Is Vibration the Key to Balance?

Years ago, in Lancet (2003; 362: 1123–24) I remember reading about a study that was done where the researched put vibrators in peoples shoes and the participants improved their balance.

This study revealed that there was a reduction in seven of the eight sway parameters in young participants and all of the sway variables in elderly participants. Postural sway, has been determined to be the primary reason for falls in the elderly.

The mechanism as to why vibration may help with balance in the elderly is as follows:

• Vibration has documented circulatory effects, whereas applying a vibrating stimulus to a muscle belly has been shown to facilitate motor responses, even under pathological circumstances. This reflex muscle contraction is known as the tonic vibration reflex. 
• There are several ways vibration may potentiate muscular contraction. Together with enhancing the stretch reflex, vibration also stimulates somatosensory areas of the cortex, which can facilitate subsequent voluntary movement. 
• Increased muscle temperature, due to better perfusion and dampening of mechanical vibration, also may have a positive effect on force generation 

In my Balance Enhancement and Fall Prevention course I mention this research and suggest that appropriate patients purchase a vibrating pad, like the ones used on a car seat and rest their feet on the pad when they are sitting and performing exercises in standing.

There seems to be a resurgence in this idea as I was recently sent this link about a company producing vibrating shoes.

Want to improve Balance, Gait and Bunions?

One of the 3 primary senses involved in balance is proprioception. As people age, they lose proprioception, particularly in the most distal regions of their bodies, the hands and feet. Research has found that even if a proximal joint was replaced by surgery the proprioception in that joint was not as diminished as in the feet. Additionally it has be shown that individuals over the age of 80 are most affected by these deficits in distal proprioception.

In the foot, the primary location of propriception is located in the area around the hallux and therefore this location is a primary reason why individuals lack balance. Persons with hallux amputation experience a balance deficit of approximately 40%. Additionally, research has shown that the hallux is of particular importance to balance in forward and backward weight shift and walking.

When treating patients for proprioception we try to encourage the entire Hallux to be articulating with the floor in order to gain as much proprioceptive input as possible.

Elf Toe is a condition where the tip of the distal Hallux is curved up. It is caused by Hallux Ridigus which is a condition where the proximal phalux is hypomobile creating a hypermobility of the distal phalux and 1st Metetarsal phalangeal joint. This hypermobility can cause an arthritic bunion to form at the MTP joint. My 3 year old, started to develop such a bump. 

Because extension of the big toe is an important mechanism for the push-up phase of gate, with every step a patient with hallux ridigus is affected.

When treating this condition with the ARMS release technique, you would first stabilize the hypermobile distal phalanx, by doing this you will reveal the area of restriction of the proximal phalanx that is NOT in articulation with the floor. Then you will release the hypomobile proximal phalanx.

After treatment you would re-educate with functional exercise and/or taping. 

With this simple technique you will be treating not only balance, but bunion formation, as well as improving the quality and efficiency of gait.

The Science of Trips and Falls

The Wall Street Journal just published this article citing new research on how humans maintain their balance. 

What was of particular interest to me was that foot placement is the primary mechanism for maintaining side-to-side balance or sway.  Going along with that researchers found the biggest reason for falling, accounting for 41% of all falls, was due to incorrect weight shifting.

Clinically, I have found the same thing when I have evaluated and treated the foot and ankle;

• patient's improved their balance by at least 1 grade
• persons who could not perform single leg balance now could
• individuals who were chronic fallers, no longer fell

 In both the Foot and Ankle and Balance Enhancement and Fall Prevention Classes we evaluate and treat sway using a diagnostic motion evaluation called Foot Clocks. 

The article also mentions that the body has three main systems that help us stay balanced; The visual, proprioceptive and vestibular system.

The research has shown if at least two of these systems are impaired, people tend to have trouble with balance.  

As we know older individuals rely more on the visual system and report difficulty walking as well as experiencing a higher rate of falls at night secondary to the dark conditions. This problem is easily diagnosed and managed by prescribing glasses, surgery for cataracts, and improving home lighting. I believe that our health care system is doing an adequate job in addressing the visual component of balance.

Unfortunately,  the proprioceptive and vestibular systems are not routinely evaluated nor treated by health care professionals for the following reasons:

1. Little is know about these systems when compared to the visual system
2. They are expensive to diagnosis and manage
3. When we consider proprioception with regard to balance the most important structure is the foot. Health care professionals do not learn how to evaluate and treat the feet for balance and function 
4. Health care professionals rarely evaluate or treat the vestibular system unless there is a blatant dysfunction, like vertigo.  

The article mentions that improved diagnostic measures need to be incorporated by health care professionals to maintain the integrity of all 3 systems responsible for balance. 

To read the full article click the link below: 
http://online.wsj.com/article/SB10001424052702303983904579093560173066446.html?goback=%2Egde_2499430_member_276495644#%21

How the On-Live Seminar Works

For those of you who haven't heard of our amazing new method of presenting continuing education, here is how the On-Live Seminar Works. 

A student has access to all of the material online prior to the live portion of the course. We use interactive video presentation for our courses as well as downloadable pdf's. 

The student need not worry about getting a good seat or contorting themselves to see the material. Everyone has a front row seat!

The movies are shown at different angles so you are able to see everything that is going on during evaluation and treatment and if you don’t just hit rewind.

The student has access to the teacher via email to answer any questions along the way, 30 days prior and 30 days after the live class.

