Movements can be modified in 5 simple ways to affect the degree of balance difficulty. In the paragraphs below the following 5 movement modifications will be discussed: arc, speed, direction, anticipation, and targets.
- Arc of movement is the range or distance through which the body position or location is changed. Smaller arcs of movement (partial turns, closer reaches, smaller weight shifts, etc.) are easier on balance than bigger movements, such as, reaching overhead, turning/looking over one's shoulder, or stepping up onto a tall curb.
- Speed is how fast a movement occurs. Movements can be slowed down to emphasize control and stability. For example, instructing a patient to sidestep softly, without stomping, will result in slower, controlled movements. Conversely, quicker movements focus on a different component of balance: agility. It should be noted that slow and fast movement speeds are not comparative, rather they emphasize and challenge orthogonal aspects of balance.
- Movement direction is the plane of motion or point in space to which changes in body position or location occur. Examples of movement directions include: reaching up, down, out, or across midline (changes in body position); or walking forward, backward, sideways, or across midline (changes in body location).
- Anticipation is how well the patient can expect or predict the movement. If a movement is unexpected, e.g., then the patient has poor anticipation and the result is more likely a reactionary movement. Responding to perturbations, sudden tilts on a wobble board, or errant balls while playing catch are examples of reactionary movements. Since falls result from unanticipated loses of balance, it is important, when clinically appropriate, that reactionary movements be considered for balance training.
- Targets are points in space that help direct movements. Targets define a location to which movements are aimed. Examples of aiming targets include placing a cup on a shelf, putting a ring on a rod, or walking a line on the floor. Targets can also be used as locations or objects to be avoided. Examples of avoiding targets include stepping over a bolster, walking around a cone, or ducking under a pole.
Manipulating these 5 areas of movement will create new and challenging ways to improve balance and help prevent falls.