Dynamic Balance Rehabilitation Protocol - Geriatrics

This protocol outlines a progressive rehabilitation program for geriatric patients presenting with deficits in dynamic balance, with the goal of improving mobility, reducing fall risk, and enhancing overall function. This protocol is intended as a guideline and should be individualized based on the patient's specific needs, comorbidities, and response to treatment.

I. Clinical Presentation

Geriatric patients with impaired dynamic balance may present with the following:

• History of falls or near falls.
• Fear of falling.
• Difficulty walking, especially on uneven surfaces or in crowded environments.
• Slowed gait speed and decreased step length.
• Compensatory strategies such as wide base of support or shuffling gait.
• Decreased lower extremity strength and range of motion.
• Impaired proprioception and vestibular function.
• Cognitive deficits impacting safety awareness.
• Medications that contribute to dizziness or postural hypotension.

II. Rehabilitation Phases

Phase 1: Acute/Protective Phase (1-2 weeks)

Focus: Reduce pain and inflammation, improve safety awareness, and initiate basic balance exercises.

• Goals: Reduce pain, improve static balance, increase ROM, improve awareness of postural control.
• Interventions: Education on fall prevention strategies, assistive device fitting (if needed), gentle range of motion exercises, ankle pumps, weight shifting in sitting, static balance exercises with wide base of support (eyes open then closed), postural control training.

Phase 2: Subacute/Strengthening Phase (2-4 weeks)

Focus: Improve lower extremity strength, core stability, and static balance.

• Goals: Increase lower extremity strength, improve core stability, improve static balance with narrowed base of support.
• Interventions: Progressive resistance exercises for lower extremities (e.g., squats, heel raises, leg presses using bands or light weights), core strengthening exercises (e.g., pelvic tilts, abdominal bracing), static balance exercises with narrowed base of support (tandem stance), single leg stance progression.

Phase 3: Dynamic Balance Training Phase (4-6 weeks)

Focus: Improve dynamic balance and gait parameters, challenge postural control.

• Goals: Improve dynamic balance during gait, increase gait speed, improve postural control during functional activities.
• Interventions: Dynamic balance exercises (listed below), gait training on variable surfaces (e.g., carpet, foam pad), obstacle course training, dual-task training (walking while performing a cognitive task), community reintegration activities.

III. Exercise Examples (Dynamic Balance)

1. Tandem Walking: Walking heel to toe, focusing on maintaining balance.
2. Lateral Stepping: Stepping sideways with controlled movements.
3. Backwards Walking: Walking backward, maintaining balance and coordination.
4. Clock Reach: Standing with feet shoulder-width apart, reaching forward, sideways, and backward as if reaching for numbers on a clock.
5. Resisted Trunk Rotation: Using a resistance band, rotating the trunk while maintaining balance.
6. Single Leg Stance with Head Turns: Performing single leg stance while slowly turning the head from side to side.
7. Step Ups/Downs: Stepping up and down onto a low step, focusing on controlled movements and balance.
8. Cone Walking: Walking around cones in a figure eight pattern.
9. Ball Toss: Tossing a ball back and forth while standing or walking.
10. Perturbation Training: Gentle nudges while the patient is standing to improve reactive balance. Use caution.
11. Gait Training with Dual Task: Walking and counting backwards by 3s, or reciting the alphabet.
12. Tai Chi or Yoga: Modified exercises focused on balance, coordination, and flexibility.

IV. Return to Function Criteria

Progression to higher levels of activity and discharge should be based on the following criteria:

• Achieving functional independence with Activities of Daily Living (ADLs).
• Improved gait speed and stride length to within functional limits.
• Ability to safely navigate uneven surfaces and obstacles.
• Demonstrated improved performance on balance tests (e.g., Berg Balance Scale, Timed Up and Go).
• Reported decrease in fear of falling and increased confidence with mobility.
• Patient education on home exercise program and fall prevention strategies.

This protocol should be used in conjunction with clinical judgment and ongoing assessment of the patient's progress. Regular communication with the patient, family, and other healthcare providers is essential for optimal outcomes.