Balance Training Tool Box for Older Adults A Squeaky Wheels Approach to Balance and Mobility

Better Living through Exercise ABLE CAPABLE BALANCED

Squeaky Wheels Approach to Balance Exercise Science Perspective Critical Thinking People Skills Able, Capable Living

Exercise Science Perspective

Critical Thinking

People Skills

Perspective: Exercise As Medicine Imagine the possibilities!

Imagine the possibilities!

Exercise as Medicine Movement is a medicine for creating change in a person's physical, emotional, and mental states. ~Carol Welch

Prescribing Exercise as Medicine Specificity Overload Protocols Mode, Intensity Frequency, Duration Outcomes

Specificity

Overload

Protocols

Mode, Intensity

Frequency, Duration

Outcomes

Specificity Finding the right targets Specific to tasks Appropriate systems

Finding the right targets

Specific to tasks

Appropriate systems

Overload Stress that is more than normal Individual System(s) Engaging, challenging, safe

Stress that is more than normal

Individual

System(s)

Engaging, challenging, safe

ACSM Position Statement on Balance Training Use progressively more difficult postures . . . that gradually reduce the base of support require dynamic movements that disturb the center of gravity stress posturally important muscle groups reduce sensory input conform best to the accepted theories of balance control and adaptation ~ASCM Position Statement, 1998

Use progressively more difficult postures . . .

that gradually reduce the base of support

require dynamic movements that disturb the center of gravity

stress posturally important muscle groups

reduce sensory input

conform best to the accepted theories of balance control and adaptation

~ASCM Position Statement, 1998

Balance Protocols for Fragile Elderly Specificity Overload Protocol Modes Specific to goals Engage relevant systems Multiple modes Layering Intensity Challenge system Engage the Individual Frequency & Duration Still researching

Specificity

Overload

Protocol

Modes

Specific to goals

Engage relevant systems

Multiple modes

Layering

Intensity

Challenge system

Engage the Individual

Frequency & Duration

Still researching

Understand the Overall Picture . . . Specific components for balance in the elderly Strength Posture Flexibility Vision Vestibular Somatosensory Reflexes Experiences Skills Learning

Strength

Posture

Flexibility

Vision

Vestibular

Somatosensory

Reflexes

Experiences

Skills

Learning

What Tools Will You Need in Your Tool Box? Posture & Flexibility Strength & Endurance Purposeful strength Legs, core muscles and triceps Balance and Mobility Visual, vestibular Somatosensory Automatic systems Gait training & ADL skills Confidence & Trust Educate and engage their mind Good, clean fun

Posture & Flexibility

Strength & Endurance

Purposeful strength

Legs, core muscles and triceps

Balance and Mobility

Visual, vestibular

Somatosensory

Automatic systems

Gait training & ADL skills

Confidence & Trust

Educate and engage their mind

Good, clean fun

Where to Start? Tools Critical thinking skills

Tools

Critical thinking skills

Assessments Identify & Explore Problems Observe Posture Flexibility Agility Strength Written evaluations Existing Balance Confidence So Ma’am, What seems to be the problem?

Identify & Explore Problems

Observe

Posture

Flexibility

Agility

Strength

Written evaluations

Existing

Balance Confidence

Assessments Flexibility & Posture Modified Sit & Reach (Rikli, Jones) Back Scratch Test (Rikli, Jones) Grids Strength Chair Stands Endurance 2-minute Step Test (Rikli, Jones) 6-minute Walk (Rikli, Jones) Power Max Gait Speed (Rose)

Flexibility & Posture

Modified Sit & Reach (Rikli, Jones)

Back Scratch Test (Rikli, Jones)

Grids

Strength

Chair Stands

Endurance

2-minute Step Test (Rikli, Jones)

6-minute Walk (Rikli, Jones)

Power

Max Gait Speed (Rose)

Balance Assessments BALANCE Walkie Talkie (Rose) Walk with Head Turns (Horak) Modified CTSIB (Horak, Rose) Get up and Go (Rikli, Jones; Horak) Rise to Toes (Horak) Toe Taps on Step (Horak) Functional Reaching (Rose) Tandem Walk (Rose) Tandem Stand

BALANCE

Walkie Talkie (Rose)

Walk with Head Turns (Horak)

Modified CTSIB (Horak, Rose)

Get up and Go (Rikli, Jones; Horak)

Rise to Toes (Horak)

Toe Taps on Step (Horak)

Functional Reaching (Rose)

Tandem Walk (Rose)

