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Suggested Sitting Position: Optimal Posturę (con't)

To Begin: Sit in the center of the bali with hips and knees bent at 90? angles and Iegs parallel at hips’ width apart. Place feet firmly on the floorin proper alignment (avoid pronation or supination). Knees should be directly over ankles. In tllis position, ankles, knees and hips are centered. However, slouching is still possible. Use following methods to achieve optimal spinał alignment. Notlce: If hips are purposely positioned off-center, it takes morę effort to balance and will become uncomfortable.

Methods to Achieve Optimal Posturę:

Following are three methods to achieve optimal posturę. The first two methods require conscious effort and verbal cues from an obsetver may be neoessary to achieve correct alignment. In contrast, the third method facilitates optimal posturę without conscious effort as the gentle compression and distraction caused by bouncing aligns the spine in its most efficient position independent of verbal cues and with consistent resuNs.    |

1.    Sit up as straight as possible by imagining puppet strings are attached to the top of head and are pulling up (Avoid pressing rib cage forward and arching Iower back).

Then, feel body weight drop into the bali. Relax shoulders and let arms hang at sides.

Shoulders should be directly over hips and ears should be in linę with shoulders (look in a minor). If the spine is not properly aligned, use method #2 or #3.

2.    Let the bali roli forward until it touches the back of the legs allowing Iower spine to curve. Then, roli the bali backward as far as possible allowing Iower spine to arch. Now, find the position in between which is the most comfortable (symptom free or minimized symptom) and reąuires little effort.

Tuck chin so ears are aligned over shoulders.

3.    Begin with Basic Bounce by pressing feet into floor thigh and hip muscles to slightly lift trunk. Relax. Continue bouncing by alternately tightening and relaxing these muscles as vigorously as balance. coordination and comfort allow (See page 37). Notice: When bouncing, the spine will gravitate to the most comfortable, energy efficient position (optimal posturę) by putting the body's center of gravity over its base of support to reduce any uneven compression or shearing forces between the vertebrae or stretch of ligaments or muscles. It will also activate the appropriate muscles automatically to support the spine in this posturę.

Maintain this posturę when you stop bouncing.

Notice: Bounce and feel how abdominal muscles tighten. Now concentrate on relaxing the abdominal muscles while bouncing. Feel how difficult it is to do this and maintain the stability of the spine, especially while lifting feet one at a time.

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CAUTION: NEVER BEND OR TWIST SPINE WHILE BOUNCING AS THIS COULD CAUSE OR AGGRAVATE INJURY.

© 1995 by Joannę Posner-Mayer, PT

Guarding Options for Therapists

Provide an unobstructed space for patient and therapist to exerci.se sately using the bali. Anyone who can walk unassisted or most people who use a cane for assistance should be capable of independently sitting on the bali and keeping their balance. If an ambulatory person still feels insecure exercising on the bali. take precautions to otter them a slight balance assist which can be either the light touch of another person or a stable object.

If the patient is exercising at home. instruct them to touch a chair. a wali or sofa placed at their side so they can release the object when they feel in control but can ąuickly touch it for balance. As soon as they feel comfortable without the assist. it is adcisable to move away front the object. These patients can also use a Physio-Roll™ instead of a bali for less challenge.

It is helpful to give the patient visua! cues such as placing the patient in front of a mirror. The therapist can also increase the difficulty by removing visua! cues. These techniques work well for both balls and the Physio-Roll™.

Patients who reąuire an assistive device to walk or who are not ambulatory will need morę guarding and hands-on control. If the patient is non-atnbu-latory, it ntay be safcr to start them on a Physio-Roll™ which will be easier to control for both parties. If the therapist has to work hard to control the patient, either the exercise needs to be modified to a Iower level of difficulty or the therapist should use techniąues that increase their stability. Ideally. the patient should be working hard while the therapist should be hardly working.

It is not effective for the therapist to sit on a chair to sately guaid the patient at their waist because the therapisfs spine will be in an uneomfortable and precarious position especially if the patient loses their balance. It is also not recommended for therapists to sit on a bali in front of the patient as it increases the risk of falling by putting both parties on an unstable base of support. There is a greater risk if the patient is touching the therapist for balance assistance. With the exception of standing behind the patient on a Physio-Roll™. guarding from behind is not efficient or safe. Only progress to sitting on a bali to demon-strate exereises once the patient does not require any guarding. Then. it can be a caluable method of instruction because it reduces treatment time required compared to sharing a bali. Also, people who are visual learners will perform better with visual instructions.

For both therapist and patient comfort, perform exercises on a mat or a well cushioned carpet. Following are suggestions for guarding techniques for patients who are cooperative and can follow directions. starting from most assistance and progressing to least assistance. Please practice these techniques with a partner before using them with a patient. Remember the Physio-Roll and bali are uniąue tools because they offer an unstable base of support; therefore, there is always an element of risk involved.

© 1995 by Joannę Posner-Mayer, PT

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