Figure 44.8

SOT scores before (upper) and after 1 week of training (lower) for two TBI subjects. Note that the greatest functional improvement occurred in the most dynamic and challenging tasks: condition 5: eyes closed with platform-induced anterior/posterior sway; (more...)

44.8.2. Balance Training

The goal of balance training is to create body awareness, correct postural alignment, and improve balance. The individual uses the PoNS device during balance training while getting feedback from the trainer, which allows proprioceptive and vestibular inputs to recalibrate.

44.8.2.1. Training Positions

Various sitting and standing positions are used for balance training. Finding the proper starting point is key. To find the starting point, the trainer tests the individual until they find the point at which the person must work in order to maintain balance control with proper alignment, but not work so hard that they continuously struggle or lose their balance.

Sitting and standing positions are affected by external and internal variables. External variables that affect seated stability include sitting surface, back support, arm position, base of support, use of touch point, and eyes open or closed (Table 44.2). External variables that affect stability in standing include standing surface, base of support, foot position, shoes, use of touch point, and eyes open or closed (Table 44.3). In a person with a neurological dysfunction, internal variables are related to the lack of communication in the neurological network, which includes the lack of firing or misfiring of neurons, manifesting outwardly as abnormal posture and instability.

Table 44.2

External Variables That Affect Sitting Balance Training

Table 44.3

External Variables That Affect Standing Balance Training

To find a starting point, the trainer tests the individual in the various positions, adding challenges. For example, the individual starts by standing in a comfortable position with eyes open, then in the same position with the eyes closed. If the individual sways significantly or appears unstable, this is where the training begins. If this position can be done easily, changing the variables (i.e., base of support, foot position, or use of soft foam) increases the difficulty. Each position starts with eyes open and progresses to eyes closed. When on soft foam, the individual starts with feet apart, increasing the difficulty by bringing them closer together. The trainer continues to assess the individual in this manner to find a position where he or she is challenged, but does not continuously lose his or her balance. This is where the individual begins their balance training.

44.8.2.2. Performing Balance Training

To perform balance training, the individual stands close to a table for support. With the stimulus intensity set at a comfortable level, the individual holds the device in his or her mouth, closes his or her eyes, and focuses on maintaining good posture in this position. The trainer provides standby assistance and monitors posture. Verbal cues, such as “unlock your knees” or “imagine a string pulling at the top of your head,” help create the awareness necessary for the individual to make and maintain postural corrections. The goal is for the individual to be able to adjust his or her posture internally without cues. Individuals need to work at the highest level possible where they do not need assistance. The subject’s balance is challenged with each training session, as they demonstrate improvement.