The definition of balance (balance, equilibrium) refers to the object is subject to the force from all directions and the size of the reaction force is equal, so that the object in a stable state (i.e. Newton’s first law).
Balance of human body is much more complicated than the balance of natural objects. Balance refers to a postural state in which the body is in, and the ability to automatically adjust and maintain the posture when moving or subjected to external forces.
Classification of balance
Static equilibrium: It refers to the state in which the human body or a part of the human body is in a specific posture, such as sitting or standing, to maintain stability.
Dynamic balance: It includes two aspects.
(1) Self-dynamic equilibrium: refers to the ability of the human body to regain a stable state when it performs various autonomous movements, such as switching between various postures from sitting to standing or from standing to sitting.
(2) Other dynamic equilibrium: It refers to the ability of the human body to react to external disturbances, such as pushing and pulling, and to restore the stable state.
Equilibrium reaction and its formation law
Equilibrium reaction refers to the process of restoring the original equilibrium or establishing a new equilibrium when the equilibrium state is changed, including reaction time and movement time.
The formation of equilibrium reaction has a certain pattern.
At 6 months of age, the prone position equilibrium reaction is formed.
At 7-8 months, the supine and sitting equilibrium reactions are formed.
From 9 to 12 months, the squatting reaction is formed.
From 12 to 21 months, the standing response is formed.
Maintaining the body’s balance requires the participation of three components: sensory input, central integration, and motor control.
Classification of balance training methods
According to the training position: supine position, prone position with forearm support, elbow and knee position, double knee position, half kneeling position, sitting position and standing position training.
Classification according to whether or not to use equipment: unarmed, training with equipment.
Classification according to the patient’s ability to maintain balance: static, self-dynamic, other dynamic training.
Classification by disease type: balance training for pediatric cerebral palsy, spinal cord injury, stroke, traumatic brain injury, Parkinson’s syndrome, etc.
Balance training sequence
Patients with paraplegia: prone position with forearm support → elbow and knee kneeling position → double kneeling position → half kneeling position → sitting position → standing position
Patients with hemiplegia: supine position→sitting position→standing position.
Balance training method-supine position
Classification of bridge exercise: double bridge exercise, single bridge exercise.
Bridge movement method: complete hip extension, knee flexion, and foot flat on the bed
Bridge exercise training: the therapist can place one hand on the patient’s affected knee, then pull the knee joint downward and forward, while the other hand taps the
The other hand taps the affected hip to stimulate the contraction of the gluteal muscles and help the affected hip to extend.
Balance training method – prone position with forearm support
For paraplegic patients, this is a strengthening exercise for the upper limbs and shoulders and a preparation exercise before walking with a crutch.
The patient is placed in a prone position with the forearm supporting the weight of the upper limb to maintain static balance; then the therapist pushes the patient’s shoulder in all directions to perform other dynamic balance training; finally, self dynamic balance training is performed and the patient moves in all directions by himself.
Balance training method – elbow and knee position
This training position is also suitable for paraplegics, but also for patients with motor dysfunction such as dyskinesia and Parkinson’s syndrome.
The patient is balanced in the elbow and knee position; the therapist pushes the patient in all directions; the patient moves himself or herself in all directions or lateral flexion or rotation of the trunk, and then the patient is instructed to lift and balance one upper or lower limb, and then lift and balance one upper limb and the other lower limb at the same time as stability increases.
Balance Training Methods – Double Kneeling and Half Kneeling
Mainly suitable for paraplegic patients
Static balance training: Patients take the kneeling position or half-kneeling position, and then maintain balance.
He dynamic balance training: the patient is in double kneeling or half kneeling position. The patient can kneel on the treatment bed first, and the therapist will push the patient in all directions, and then train on the balance board after the balance function is improved.
Self-dynamic balance training: The patient is placed on both knees or in a semi-kneeling position. Patients can move themselves in all directions or perform ball tossing training with the therapist.
Balance training methods – sitting position
Including long sitting balance training and end sitting balance training
Long sitting balance training: Paraplegic patients mostly use long sitting position for balance training.
End-sit balance training: Patients with hemiplegia mostly use end-sit balance training.
Balance training in the standing position prepares the patient for walking and eventually achieves the goal of walking.
Special balance training – training of vestibular function
The patient’s feet are brought as close together as possible, and if necessary, the patient holds the wall with both hands or one hand to maintain balance, and then turns the head from side to side.
The patient walks, with assistance from others if necessary.
Patients practice turning their heads while walking.
Patients should stand with their feet shoulder-width apart, looking straight ahead at the target, gradually narrowing the support surface, i.e., the distance between the feet is shortened to 1/2 foot length, the forearms are first extended during this training, then placed on the side of the body, then crossed over the chest, and each position is maintained for at least 15 s before the next difficult training, and the total training time is 5 to 15 min.
The patient stands on a soft cushion, starting with standing on a hard floor and gradually transitioning to standing on a thin carpet, thin pillow or sofa cushion.
Patients should practice turning in circles while walking, starting with turning in large circles and gradually becoming smaller and smaller in both directions.
Precautions for balance training
1.Balance function training is applicable to patients with balance dysfunction.
2.When the patient has severe heart rate arrhythmia, heart failure or severe infection, or severe spasm, etc., the training is not suitable for the time being.
3.When training, the therapist should be next to the patient to pay attention to supervision to avoid falls.
4.Before training and after the treatment session, attention should be paid to the balance function assessment to understand the problem and to develop or modify the training program.
5.Balance function training is not isolated, and other training such as corresponding muscle strength training should be carried out at the same time.