FALL: Home Based Training

Who are we?

We, Retrofit, believe that exercise intervention is an essential component in helping individuals who have suffered from any chronic illness to lead a more active, healthier, and happier lifestyle. Our qualified exercise specialists will customize workout plans for every individual, with your needs and conditions in mind.

Our Home Based Training program, also known as HBT, is a great way for individuals with mobility issues to get the exercise they need at the comfort of their own home to perform daily tasks. By combining your goals to our initial assessment, we prescribe appropriate exercises to improve your strength, BALANCE, flexibility and also functional mobility. In this article, let me introduce to you what balance is and how our HBT program can reduce your fall risk.

What is balance?

A biological system that enables us to know where our bodies are in the environment and to maintain a desired position. Normal balance depends on information from the inner ear, other senses (such as sight and touch) and muscle movement. [1]

Loss of balance can result from disruption of any sensory input, processing disorder  or lack of motor control.  Depending on the parts affected, it will be associated with some other symptoms such as blur vision, dizziness, uncoordinated movement and muscle weakness which can be linked to high risk of falling.

Evaluate your Balance

 

Let’s have a quick test to see how you keep yourself balanced while performing the tasks below.

Four Stages of Balance Test

A tool to assess your mobility and risks of falls by evaluating your static balance. If you can hold a position for 10 seconds without support or moving your feet, go on to the next position. If not, stop the test. No assistive device (cane or walker) allowed and should always keep your eyes open
Four positions include:
1. Stand with your feet side-by-side.
2. Place the instep of one foot so it is touching the big toe of the other foot.
3. Tandem stance. Place one foot in front of the other, heel touching toes.
4. Stand on one foot.

Unable to hold task 3 for 10 seconds is an indication of increased risk of fall.

How can we help?

Our program includes four key areas: Intervene, Adjustment, Prevention and Education. Along with physiotherapists, we will prescribe a comprehensive plan that will address your fall risk factor and also improve your balance control.

1. Environment Modification

1.1. Through our initial assessment, we will identify the possible hazards which could lead to falling in your home. Some advice and tips will be given to fix the problem. In addition, we will also help our client to set up a workout area if needed. Then, they are able to make our prescribed exercise become a part of their daily routine.

 

2. Walking Aids Reeducation

2.1. A study showed that incorrect use (of walking aids) was observed for 16% of single support periods and for 29% of dual support periods. Clinical guidance cannot easily be adhered to and self-selected strategies reduce stability, hence placing the user at risk. [3] Therefore, we can see that improper use of it might even increase the chances of falling. As a licensed health professional, we possess related skills and knowledge to help with adaptation for proper use of walking aids.

 

3. Individualised Designed Exercise Program

3.1. Falls in Individuals with Cardiopulmonary Condition
Postural Hypotension:
Abnormal drops in your blood pressure while trying to get up quickly from bed or stand up from a seated position. You may experience lightheadedness, blur vision and most likely fall down if you are unable to keep yourself balanced. The reason why you are doing your position changing quickly is you lack muscle strength to perform and will compensate with your body’s momentum instead. Therefore, we will look through your movement, find out what is missing or doing incorrectly, and then address it until you can perform the technique precisely.
Practice: Try to lie on your side first before pushing yourself up to a sitting position. Put your legs on the edge of the bed and use your elbow to push yourself up if you don’t have enough strength.

Shortness of breath: If you are diagnosed with any heart and lung disease, you most probably will experience shortness of breath (SOB) in certain timing and conditions. If you are unable to breathe well, the oxygen level in your blood will be depleted, leading to dizziness and whole body weakness. In order to relieve the unpleasant effect of SOB, chest expansion exercise and breathing techniques are required in our HBT program.
Practice: If you feel a slight SOB, try to breathe in through your nose for 1 second and breathe out through your mouth for 2 seconds by placing your both hands on the diaphragm (center point). Repeat for 3 to 5 times.

