Topic 3- Intervention

Situation: 81 yo male who has been attending our physiotherapy no falls class for people wanting to improve their fitness and balance. The physiotherapist noticed that his balance was decreasing and she was having to alter the activities performed in her class due to fear we would not be able to cope and would fall. So she booked him in for 1 on 1 therapy with me to improve his balance and poor posture.



Task: To improve patient A's balance and poor posture through education, exercise and retraining.



Action: I used a variety of techniques on patient A as a way of training to improve his posture and balance. I began with fixing his posture with feedback and tactile stimulation. Patient A was constantly leaning backwards and so my aim with him is to correct his posture and to over emphasise a slight lean forward/ bottom out posture. Throught the use of functional reach type activities in standing and on the fitball, i was able to work both his posture and balance. I did lots of balance exercises (eyes open/closed, change of surface and base, adding arm movements, standing on a trampoline) as well as incorporating some strengthing work e.g. UL theraband and using a step machine (as the patient had to lean forward to hold the handles. I also believe it would be important to practice stepping and getting up from falls. I also got patient A completing an obstacle course. I have gradually been progressing his exercises and have seen huge improvement.




Result: Patient A's posture and balance improved significantly with my therapy. He is now able to not only stand and move with good posture, he is able to correct himself. He is still wobbly with tandom walking but other than that his balance has greatly improved. He is now able to sit on a fitball again and not look unsafe. I was also feel more confident that he might be able to attempt to save himself if he did indeed trip. Even through his balance warrants further improvement, i believe with the significant importants that have occurred in such a short period of time, it will no take long.



Evaluation: I am very satisfied with my treatment of patient A. I believe i chose activities that were not only relevant but challenging and achievable. I learnt that this patient needed lots of tactile stimulation and verbal feedback, and i adjusted my treatment accordingly. I seem to have connected well with patient A and he is keen to take on my advice and practices his posture and balance exercises. I have managed to keen sessions interesting and by adding something new to each session, i am keeping it challenging and fun. I believe i didnt do a thorough outcome/baseline measure before treatment and so it has just been visual improvements that have been noted.

Strategies: To address the issue of not doing a baseline measure, i believe in future it would be useful and nessessary to use a baseline measure such as the BERG balance scale to get actual noted improvements, to compare to normal and to use as further motivation. Other than that i am extremely satisfied with the treatment of this patient.