According to the CDC, falls are common among older adults with 36 million occurring each year and more than 8 million requiring medical attention. Among those with Parkinson’s disease, diabetes, stroke, and those experiencing impaired strength, coordination, and balance after prolonged hospitalization falls are also common. Individuals with or recovering from COVID-19 may also have these impairments and are at an increased risk of falls.

Rehabilitation professionals address both static and dynamic balance. In order to maintain balance one must be able to shift their center of gravity in response to internal or external perturbations. Shifting the center of gravity initiates the ankle, hip or stepping strategy in an attempt to prevent loss of balance. Based on thorough assessment of balance including the use of evidence-based objective tests and measures (TUG, Berg Balance Scale, Functional Reach), interventions including biophysical agents and advanced technologies may improve balance and reduce risk of falls.

Research helps identify causes and supports the use of advanced technology and biophysical agents in the treatment of balance impairments to reduce falls:

• The most frequent (41%) cause of falling in 130 individuals residing in long-term care who fell 227 times on video was due to incorrect weight shifting. (Robinovitch, et al., 2013)
• Performance on the TUG was significantly greater in the endurance training + resistance training + NMES group than the endurance training + resistance training group. (Acheche, et al., 2020)
• Stationary cycling exercise training is an effective intervention for increasing balance and gait abilities in patients with chronic stroke. (Kim et al., 2015)
• Virtual reality-based ankle exercise effectively improves the dynamic balance, muscle tone, and gait ability in patients with stroke. (Yom, et al., 2015)
• In meta-analysis the number of participants with Parkinson’s disease who experienced a fall was significantly lower in the Tai Chi group than the control group. (Liu, et al., 2019)

Patterned Electrical Neuromuscular Stimulation (PENS) to improve lower extremity strength and coordination. PENS to the affected area can be used bilaterally or unilaterally to facilitate muscle activation and strength depending on patient need. The OmniCycle^® can be used with or without PENS cycle protocol during interactive biofeedback exercises such as porcupine and traffic jam to facilitate improved coordination, balance, and gait. PENS walk protocol can be used during gait training to facilitate reciprocal lower extremity patterning.

OmniStand^® and OmniVR^® to assist and challenge balance training. The OmniStand^® can be used to safely and efficiently progress static and dynamic balance starting with ankle, hip, and stepping strategies when independent standing is a challenge. Exercise with the OmniStand^® can then be progressed to incorporate additional exercise such as Tai Chi or virtual reality. When independent standing is achieved,OmniVR^® dynamic balance activities can be further progressed.

References:
Acheche, A., Mekki, M., Paillard, T., Tabka, Z., & Trabelsi, Y. (2020). The Effect of Adding Neuromuscular Electrical Stimulation with Endurance and Resistance Training on Exercise Capacity and Balance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Canadian Respiratory Journal. 2020:9826084. http://doi.org/10.1155/2020/9826084 
Kim, S. J., Cho, H. Y., Kim, Y. L., & Lee, S.M. (2015). Effects of stationary cycling exercise on the balance and gait abilities of chronic stroke patients. Journal of Physical Therapy Science, 27(11), 3529-3531. http://doi.org/10.1589/jpts.27.3529 
Liu, H.H., Yeh, N.C., Wu, Y.F., Yang, Y. R., Wang, R.Y., & Cheng, F.Y. (2019). Effects of Tai Chi Exercise on Reducing Falls and Improving Balance Performance in Parkinson’s Disease: A Meta-Analysis. Parkinson’s Disease, 2019:9626934. http://doi.org/10.1155/2019/9626934 
Robinovitch, S.N., Feldman, F., Yang, Y., Schonnop, R., Leung, P.M., Sarraf, T., Sims-Gould, J., & Loughin, M. (2013). Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet, 381(9860), 47-54. http://doi.org/10.1016/S0140-6736(12)61263-x 
Yom, C., Cho, H.Y., & Lee, B. (2015). Effects of virtual reality-based ankle exercise on dynamic balance, muscle tone, and gait of stroke patients. Journal of Physical Therapy Science. 27, 845-849. http://doi.org/10.1589/jpts.27.8455