3.2. Falls in Individuals with Musculoskeletal Condition
Lower limbs weakness:
Commonly due to physical inactivity or aging. There are two possible events if you don’t take it seriously: i) Experience sudden knee buckling associated with pain. If your legs cannot hold your whole body weight and just lose control due to weakness, your knee will give way, strike onto the ground, then contusion happens. Don’t refuse to exercise even if you think you are weak. Regular resistance training can have a direct effect on your lower limbs’ strength by challenging them to fight against an external force or weight.
Practice: We have prepared three exercises below for you to practice at home. Enjoy!

Lower Limbs Injury: Any kind of lower limb injury, especially in your ankle (most common example: ankle sprain) will give rise to proprioceptive dysfunction. Information will be disrupted when sending to our cerebellum and cause muscles unable to react to the changes on time. In order to prevent proprioception-loss induced fall, we will include related training in our program by challenging your ankle stability and balance control on different stepping surfaces.
Practice: Perform Four Stages Balance Test as your proprioception training until you can hold a certain position for more than 10 seconds. At the beginning, you can support yourself with one hand holding the wall.

3.3. Falls in Individuals with Neurological Condition
Poor trunk control:
After someone was diagnosed with neurological disorders such as stroke, spinal cord injury, parkinson or motor neuron disease, they were generally presented with difficulty in engaging their abdominal and back muscles to keep the body upright without shifting while sitting/ standing. It will be very dangerous for them if they try to stand up forcefully without any proper training of the trunk control component first (they may fall and reinjure again). An improvement in your trunk control is determined by your ability and motivation to activate your trunk muscle working again, then slowly regain your bed and functional mobility with less fear of falling.
Practice: Have a feel how you activate trunk muscle to keep yourself stable by performing bird dog exercise in the CHALLENGE section. (kindly go through an assessment with us first before self-trying trunk control exercise if you are suffering from any neurological disorder)

Poor coordination: For most of us, we can perform our daily tasks in a smooth and coordinated way. Our processing area, Cerebellum, will receive and interpret the information from different sensory input and then send the instruction to a specific muscle group for certain movements. If now there is damage to your processing area, our muscle cannot get a proper instruction from it and eventually unable to perform the action accurately. It may be accompanied with some unwanted movement which will disturb your balance and increase the possibility of falling. Specific resistance and functional exercises are useful to assist you to have a more voluntary control of the muscle with your own visual cues and trainer’s tactile guidance.
Practice: Find around 5 minutes a day to challenge your coordination by walking through a straight line. You will find that it could be difficult and need a lot of muscle involvement to coordinate the movement.

Challenge

Here we have three exercises which target different muscles which help in your strength training and balance control. Give it a try and what we expect is gradually you can perform your ADL (activities of daily living) easier with a more steady feel on your feet. If the expectation is achieved and you want to learn more, don’t hesitate to We are Retrofit, where it is POSSIBLE.

Seated Knee Extension

Position: Sitting on a chair with back against it Instruction: Fully straighten the knee and lower it down slowly
Repetition: 3 sets x 10 repetitions (x 5 seconds hold) for both legs
Aims: Strengthen your quadriceps

Standing Clam

Position: Single Leg Standing with one hand holding the wall for support
Instruction: Rotate the bent knee outwards to squeeze the ball to the wall
Repetition: 3 sets x 10 repetitions (x 5 seconds hold) for both legs
Aims: Strengthen your gluteus

Bird Dog

Position: Four Points Kneeling
Instruction: Raise up one leg until parallel to the floor by contracting tummy
Repetition: 3 sets x 8 repetitions (x 5 seconds) for each side
Aims: Strengthen your trunk muscle

References

MedicineNet. (2021, MARCH 29). Medical Definition of Balance. https://www.medicinenet.com/balance/definition.htm

Centers for Disease Control and Prevention. (2017). The 4-Stage Balance Test. https://www.cdc.gov/steadi/pdf/4-Stage_Balance_Test-print.pdf

Thies, S. B. (2020, MARCH 04). Are older people putting themselves at risk when using their walking frames? https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-020-1450-2.pdf

Have a question?

Call our central-line at +65 6681 6536
Email your queries to enquiry@retrofit.sg or use this form