Twenty Students, Twice, Both discussed on Academy of Neurologic Physical Therapy Podcast
And in looking at that. It occurred to me that there is no way to measure. How difficult is this balance task for this person. You can measure. How fast is the floor moving. Or how much did. I use to nudge them. You can measure if it's proactive. You can measure. How far forward did they lean on. How quickly but that's measuring the performance. That's not measuring how hard the task was so. I did a lot of research in the really. There was nobody measuring intensity for balance training. If you go to dose and exercise program you need to have the frequency the intensity type in the time that intensity portion is easy for weight since easy aerobics. Easy for stretching. It's easy for most of the other. Modalities that we administer but it's not motor. Learning is another example where it's not easy to dose the intensity level. But it isn't didn't so i worked with students at a colleague to just brainstorm ideas for how we might measure this and we came up with something that sort of a modified of the visual analog scale. The scale urban graded both and i in doing a lot of reading decided that i believe that this balance intensity is a lot like pain that it is individual to the person that we can't look at from the outside and say this is this heart for this person or this hard. Just you can't look at somebody and say they're experiencing this much pain because everybody perceives pain differently there just too many systems that going to balance that we've had students where we set up a bunch of different tasks symbol twenty students come through some really welcome slack line but can't stand on a bosa ball to save their life and vice versa and just different people their experiences the bodies they different things are challenging to different people that that's really great and at one of the things that Trying to go through and and catch up on my csm presentations because there's some amazing presentations This really resonates with me because One of the speakers was lou national and he talks about a lot of times what we call reactive balance people kind of anticipate unless you're really good at mixing it up and so you might be scoring reactive balanced but really it's an a. as And i wonder if your scale would help get at that. I don't know i. I completely agree though because even with Mechanical perturbations joe. Pryatta somebody whether it's eight participations standing provision trauma perturbations certainly it. It's well established that once the person is done at once or twice or three times. They changed their their set ahead of time so that they can respond more easily or so. The probation doesn't push them outside of their limits to begin on. And that's that's establish and i i think it the reverse of that is a little bit true civil. We do pretty intense gaming with difficult services and Video games that really requiring a lot of cognitive skill a lot of Stepping reaching all at the same time. If somebody reaches that's proactive. But now if the floor moves in unexpected way there's a reactive component to that activities. I think you get a little bit of both home in what we tend to call a proactive activity. But i don't know that that are scale would be able to distinguish. But i do think what it would find that as you do the task and what we have found when we apply this to reactive tasks certainly you know that people find the thing to be easier as they go. I think that is because they're able to have that set ahead of time where their their center of mass is in a better location to resist the type of perturbation. They're about to get on their basal. Supporters better set all of those kinds of things. Still so going back. Sorry i didn't mean to step on your words going back to what you said a little earlier about reactive balance being more challenging And i and i think i also heard that it's more modifiable through interventions which is exciting if you touched in someone's apa's and used your scale. And then. i went in and did reactive balance. Which would i anticipate that. They're perceived stability Rating would be different if reactive bounces indeed more challenging That i could see if i really got reactive versus if it was still an apa. Because they didn't do it. so great. And i still got the same score. I don't know. I know that You know the evidence seems to say that if you're training reactive tasks as you learn the task you begin to develop not just this more favourable set ahead of time but also if the task is slow enough for known enough you can develop. Aps to the reactive task which is not what normally happens in a reactive task. And i think that that's part of the learning. I think it's probably all adds into why the person feels less challenged and i and then go along with each other right that. If the person is more successful in recovering to that perturbation they probably felt less challenged. That's the logic of it But i don't know it would be interesting actually to look and see if you can differentiate some of those.