What we do at AIB

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balance

How we Assess and Treat Balance Challenges

Adventures in Balance LLC focuses on all types of balance disorders that affect children and adults.

Poor balance and poor vestibular responses have shown positive correlations with anxiety, decreased school performance and of course falls.

Our approach is to do a systematic evaluation looking at gross motor functions: strength, range of motion, symmetry, balance, coordination, visual motor skills, vestibular responses and the ability to integrate these skills. This includes the ability to separate head and body movements and eye and head. An integrated person should be able to move only their eyes when tracking a moving object in the frontal plane. They should be able to walk and turn their head without losing the ability to walk in a straight path. They should be able to turn their head and remain focused on a central target without the sensation of the target moving or becoming fuzzy. They should be able to turn their head without becoming dizzy or nauseated.

While we see patients that have acute changes in their balance or vestibular systems there are many people who have a hypo-vestibular system where one side does not respond as robustly as the other side and this gives the sensation of movement, tilting or falling to the side that reacts the most so they compensate by moving to the opposite side. This is seen when the person closes their eyes and tries to stand in a narrow stance with one foot in front of the other, or on one foot and they fall to the less reactive side.  This may cause decreased tracking, attending or convergence/ divergence on that side since all of those motor skills are affected by the visual-vestibular system.

Our approach is to gain cervical and trunk symmetry with stretching and range of motion exercises followed by core strengthening. We follow that with coordination exercises with rotation combining balance, visual stability and attention. Progressive stability and bilateral coordination is developed. Stable gaze with the Vestibular Ocular Reflex is worked on in a progressively challenging environment from slow movements lying supine to walking with head movements in busy or moving environments.  After that we may add common dual tasks to simulate real life.

We work on strength, speed, duration and symmetry of movement this keeps the activities measurable for progress comparison.

How do we know if a child or adult needs physical therapy for coordination or vestibular rehabilitation?

Children and Adults Should be Able to Perform these Key Actions:

  • Do they complain of dizziness, swirling, vertigo or nausea when walking, reading or during rides in a car?
  • Can they follow a moving object with their eyes alone and little to no head and trunk movements?
  • Is the person standing asymmetrically with a head tilt or rotation?
  • Can they stand on either foot for over 10 seconds?
  • Can they stand on one foot with eyes open but not closed?
  • Can they hop on either foot for 10 hops?
  • Can they do an organized jumping jack and alternate arm and leg jump?

 

Young Children should be able to do the following:

  • Babies should be symmetrical
  • They track a rattle to midline, if their head is turned and midline to 90 degrees both sides at 2 months.
  • 4 month babies track beyond midline in supported sitting and reach to midline lying on their backs for a toy.
  • 1 year: maintain central gaze on a person or thing even if they move their head. Moving his or her head should not change the tone of the body.
  • Supine: Move with symmetry, lift legs easily off of the floor, roll evenly, and walk with wide based gait. Walk with feet flat, tip-toes is not normal gait and should only be occasional.
  • 18 months: running, can high kneel and rotate head to track visually, they should be starting to throw tennis balls, scribble and build 2-4 cube towers.
  • 2 year olds can walk up 4 steps, kick a ball, jump a little 4” forwards, turn pages in a book, draw vertical lines.
  • 3 years: Running with arms pumping and some rotation at the hips and shoulders, jumping forward 2 feet with both feet, squatting in play and starting to catch balls with arms extended.
  •  5 year olds should be able to do a sit up, stand on one foot right and left, skip and start to catch balls with hands only.

 

 

 

 

 

 

 

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