Small Adjustments Produce Big Changes

As a Physical Therapist, I treat many deconditioned patients in their home.  Most of these patients suffer from generalized weakness, balance deficits and difficulty walking.  Initially, depending on the extent of their weakness, I may start them with seated or supine (lying down on their back) exercises.  They then progress to standing exercises, usually holding onto their kitchen sink.  These exercises include heel raises, marching, squats, etc.  We use the sink because it is a stable surface that will not move while the patient holds onto it for balance.  Most of these patients have a fear of falling due to poor balance.  As time goes on, they begin to have less trouble with these standing sink exercises.  However, what is the true functional value of these exercises?  If your patient's goal is to walk without a cane or walker, they are definitiely not going to be walking while holding onto a sink, right?  So how do we get them ready to be independent with their daily activities?

One small adjustment to their position during your sessions will make a big change in their confidence, strength, balance and walking ability.  Have them step back away from the sink, into the middle of their kitchen, with nothing else at arm's reach except for you.  Make sure you remain close to them, but only place your hands on them to prevent a fall.  Now have them perform the same standing exercises that they did when they held onto the sink.  They will seem very cautious, almost fearful.  Progress slowly with this.  Perform only a few reps of each exercise.  This is a confidence building exercise as well as balance and strength building.  They will feel a much greater challenge due to the mental aspect.  The difference here is the risk or fear factor.  They no longer have their security blanket, the kitchen sink.  They must rely on their own abilities (as well as your ability not to let them get injured).  Once they accomplish these tasks over numerous sessions, you will see improvement in confidence, strength, balance and walking ability.  You will see that one minor change can have a very beneficial effect on your patient's progress.  Remember, you are not just training their body, you are also working on their mind.  Take away their "crutch" to get them to the next level.