Who will benefit most from attending?

Any physiotherapists, occupational therapists or exercise physiologists who are working with people with balance problems or older people.

Why is there a challenge around the implementation of evidence-based exercise guidelines in clinical settings to improve balance and prevent falls?

The evidence-based guidelines for improving balance and falls prevention recommend exercises that have a moderate to high challenge to balance with a high dosage of those exercises; that is, at least three hours a week (Sherrington et al 2016).

This presents two difficult clinical problems.

Firstly, providing exercises that have a moderate to high challenge to balance means that specific strategies need to be used to make the exercises safe while maintaining a sufficient level of difficulty.

The evidence strongly suggests that balance exercises need to minimise/discourage hand use.

So clinicians have the difficulty of providing high dosage of challenging balance exercises while avoiding the use of hands for balance.

Secondly, high dosage of exercise is a challenge and clinicians struggle to provide the opportunities for people to do large amounts of specific balance exercises over long time periods. High dosage means that clinicians are not able to deliver this intensity in one-to-one therapy.

Consequently therapists need to actively establish and provide opportunities for semi-supervised and independent practice that is safe.

The workshop aims to provide strategies to help clinicians to establish safe and effective high dosage balance training either in hospital, at home or in the community.

What are some of the key takeaways participants will gain from attending this course?

The first key takeaway will be an understanding of the biomechanics which underpin balance.

There are some common misconceptions about the control of movements of our centre of mass over our base of support.

For example, there is a widely held belief that the trunk muscles play an important role in balance. This belief is erroneous.

Trunk muscles cannot make much difference to movements of our centre of mass over our base of support as they can only make movements within the trunk.

It is our leg muscles, particularly those at the base of support, that are essential in maintaining balance in sitting or standing.

In addition, there are some historical misconceptions such as the belief that balance is a reactive or reflex system that can be trained using external perturbations.

In fact, we control movements of our centre of mass with anticipatory and ongoing postural adjustments when we move. There is great adaptability and capacity for change within the systems that control balance.

The next one is strategies for implementing high dosage, challenging balance training, which include:

• a review of effective coaching in order for therapists to be using the most effective instructions, feedback and environment set-up to create effective skill acquisition


• strategies to increase people’s self-efficacy for doing large dosages of exercise


• strategies for increasing motivation to exercise


• strategies to increase the delivery of semi-supervised and independent exercise opportunities.

The best takeaway is that we are in an amazing profession that can dramatically reduce the incidence of falls in the community.

Exercise alone can reduce the incidence of falls by almost 40 per cent if the exercises meet the recommendations described above (Sherrington et al 2016).

Simone Dorsch and Karl Schurr will present ‘The balance workshop’ on 17–18 July in South Australia. Click here for more information and to register.

Simone Dorsch is a physiotherapy clinician, researcher and educator with 20-plus years’ experience in stroke, brain injury and aged care rehabilitation. Simone is a senior lecturer at the Australian Catholic University in North Sydney and a presenter with the StrokeEd collaboration. Her research focuses on the relationship between loss of strength and activity limitations and strategies to increase amounts of practice in rehabilitation.

Reference

Sherrington C et al (2017). Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. Br J Sports Med 51:1749–1757..