Occupation-Based Balance Interventions For Your OT Practice

If you’re an occupational therapy practitioner or OT student searching for occupation-based dynamic balance interventions for your adult-setting rehab patients, then this article is just for you!

Occupation-based interventions are not only our bread and butter, but they also can help differentiate us from physical therapy.

It can be way too easy to accidentally do the same non-occupation based balance interventions as our physical therapy counterparts in rehab settings, so with this list you’ll know you’re providing functional, client-centered interventions for your patients.

Many of these intervention ideas came from the amazing members of the My OT Spot Facebook group, which I want to give a huge thanks to for helping me with this list. (If you aren’t a member, join here!)

So without further ado, here are our favorite occupation-based standing and sitting balance interventions that you can start using in your practice today!

Occupation-Based Dynamic Standing Balance Interventions

If your patient is higher level, meaning they can stand and ambulate, and they demonstrate impaired balance, these activities can provide a great challenge. Before diving into them, be sure you ask your patient if they do these activities at home to ensure your intervention is client-centered.

You can also incorporate the use of a reacher with many of these activities to add in adaptive equipment training when you feel it is appropriate. In addition, don’t forget to use a gait belt and the patient’s appropriate DME during the task for safety.

And remember, you can grade any of these interventions up or down based on what your patient is able to tolerate.

1. Dynamic Balance During Basic ADLs

• Side-stepping in out and out of the tub with the wall or grab bar (if they will have), if your patient is going home to a tub. I like to do multiple reps of this if my patient can tolerate it since it’s a good challenge.
• For a less difficult activity, you can have your patient side-step over the lip of a walk-in shower if they are going home to a walk-in shower.
• Toilet sit-to-stands without the use of their hands. If this is too hard, they can use their hands and will still benefit from this activity.
• Grooming at the sink in standing with reaching out of base of support for items.
• And of course, bathing in standing! If this is too difficult or unsafe to do for a full shower, you can incorporate standing components along with sitting on a tub bench or shower chair. I always recommend having a seat just in case your patient gets fatigued.

2. Dynamic Balance During Instrumental ADLs

There is also so much you can do to incorporate appropriate I-ADLs, even in a hospital room. Here are some examples:

• Making the bed in standing, including stripping the sheets and putting on clean sheets for an extra challenge.
• Retrieving or putting away clothing or linens from high surfaces (the closet) or lower surfaces (the nightstand, low dresser drawers, even the floor)
• Dusting high and low surfaces.
• Tidying up clutter by ambulating around obstacles and incorporating reaching out of base of support.
• Putting away and retrieving grocery containers from lower heights in the refrigerator. I make sure I’m right behind them and holding on if needed since this one can be hard.
• Putting dishes in the dishwasher or in high cabinets (bonus if you incorporate the weaker arm if your patient has hemiparesis).
• Prepare a simple meal, incorporating reaching and stepping out of base of support.
• Sweeping or mopping is another great challenge that also addresses activity tolerance.

3. Recreational Activities that Address Balance

• Golfing is a great way to challenge dynamic balance for those who would rather be golfing than bed-making. A putting green like this one makes setting this intervention up quick and easy.
• Dancing with your patients to their favorite music is a fun and challenging balance intervention. This can of course also be done in sitting as seen in the linked video.
• If your facility has the equipment, table tennis is another fun occupation-based balance challenge that feels more functional than basic balloon batting.
• Yoga and Tai Chi: These mind-body practices are low impact activities that are shown to that can help improve both balance and coordination as well as reduce the risk of falls.

Occupation-Based Dynamic Sitting Balance Interventions

Dynamic sitting balance is also an important activity to address for patients who may not yet be able to stand, and who have impaired balance during unsupported sitting.

Just be sure to have your activities set up prior to starting these interventions and never leave your patient sitting at the edge of the bed without you being in arms reach (I had a close call back in fieldwork which taught me this the hard way!).

1. Dynamic Sitting Balance Activities During ADLs

If static sitting edge of bed has become manageable for your patient, you can progress to sitting unsupported at edge of bed and completing the following dynamic activities to challenge sitting balance. Your patient may require a second set of hands for these activities. Also, be sure you stay close at all times in case there is a loss of balance.

• Lower body dressing, which can include donning/doffing socks and shoes, as well as threading pants. This also incorporates reaching to low surfaces along with challenging balance.
• Bathing, including lower body bathing if possible. If lower body ADLs are too challenging, you can grade this down for the patient to focus just on upper body bathing edge of bed.
• Other upper body ADLs in unsupported sitting: grooming, upper body dressing, while reaching in multiple planes to retrieve the items.

2. Dynamic Sitting Balance During I-ADLs

• Laundry management in sitting (either edge of bed or wheelchair-level), which can include reaching for the floor to retrieve and place clothing items in multiple planes. This can be done with or without the use of a reacher.
• Organizing the hospital room from wheelchair level, which could include reaching in high and low planes to rearrange or throw away items.
• Meal preparation sitting in the wheelchair, while adding in reaching for dishes, pots, pans, food items, etc.
• Window washing with reaching incorporated.

3. Recreational Activities to Challenge Sitting Balance

Many of the above standing recreational activities can also be applied while seated. Here are some other ideas for sitting balance:

• Playing corn hole, which incorporates functional reaching and core control
• Bowling in seated
• Completing Wii games and activities with reaching incorporated
• Seated table tennis
• Playing Horseshoes competitively with other participants

To challenge sitting balance when your patient is supported in their wheelchair, you can have them scoot their hips forward so their backs are off of the seat to challenge their balance further (if the patient is safe to do this).

Lastly, Don’t Forget About Falls Education!

While this isn’t a physical intervention, I wanted to add in the importance of regularly providing education regarding your patient’s impaired balance and increased fall risk. During your treatments, be sure to educate about the basics of reducing falls at home (removing clutter/cords, having the right lighting, appropriate footwear, using their assistive devices, etc.).

It might seem like common sense to us as therapists, but many patients might not be aware of the basic fall risks after they go home. You can also provide easy to read handouts like this one from the CDC to your patient/their caregiver in case they aren’t able to retain all of your education.

 

_______________

I hope this post sparked some fresh new balance intervention ideas for you! With any intervention, I do want to end by reminding readers that the intervention you choose will depend on your patient’s individual’s needs and goals, as well as their specific medical condition. Remember to always keep things client-centered and adhere to any precautions.

What are your favorite occupation-based balance interventions? Please feel free to share them in the comments below!

This post was originally published on January 28, 2018 and updated on October 1, 2020 and May 9, 2023.