Therapy in Motion, TN
A Mobile
Physical Therapy Service.
We come to you...
Dr Michael J. Malawey, PT (760)-224-3081
Dr Cindy Malawey, PT (760)-715-4789
Fax 1-833-467-2764
How Balance and Walking Meet
Guided Physical Therapy - Balance Restoration
Assisted technology guided physical therapy allows you to train to the universal and normal balance control. That is key. While each of us is unique and ultimately no two people have the same collection of problems, we all have the same version of a human body: two legs, two arms, a torso and head. We all have a body in space that we need to control within our balance field.
Standing Balance (Dynamic and Static): Mechanism of operation: In real time, Envision Guided Therapy, monitors the body’s Center Of Mass (COM) or "predominant weight" moving over the foot or feet which is the body's Base of Support(BOS). The general process of retraining involves monitor the body’s COM over the ideal zone(s) of the BOS. A grid is superimposed (overlay) onto a defined region, specifically the surface area of the feet and space between them in which the body in upright position is mechanically stable and in “balance”. The intent of the intervention activity is that of moving the COM into each area(grid cell) which when competed shades in and to further develop control, maintain the COM in a single grid for a sustained time. The Activity of illuminating each grid cell continues until all the cells are filled in.
Figure A:
Full Balance Field Training
Hand Support
7-30-2021
Berg Score = 37/56
Figure B:
Full Balance Training
No Hand Support
8-1-2021
Figure C:
Remote Monitoring of Activity by PT
10-4-2021
Berg Score = 56/56
An additional challenge is that people with balance deficits are unable to see (visualize) their Base Of Support(BOS). This fact makes retraining balance inherently fear-filled, even when the individual from a biomechanical point of view is within his safe zone or region. A safe zone is simply a condition in which the body’s Center of Mass is oriented over their base of support(feet or foot).
Once a balance problem exists, they unknowingly will be “comfortable” in a very limited portion of the normal region. The individual is only willing to stand or place their body weight in a narrow region, usually at the very center or most stable region of the BOS. They feel as though they are losing their balance and falling (perceptual only)when they move outside that very limited zone. They do not respond appropriately with regards to righting and equilibrium reactions. Either they have no reaction at all or overreact. In either case, the body weight moves outside the patient's perceived "safe zone" of the BOS and the result is a fall. This reinforces their fear, perceptions and further limits ability to restore their balance function.
The below Balance field Assessment and training is on the first patient when this concept was understood. If the patient moved outside of the colored regions, she lost her balance. As she trained she could move in her entire "Balance Field". Her balance had not improved in years because neither the patient nor the therapist could see and train to her balance field. At 36/56, on the Berg, the patient could fill in her entire balance field. The other 20 points of the possible 56/56 represents control within the field. This improvement happened after 5 year of no progress
Initial Balance Field Assessment
Berg Balance Scale 13/56
10-17-2018
Berg Balance Scale: 18/56
01-22-2019
Berg Balance Scale 26/56
02-26-2019
Berg Balance Scale: 33/56
04-03-2019
Berg Balance Scale: 36/56
05-10-2019
An example of the difference Guided Physical Therapy in regards to patient treatment and recovery is illustrated in the two video clips below. The first clip demonstrates right to left pusher syndrome. A common and difficult phenomena in which the patient pushes very strongly to the weaker side. The first clip shows the unguided method in which two people struggle with the patient to get them to lean on a table to the right. The patient's perception is that he is falling to the right and pushes to the left. The second clip demonstrates a patient with the same problem. He is supervised as he is guided by the display in real time. Instead of a fear-filled fight, he knows he is safe and is tryin to shift weight onto the right leg.
An example of unguided treatment of "pusher syndrome"
The Envision Guided Physical Therapy System - To treat and resolve the right "Pusher syndrome"
Balance Meets Gait
The union of the human balance field and the gait tracer pattern. Gait or walking has been described in many ways. One of the descriptions terms the activity of walking as a "dynamic balance activity". This is certainly true in terms of the union of the human balance field and the normal walking pattern. In order to restore normal or ideal walking, an individual must have full access to the area of their balance field and 5 level mechanical - postural control (head to toe control) of their body's weight or mass as it moves within the full field.
There is no possible way to restore the walking ability/activity to a normal state unless these conditions are restored. Yes, you can still walk in a compensated fashion. The severity of loss of control of the body and the loss of ability to access the balance field dictates the degree of impairment. These factors traditionally are measured by outcome testing. Balance can be measured by a Berg Balance Score for instance. Gait can be measured by a Tinetti's Gait Test. These tests measure status and outcomes of treatment. Guided Physical therapy will display the Human Balance Field in the moment biomechanical (physics) of the body as it interacts within the patient's balance field. This give both the clinician and patient real time, and in the moment ability, to retrain to normal parameters.
​
​
Figure 1:
The Human Balance Field Display
Figure 2:
The Bowtie (Normal Walking Pattern) within the balance field (display)
Figure 3:
What the patient sees and he trains.
A Partial Spinal Cord patient gait training using the display
Prior to the development of this technology, the treatment was a best guess or in medical terms "blind". That is because without the technology, you can not see your balance field or how your body is interacting within it. You indirectly can sense it. How? You feel unsteady. You have a tendency to fall. You know your balance is off. You know your walking is impaired and no matter how much you work at it, it is not getting better. This phenomena of practicing, but experience no improvement is not new. It is true that it is necessary to practice a great deal to progress, but that is only a piece of the process. If you practice the ineffective or abnormal patterns, you only reinforce the impairment and disability. You, in essence, are training ineffective control, movement patterns and function.
Guided physical therapy allows you to train to the universal and normal balance and walking patterns. That is key. We all have 5 anatomical levels of the body in space that we need to control. The general human design is universal and so is the Human Balance Field( Figure 1)and the normal Gait Tracer Pattern (GTP) or "Bowtie Pattern"(Figure 2). The Envision system technology allows not only the patient to see the physics of the body, it allows you to confidently train to the ideal mechanics. It guides you in the moment to ensure accurate performance of exercise, balance and gait activity. Figure 3 displays a zone map of the patient would use to train standing balance on both and each single leg. Figures 4 and 5 display the union of the normal human walking pattern within the balance field. With guided physical therapy the patient is training to re-establish the normal and universal body control within the 3 zones of the balance field and the normal walking signal within the balance field.
Figure 1:
Display of the Human Balance Field
Figure 2:
A normal walking signal or Bowtie pattern
Figure 3:
The 3 zones of the human balance field
Figure 4:
Display of the balance field grid and normal vector pattern of walking
