Balance Management: It's the Little Things

Donna Deidrich | posted February 15, 2009 |

They say it's the little things in life that will trip you up. Nowhere is this truer than for someone with balance deficits. Everyday obstacles that go unnoticed to most, pose likely hazards for those with balance deficits.

We have a comprehensive Balance Management program at Aegis Therapies, which provides us with the necessary skills and environment to help patients with this condition. The key to good balance requires the patient to overcome the extenuating factors of his/her condition. There are many extenuating factors that can impair one’s balance; the two I will be addressing here are intrinsic and extrinsic factors.
 
Intrinsic factors include muscle weakness, loss of sensation, pain, visual perceptual impairments and more. Extrinsic factors include side effects from medications, the physical environment and the patient’s need for adaptive equipment (i.e. walker, wheelchair, quad cane, etc.).

Working as a physical therapist I've helped many patients who have endured this impairment, but one case always comes to mind. The patient was a retired businessman who had suffered a severe stroke, resulting in significant motor and balance impairment on his right side. A man with a lot of pride, he had always been the "breadwinner" of the family, and not at all used to the dependent role he now faced.

We worked with him for almost three months providing occupational, physical and speech language therapies. Physically he regained the use of his right leg much sooner than his right arm. Without a natural arm swing this posed a challenge for him to walk. He also required a short leg brace and the use of a quad cane for gait and mobility. 

The patient was faced with a huge obstacle in the course of our treatment. His youngest daughter was getting married. As father of the bride, he was determined to walk her down the aisle. This proved to be a true test of his newly regained intrinsic balance skills, in addition to the extrinsic factors he would be facing at the church.

Weeks prior to the wedding, our team made an assessment of the church and the extrinsic factors he faced. This included his car transfers, ability to access the church, walking down the aisle and standing at his daughter’s side. Our patient had a lot of anxiety surrounding the event. But he was determined to overcome any challenge that would prevent him from successfully escorting his daughter down the aisle.

The patient was very focused and learned how to use the environment to his advantage. We proceeded with treatment adaptations and the compensatory techniques required for improving toe clearance over the church's plush carpeting. He practiced weight shift skills for walking down the incline of the center aisle. And finally, he learned standing balance skills that allowed him to safely lift his daughter's veil for his kiss and well wishes.

Once he mastered these skills, he had to adjust his balance and walk from her side to the first pew, and then sit down next to his wife for the remainder of the ceremony. He was determined to accomplish this without the use of his quad cane. With progressive treatments and some accommodations, such as accepting the need for his quad cane to exit the church, the patient successfully attained the balance and functional endurance needed for this important milestone.

We continued to treat the patient after his daughter's wedding, and he was able to return home to his wife and attended out-patient therapy. His story reminds me of how I, and my fellow rehabilitation therapists, can make such a positive impact on the lives of others.