orientation is established • Sensory reweighting : Encourage isolated use of paretic limbs to reweight somatosensory to that side • Processing : Blocked practice with frequent feedback initially to establish habitual behavior, then transition as able to more variable practice and DT training • Compensatory strategies : Shorten assistive devices to limit strength of push, teach compensations for transfers ○ Use visual/tactile targets and pivots
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