I recently attended a week-end workshop on balance. It was taught by Dr. Faye Horak from Oregon, a Physical Therapist who does research in the area of balance and has done so for most of her career. She suggested a systems approach to balance which is divided into 6 sections.
- Biomechanical constraints, which include things like deformities in the feet, weakness, decreased ROM and pain
- Stability limits which are assessed by leaning in sitting and functional reach measurements
- Anticipatory postural adjustments that are tested by sit to stand, toe raises, standing on one leg and arm raises
- Reactive postural responses done by giving and removing resistance to see what reactions occur (i.e. ankle strategy or stepping responses)
- Sensory orientation which is checked by varying the amount of input from one of three systems: visual, proprioceptive or vestibular
- Stability in gait which includes components of the Dynamic Gait assessment and the timed up and go tests
Dr. Horak has devised a balance assessment to include all 6 components called the BESTest. There is also a mini-BESTest. I’m looking forward to integrating these aspects of testing and treatment into my practice.