BALANCE FOR SAFETY SAKE!

Published: NaCCRA Lifeline (National Continuing Care Residents Association), Vol. 17, No.4, July/August 2012

“I know where I am and I have all the time in the world.”

This is an affirmation worth considering as we explore together its implications!

Balance is such an integral, ever-present aspect of life experience that most people take it for granted. That is, unless you experience the unnerving moment of slipping, losing control of balance, and falling.

Falls are nothing new. I clipped out articles on fall prevention as far back as the early 70’s when I was teaching exercise and dance. One that stands out was clipped from the NY Times about the value of exercise in fall prevention among the elderly. Building strength, stamina, and balance skills was valued and proven to be effective in fall prevention.

The recent success of the Otaga Exercise Program, developed in Canada for the geriatric population, demonstrates the premise that even small gains in strength and balance can lead to significant improvement in stability, especially in the independent geriatric population. The Otaga program researchers concluded that the best time to begin a program of balance skills is prior to the predicted progressive loss of muscle strength and stability of the aging process, that is, before the loss reaches the threshold when daily functions are affected. The Meeks Method, developed by Sara Meeks, P.T., expands the premise by showing that even the most frail will gain strength, balance, and function when given the correct exercise prescription with appropriate incremental progressions to develop trunk alignment and leg strength.

Now, as I direct a fall prevention program at Deerfield Episcopal Retirement Community in Asheville, NC, I find value in integrating my experience in physical therapy and geriatric exercise with the wisdom of the Alexander Technique with its emphasis on perhaps the neglected ingredient in our quest to prevent falls: our inner attitude toward time. So often we can look back at a fall and recall a hurried state of mind associated with the fall. “I just wasn’t looking where I was going.”  “I was frantically looking for my keys when I tripped on the corner of the open drawer.” “I was hurrying to catch the bus and didn’t see the curb step down.” Do any of these scenarios sound familiar?

Fredrick Matthias Alexander, in his landmark discoveries during the early years of the last century, recognized the harmful effects of a hurried state of mind. He incorporated this observation in the framework of the technique that would eventually carry his name, the Alexander Technique. Interested in how our inner attitudes, perceptions, and thoughts interplay, he observed that the way our alignment and movement styles develop reflects how we think about (or don’t think about) the way we move every day. He saw, too, that hurrying led to poor coordination and decreased awareness of the environment around us.

Let’s step back and examine what happens when we are hurried. Our mind jumps to the end – we are picking up the phone in our mind before we have gotten out of the chair. In other words, we lose awareness of where we are, as well as what and how we are doing what we are doing in the moment. Our body will likely be literally out of balance, as well - chin jutting forward, back arched, thighs pulled in with knees knocking. Thinking only of the phone ringing, we may be unaware of how our bodily distortions have replaced the possibility of a more balanced, easeful way of moving out of the chair and stepping forward. We are also paying little attention to what is immediately in front of us in our environment as we dash for the phone, making us vulnerable to a preventable fall.

Balance is a skill - the ability to control and maintain the body's position as it moves through space. Our challenge is to develop and maintain this skill with practice addressing all components of mobility and balance to create an effective fall prevention program. These include: (1.) the visual system (challenging our visual dependence and varying the way our eyes coordinate with body movement), (2.) the vestibular system (altering head positioning to highlight information from the inner ear), and (3.) the somata-sensory system (also known as proprioception, our sense of spatial orientation and organization from specialized receptor cells found in the skin, muscles, joints and tendons)

While each sensory input is independent of the other, each also influences the other. Our eyes confirm what our somata-sensory system perceives. Our vestibular system may tell us the room is turning, altering the input from our eyes. And the following ingredients of good balance and mobility will heighten all three systems: (4.) postural alignment (increasing our ability to perceive information from our joints and muscles, from our inner ear regarding head positioning, and from our eyes when at proper alignment with the horizon), (5.) muscular strength in the large muscles of the legs (offering general stability), and last, but not least, (6.) a calm conscious state of mind, as opposed to a hurried state of mind (allowing us to pay attention to all stimuli: visual, vestibular, and somatasensory.) The hurry to rise from bed or chair may also deny us the time to adjust to a change in blood pressure with momentary dizziness yet another challenge to our ability to remain in balance.

The aging process’s slowing of reflexes, progression of muscle weakness, and loss of eyesight and depth perception often complicated by onset of conditions such as Parkinsonism, Meuniere's Disease, and arthritis contribute to a diminished sense of equilibrium. The good news is that we need not succumb to being accident-prone!

Movement, posture, vision, and balance can improve with training, and various movement techniques offer help.  We can take advantage of balance classes, Alexander lessons, Feldenkrias, Tai Chi, chair Yoga, Body Recall, and Pilates classes, and seek strength coaching in our respective residency programs, and, we can make a conscious effort to apply the Alexander Technique principle of saying “no” to a hurried state of mind, instead taking time to think about how we are going to navigate our movements – with a keen awareness of our body and our environment.

Attention expands from skills learned in classes to body coordination in every day activity. With improved leg strength, alignment and coordination, we gain ease in changing positions, walking, bending, and lifting. We are able to problem solve an array of tasks: working at the computer, standing in the kitchen, climbing or descending curbs and stairways, or negotiating uneven surfaces.

Let’s return to our mantra: “I know where I am and I have all the time in the world.” Our conscious slowing down in activity offers a safe approach to increasing activity, which in turn kindles our desire to participate in more activity, which in turn builds strength, flexibility, and endurance. Sensory input becomes more reliable; posture more upright; dynamic balance more consistent. Even a person frail with severe osteoporosis or limited by Parkinson's Disease can learn safe ways to re-engage in dynamic activity without fear of falling.

about the author: Idelle Packer, MS, PT, mAmSAT, (AmSAT certified teacher of the Alexander Technique) teaches at Deerfield Episcopal Retirement Community (Asheville, NC) and has a mother at Glen Arden Retirement Community (Goshen, NY).

Resources:

Balance as a function of Intelligence by Walter Carrington

How You Stand, How You Move, How You Live by Missy Vineyard

Otaga Balance Program developed in Canada: http://www.nvfgnet.nl/scrivo/asset.php?id=918589

Meeks Method: Walk Tall by Sara Meeks,PT.