Tandem Stand

Balance Training Progressions and Layering . . . Gradual increases in difficulty Resistance Balance required Complexity of the task Number of systems involved Makes each exercise or activity more productive

Gradual increases in difficulty

Resistance

Balance required

Complexity of the task

Number of systems involved

Makes each exercise or activity more productive

Flexibility Improves range of motion in key joints Better posture More efficient movement

Improves range of motion in key joints

Better posture

More efficient movement

Flexibility Ankles & Calves Hamstrings, Gluteals AB/ADDuctors Chest & Back Shoulder girdle Triceps Axial skeleton Head turns, tilts, rolls, chin dips

Ankles & Calves

Hamstrings, Gluteals

AB/ADDuctors

Chest & Back

Shoulder girdle

Triceps

Axial skeleton

Head turns, tilts, rolls, chin dips

FLEXIBILITY Tools Conceptual Activities Enhance cognitive learning Learn with their bodies and their minds Inside out Learning Build confidence & trust Physical Activities Target key joints Provide somatic cues & sensations

Conceptual Activities

Enhance cognitive learning

Learn with their bodies and their minds

Inside out Learning

Build confidence & trust

Physical Activities

Target key joints

Provide somatic cues & sensations

Conceptual Flexibility Venus Di Milo Arms Inside-Out Learning A sense that their arms can reach much further

Venus Di Milo Arms

Flexibility Activity Supple Spine Relaxercise - Zemach-Bersin and Reese, 1990 Even gentle flexibility can improve function

Supple Spine

Whole Body Flexibility Farmer’s Stretch Carry the Baby Gentlemen’s Bow

Posture & Core Stability Inter-related, Complimentary Proper alignment Braces posture Steadies against balance disturbances Jostling crowds, perturbations Head turns, arm swings

Inter-related, Complimentary

Proper alignment

Braces posture

Steadies against balance disturbances

Jostling crowds, perturbations

Head turns, arm swings

Conceptual Posture Tools Parts of the Whole Breathe Easy Posture Affects Function

Parts of the Whole

Breathe Easy

Posture Affects Function

Conceptual Core Strength Tool Torso as a Cylinder Take Home Message Posture affects balance Renewable

Torso as a Cylinder

Take Home Message

Posture affects balance

Renewable

Conceptual Tool for Core Stability Mohammed & the Mountain

Mohammed & the Mountain

Training Core Strength Target Muscles Scapula & Head Retractors Abdominals & Obliques Back Extensor Simple to Complex Parts to Whole Resistance Task Complexity Elements of Balance

Target Muscles

Scapula & Head Retractors

Abdominals & Obliques

Back Extensor

Simple to Complex

Parts to Whole

Resistance

Task Complexity

Elements of Balance

Sample Strength Progressions Tall Sits Add overload Reps, time Resistance Add motion Buddha’s Prayer Curl up & sit tall Indian Chiefs, Chiefs w/a twist, w/ knee lift Add elements of Balance Narrowed base Dyna Disc

Tall Sits

Add overload

Reps, time

Resistance

Add motion

Buddha’s Prayer

Curl up & sit tall

Indian Chiefs, Chiefs w/a twist, w/ knee lift

Add elements of Balance

Narrowed base

Dyna Disc

Posture & Core Strength Training Rows Seated w/ a tall a sit Alternating arms or obliquely Seated on a Balance disc Combined with small squats Knee Lift, Abs in Seated Curl up and sit tall Standing Dyna disc or ball w/ holder

Rows

Seated w/ a tall a sit

Alternating arms or obliquely

Seated on a Balance disc

Combined with small squats

Knee Lift, Abs in

Seated

Curl up and sit tall

Standing

Dyna disc or ball w/ holder

Core Stability – Back Extensors Up & Ups Stretching Reaching w/one arm Add Venus Di Milo Arms W/ balloon W/resistance YMCAs Standing

Up & Ups

Stretching

Reaching w/one arm

Add Venus Di Milo Arms

W/ balloon

W/resistance

YMCAs

Standing

Strength with a Purpose Target Muscles Posture and Back Extensors Whole leg Triceps Movement patterns mimic ADLs Flag Salutes Teeter Totter Chair Stands

Target Muscles

Posture and Back Extensors

Whole leg

Triceps

Movement patterns mimic ADLs

Flag Salutes

Teeter Totter Chair Stands

Progressions & Layering for Strength Training As tolerated To fatigue (within 6-15 reps) Parts of motion before whole motion Single muscles groups to multiple muscle groups Seated, Standing, Moving Music Secondary tasks

As tolerated

To fatigue (within 6-15 reps)

Parts of motion before whole motion

Single muscles groups to multiple muscle groups

Seated, Standing, Moving

Music

Secondary tasks

More Examples: Heel & Raises

Balance Training

Balance Safety & Confidence TAKE TURNS!

