Reactive balance training (RBT) is a type of exercise. RBT can improve control of certain reactions when someone loses their balance and they want to keep themselves from falling. RBT involves whole-body exercises that have similar benefits to other exercises Examples include walking, and may also improve a person’s strength and fitness over time . RBT has the potential to improve multiple aspects of physical health simultaneously .
The indications for using RBT as a treatment technique are mainly (but not exclusively) based on indications that patients have balance problems. As a physical therapist, there are many ways to assess balance, but the Berg Balance Scale is a useful outcome measure that can predict Risk of falls in the elderly . It is also important to ensure that patients receive appropriate exercise for their current condition. The Balance Intensity Scale (BIS) is a clinical measure of the intensity of balance exercise in older adults . BIS has a component rated as Components assessed by clinicians and by exercisers . Many patients may benefit from RBT, such as stroke patients  Parkinson’s disease patients  and anyone at risk of falls.
Here is an example of RBT:
How Does RBT Work?
The therapist deliberately exposes the patient to challenging experiences, gradually increasing the challenge over time. Apply force to the patient. The forces may be internal or external, and these forces affect the patient’s center of gravity. The purpose of the exercise is to create Instability in intensity levels requires the patient to implement strategies to keep the center of gravity at the bottom of the support to prevent falls.
These exercises may often involve repeated introductions of the same unexpected dynamic activities that require a bodily response to prevent falls until the patient can sustain the response in a manner that ensures adequate control of the center of gravity.
Four Important Aspects of RBT
1. Internal and external perturbations
Reactive balance training incorporates perturbations into the intervention .
Internal disturbances occur when patients perform expected activities and do not have adequate control over their center of gravity. It is the patient’s own i) lack of control ii) poor coordination iii) lack of mass awareness center or iv) lack of adequate motor response Causes the center of mass to approach or fall outside of its supporting base.
External disturbances are different from internal disturbances. An external disturbance requires something in the person’s external environment to induce a force on the center of mass that causes the center of mass to move and reach or exceed the stability limit.
Read more about perturbation technology.
Watch the following RBT video using a rolling platform to see if you can identify different types of disturbances.
2. Postural control
Postural control is the body’s way of maintaining balance in any situation. It requires a flexible and automated system to adequately respond to expected and unexpected events. It includes feed-forward mechanisms and reactive strategies. Successful postural control relies on Various systems such as: somatosensory system, vestibular system, visual system and neuromuscular system.
Read more about Postural Control.
3. Balance control
Balance control is simply the body’s ability to keep the center of gravity within its base of support. A fall occurs when a person’s center of gravity falls outside the base of support and they do not have a reaction strategy. The biomechanical fall event can also be referred to as the center Mass is disturbed. The center of mass is no longer in a stable position relative to the supporting base.
Read more about Centre of Gravity.
Methods that are RBT and methods that are not considered RBT
The Otago Exercise Program:
The Otago Exercise Program is not reactive balance training, but it is a very effective way to improve balance and reduce falls in older adults . While the program includes activities to help retrain balance, these activities are anticipatory in nature. expected adjustment Challenging a person to maintain balance is not necessarily reactive balance training. When a person is aware of a task to be performed, he has time to think about the task and determine how to perform the activity. This person is able to predict what needs to be done. examples include Clinical activities such as tidbits Clock Yourself App tandem walking weave backwards walking or stretching activities. In these examples, the person knows the activity to be performed because the person is given the command and the activity to be performed can be expected.
Tai Chi doesn’t have to be reactive balance training. While Tai Chi includes slow, controlled movements that help retrain balance, the practice is primarily anticipatory in nature. If someone cannot perform the action smoothly and create an internal With perturbations of sufficient intensity to generate a fall-prevention response, the activity falls into the realm of reactive balance training. Read more about Tai Chi and older adults.
Wii balance activities are generally not reactive balance training. Balancing activities are more anticipatory in nature. Again, the patient’s performance determines whether the activity is reactive or anticipatory.
Virtual reality balance training:
Virtual reality balance training has the potential to be viewed as reactive balance training. The app needs to provide a situation where the patient feels as if unstable and needs a motor response to cope with the feeling of instability.
Designing Your Own RBT Training:
There are many examples of RBT. Situations can be set and applied to clinical interventions. When you put RBT into practice, it’s important to remember a few things.
- The intensity of the activity must challenge your patient to respond to prevent falls.
- These activities will include internal or external disturbances.
- Activities need to be progressively more challenging.
- Your patient needs to do this activity over and over again until your patient is able to respond adequately.
RBT includes providing contingencies in care. Patients should not be able to predict conditions or circumstances to pre-plan responses. Qualifying conditions include shifting the center of gravity towards the outer limit of stability, requiring a pedaling strategy to prevent drop. RBT is an effective strategy for preventing falls in patients across the lifespan .
Balance Intensity Scale
Perturbations on a Treadmill:
Reactive Balance/React Board:
Proprio Reactive Balance System:
- ↑ Mansfield A, Aqui A, Danells CJ, Knorr S, Centen A, DePaul VG, Schinkel-Ivy A, Brooks D, Inness EL, Mochizuki G. Does perturbation-based balance training prevent falls among individuals with chronic stroke? A randomised controlled trial. BMJ open. 2018 Aug 1;8(8):e021510. doi: 10.1136/bmjopen-2018-021510
- ↑ Jump up to:2.0 2.1 2.2 Barzideh A, Marzolini S, Danells C, Jagroop D, Huntley AH, Inness EL, Mathur S, Mochizuki G, Oh P, Mansfield A. Effect of reactive balance training on physical fitness poststroke: study protocol for a randomised non-inferiority trial. BMJ Open. 2020 Jun 30;10(6):e035740. doi: 10.1136/bmjopen-2019-035740.
- ↑ Lima CA, Ricci NA, Nogueira EC, Perracini MR. The Berg Balance Scale as a clinical screening tool to predict fall risk in older adults: a systematic review. Physiotherapy. 2018 Dec 1;104(4):383-94.
- ↑ Farlie, Melanie & Keating, Jenny & Molloy, Elizabeth & Bowles, Kelly-Ann & Neave, Becky & Yamin, Jessica & Weightman, Jussyan & Saber, Kelly & Haines, Terry. (2019). The Balance Intensity Scales for Therapists and Exercisers Measure Balance Exercise Intensity in Older Adults: Initial Validation Using Rasch Analysis. Physical therapy. 99. DO: 10.1093/ptj/pzz092.
- ↑ https://www.monash.edu/medicine/balance-intensity-scale/home
- ↑ Mansfield A, Wong JS, Bryce J, Knorr S, Patterson KK. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Physical therapy. 2015 May 1;95(5):700-9
- ↑ Allin LJ, Brolinson PG, Beach BM, Kim S, Nussbaum MA, Roberto KA, Madigan ML. Perturbation-based balance training targeting both slip-and trip-induced falls among older adults: a randomized controlled trial. BMC Geriatrics. 2020 Dec;20(1):1-3.
- ↑ Martins AC, Santos C, Silva C, Baltazar D, Moreira J, Tavares N. Does modified Otago Exercise Program improves balance in older people? A systematic review. Preventive medicine reports. 2018 Sep 1;11:231-9.
- ↑ Krause A, Freyler K, Gollhofer A, Stocker T, Bruederlin U, Colin R, Toepfer H, Ritzmann R. Neuromuscular and kinematic adaptation in response to reactive balance training–a randomized controlled study regarding fall prevention. Frontiers in Physiology. 2018;9:1075