When the student arrives for the live portion already have a strong base of knowledge to help them. The live class is review and practice and best of all the students have access to the online material and teacher 30 days after the class.  

Having exposure to the participants prior to class allows the teacher to customize the class based upon their needs. 

Hosting facilities are provided the opportunity to bring in their appropriate patients to be treated by the therapists. 

This allows the students to apply the material on an appropriate patient population to see the techniques at work while having the supervision of the instructor when needed.

It is great PR for the hosting facility as their patients are getting an additional treatment from an expert in the field. 

Hosting facilities can choose to use the patient care component as an opportunity for additional revenue. 

I love teaching this way it is truly a win/win situation

Check out our Upcoming On-Live Classes

What the heck is an On-Live Seminar

I am really excited to share with you a new concept in continuing education that we have begun at Signature Allied Strategies, the On-Live seminar.

I love it for so many reasons:

• The system is cost and time effective. We are able to offer the same amount of CEU’s at 1/2 the cost. 

• Students and educators need only spend only a ¼ of the time away from family, work and friends without sacrificing CEU’s and getting burnt out from too much material in such a short time. 

• On-Live seminars offer individuals an opportunity to affordably maximize their learning experience. 

• Individuals learn at their own pace and they have at least triple exposure to the material.

• Students have access to the teacher for 2 months to answer any questions.

• Students have the opportunity to practice the material on true patients and hosting facilities can bring in their own patients for the Live component of the seminar.

The feedback from students and hosting facilities has been amazing!

Here is how it works:

A student has access to all of the material online prior to the live portion of the course.  We use interactive video presentation for our courses as well as downloadable pdf"s. The student need not worry about getting a good seat or contorting themselves   to see the material. Everyone has a front row seat. The movies are shown at different angles so you are able to see everything that is going on during evaluation and treatment and if you don’t just hit rewind.

The student has access to the teacher via email to answer any questions along the way. When the student arrives for the live portion already have a strong base of knowledge to help them.  Having exposure to the participants prior to class allows the teacher to customize the class based upon their needs. Hosting facilities are provided the opportunity to bring in their appropriate patients to be treated by the therapists.  This allows the therapist to apply the material on an appropriate patient population to see the techniques at work while having the supervision of the instructor when needed. It is great PR for the hosting facility as their patients are getting an additional treatment from an expert in the field. Hosting facilities can choose to use the patient care component as an opportunity for additional revenue. 

Lastly and really most important the material is kick ass. It is designed with the goal of making our students more success and efficient therapist. The evaluation is designed to teach students to target the areas that their patient’s need to have treated.

This system teaches evaluation and treatment as a well thought out process that elicits great results in a very short period of time.

I continue to firmly believe if you are not having great results with your patient’s you are probably treating the wrong thing.

I truly look forward to having the opportunity to work with each and every one of you!

  

If your facility is interested in hosting an On-Live event, please contact us to request information:

Our next On-Live event is in NYC October 26th

click here for details. 

People have asked "if you were given only one area of the body to treat, what would it be?"

Answers by renowned therapists, have included the psoas and coccyx.

For me it would be the feet.

A bonus for me in teaching my Balance Enhancement and Fall Prevention Class has been the knowledge and importance this anatomical structure is any standing individual.

• It is our Base of Support in standing and therefore an integral component of Balance and Fall Prevention. 

• In my clinical experience 95% of falls are contributed to from foot and ankle dysfunction.

• 84 % of 65 year olds have structural dysfunction in their feet.

• Individuals increase their chances of sustaining and injury due to a fall by 2 times if they are unable to perform 1 legged stance for 5 seconds.

• A person must have 8 degrees of ankle dorsiflexion with the knee extended and 10 degrees of motion with the flexed to be at a decreased risk for falls.

• The Hallux and toes must have 90 degrees of extension is necessary for normal push off.

• It is the foundation of our body. Misalignment at the foot will cause compensations and dysfunction up the kinetic chain.

• By improving alignment at the foot we can correct dysfunctions up the kinetic chain; knee, hip, pelvis, etc...

• Proper functioning of the foot is vital for efficient walking and any ADL's that is performed in standing. 

• Research shows that there is a significant decrease in proprioception of the feet after 80 years of age. 

• We can halt the progression of painful bunions, callouses and hammer toes as well as diminish the need for orthotics.

If you don't know about NPH, please read this

NPH stands for Normal Pressure Hydrocephalus.

Diagnosis of NPH is often difficult due to the symptoms being similar to other disorders.  In many cases the NPH is thought to be mild dementia, Alzheimer's, Parkinson's or simply old age therefore, it often goes completely unrecognized.

It is estimated that 400,000 persons in Nursing Homes have this disorder and are improperly diagnosed. 

NPH patients usually exhibit:

• Gait disturbance (difficulty walking)
• Dementia or forgetfulness
• Urinary incontinence (bladder control)

*Note that not all symptoms are always apparent or present at the same time.

Here is a link to a video of a person's gait with NPH.

NPH is treatable with the implant of a surgical shunt.  These patients do not improve with Physical Therapy intervention.  

In my over 15 years of practice, I can recall 3 patients who presented with these symptoms and were not diagnosed.  Two have passed and the other is my Grandfather.  Currently, I am in the process of learning more about this disease and getting him to the correct doctor. 

The following website has information and a link to doctor's who specialize in this area:

www.lifenph.com