Systems of Balance Visual Somatosensory Vestibular Automatic Integrated Many systems are used simultaneously Layers of systems, skills, experiences

Visual

Somatosensory

Vestibular

Automatic

Integrated

Many systems are used simultaneously

Layers of systems, skills, experiences

Vision - Visual Targets Look ahead Horizon Next turn Look away Flash Lights Layer Posture & Core Stability Balance Challenge

Look ahead

Horizon

Next turn

Look away

Flash Lights

Layer

Posture & Core Stability

Balance Challenge

Kinesthetic – Somatosensory The Ball Game Coming to our Senses Belly Button Training Sways and Circles Tai Chi Reduced vision Inside Out Learning Cue for sensations

The Ball Game

Coming to our Senses

Belly Button Training

Sways and Circles

Tai Chi

Reduced vision

Vestibular Head & or Eye Motion Seated Discs, Balls Standing Walking Examples Seated Head moves Eyes move Walking Words on the Wall in the Hall

Head & or Eye Motion

Seated

Discs, Balls

Standing

Walking

Examples

Seated

Head moves

Eyes move

Walking

Words on the Wall in the Hall

Transitions – Control CoM Already covered Sit to Stand Belly Button Training Sways Heel Toe Rocking Traffic School Change of Pace Change Directions Red light, Green Light Obstacle Course

Already covered

Sit to Stand

Belly Button Training

Sways

Heel Toe Rocking

Traffic School

Change of Pace

Change Directions

Red light, Green Light

Obstacle Course

Transitions – Controlling C of M Walk the Line

Walk the Line

Transitions with Music Side Stepping Heel Toe Heel touches Back touches Both Marching Toe Taps On the ground To a line On a step On a higher step Mind - Body Connection

Side Stepping

Heel Toe

Heel touches

Back touches

Both

Marching

Toe Taps

On the ground

To a line

On a step

On a higher step

Gait Rock n Walk Stride Length Obstacle Course

Rock n Walk

Stride Length

Obstacle Course

Automatic Dual Tasks Verbal Motor Cognitive

Dual Tasks

Verbal

Motor

Cognitive

The Need for Better Balance Programming In 2004 Best Practices Statement Physical Activity Programs and Behavior Counseling in Older Adult Populations MSSE 36:11; 2004 Found just 6 exercises to improve balance in frail elderly

In 2004

Background: How Did I Get Here? Sue Scott, MS Masters & Bachelors in Exercise Science ASCM certified Exercise Prescription, Kinesiology at PSU Specialize in balance & mobility for older adults Frail Elderly Parkinson's Disease

Sue Scott, MS

Masters & Bachelors in Exercise Science

ASCM certified

Exercise Prescription, Kinesiology at PSU

Specialize in balance & mobility for older adults

Frail Elderly

Parkinson's Disease

Develop appropriate physical activities to improve balance and balance confidence in frail populations Encourage the elderly to live active, capable, involved lives Make these ideas available to others Mission

Develop appropriate physical activities to improve balance and balance confidence in frail populations

Encourage the elderly to live active, capable, involved lives

Make these ideas available to others

Exercise Enables Capable, Able, Active To do whatever we enjoy More self-reliant, independent Connected to families, communities & values

Capable, Able, Active

To do whatever we enjoy

More self-reliant, independent

Connected to families, communities & values

Achievements Achievements 2000 Developed a balance training program Designed for Frail Elderly Posture Flexibility Strength with a purpose Balance Challenges 2003 Grant from National Blueprint Active Aging Partnership Tested ABLE BODIES® techniques Significant improvements Balance, strength, flexibilty and daily activity

Achievements

2000 Developed a balance training program

Designed for Frail Elderly

Posture

Flexibility

Strength with a purpose

Balance Challenges

2003 Grant from National Blueprint Active Aging Partnership

Tested ABLE BODIES® techniques

Significant improvements Balance, strength, flexibilty and daily activity

Blueprint Momentum IAHSA Trondheim, Norway ACSM Annual Meeting, Nashville APHA Philadelphia OHCA Portland, Oregon Human Kinetics Due out next year

IAHSA

Trondheim, Norway

ACSM

Annual Meeting, Nashville

APHA

Philadelphia

OHCA

Portland, Oregon

Human Kinetics

Due out next year