PHYT1221: sensorimotor prescription

Steady-state balance

Maintaining a stationary position without changing the base of support (such as standing still), utilizing continuous sensory feedback to execute small postural adjustments.

Clinical assessments for steady-state balance

Quiet stance tests, including standing with feet apart, feet together, step stance, tandem stance, or on one leg, progressed by altering visual input or support surfaces.

Anticipatory balance (concept and assessment)

Maintaining stability during self-initiated, planned movements; evaluated using tests such as the Y-Balance Test or Star Excursion Balance Test.

Reactive balance (concept and assessment)

Recovering stability following an unexpected disturbance or perturbation; evaluated using perturbation assessments such as the Marsden Pull Test.

Quiet stance position progression (least to most challenging)

Bilateral stance with feet apart → feet together → step stance → tandem stance → single-leg stance.

Surface progression in quiet stance training

Firm surface → foam pad → mini-trampoline → single-direction wobble board → multidirectional wobble board or Duradisk.

what patients would start with quiet stance (feet apart and eyes open)

Individuals with poor balance, high fall risk, significant lower-extremity weakness, or minimal standing confidence who require a wide base of support and visual feedback.

Patient indication: progressing to feet-together stance with eyes closed

Individuals who are safe and steady standing with eyes open on a wider base, ready for a challenge that narrows the base of support and removes visual input.

Patient indication: starting balance training in step stance with eyes open

Individuals who can stand safely with feet apart but need an intermediate challenge that narrows the base of support beyond standard bilateral stance.

Patient indication: initiating balance training in single-leg stance with eyes open

High-functioning individuals or athletes in late-stage rehabilitation who demonstrate good standing balance and can safely perform unilateral weight-bearing.

Patient indication: starting balance training in tandem stance

Individuals who can safely maintain feet-together or step stance and are ready for a narrower linear base of support before progressing to single-leg stance.

Initial clinical approach to sensorimotor cases

Interviewing the patient to identify main problems and functional goals, assessing challenging activities and contributing impairments, establishing a prioritized problem list, and designing safe, graded practice.

Clinical signs of impaired anticipatory balance

Instability or loss of balance during planned movements, such as reaching, stepping, turning, transitioning from sit-to-stand, or moving a limb while standing.

Clinical signs of impaired reactive balance

Difficulty recovering stability after an unexpected trip, slip, or bump, characterized by requiring multiple compensatory steps or external support to prevent a fall.

Clinical signs of impaired steady-state balance

Difficulty maintaining a stationary posture while standing still, evidenced by excessive postural sway, reliance on upper-limb support, or inability to hold a stance for the targeted duration.

Therapeutic exercises targeting anticipatory balance

Planned standing reaches, weight shifts, clock-face or toe taps, multidirectional stepping, side steps, and controlled functional gait tasks near a sturdy counter or support.

Interventions and exercise progressions to improve proprioception

Joint-position matching (progressively fading visual, tactile, or verbal cues), narrowing the base of support, and carefully progressing to compliant surfaces or eyes-closed conditions under supervision.

Therapeutic exercise progression for steady-state balance

Holding progressively challenging stances (feet apart, feet together, step stance, tandem stance, single-leg stance) while systematically varying one parameter at a time, such as stance width, hold duration, or surface.

Therapeutic exercises targeting reactive balance

Rapid compensatory stepping in response to unexpected external cues, along with clinician-supervised perturbation training such as gentle pushes, pulls, or lean-and-release drills.

Components of the sensorimotor system

The integrated physiological network regulating posture and movement, comprising somatosensory, visual, and vestibular inputs, cognitive and central processing, motor planning pathways, and neuromuscular/musculoskeletal structures.

Steady state balance exercises

Exercise	How to do it	Make it harder
Standing with feet hip-width apart	Stand at the bench and hold a steady posture.	Bring feet closer together.
Feet-together stance	Stand with feet together, eyes open.	Hold longer, while staying near the bench.
Step stance	Place one foot a little ahead of the other and hold. Practise with either foot forward.	Bring the feet closer to a heel-to-toe line.
Single-leg stance	Stand on one leg, keeping a hand near the bench.	Use a lighter fingertip touch or hold longer.
Tandem stance	Stand with one foot directly in front of the other, near the bench.	Reduce the gap between the feet or hold longer.

Anticipatory balance exercises

Exercise	How to do it	Make it harder
Standing weight shifts	At the bench, gently shift weight forward/back or from side to side.	Shift farther, while keeping control.
Standing reaches	Reach for light objects placed close by on the counter, then return upright.	Place them a little farther away or in different directions.
Toe taps	Stand at the counter and tap one foot forward, sideways, then behind; return it each time.	Reach the tapping foot farther or use less hand support.
Clock taps	Imagine targets around the standing foot. Tap the other foot toward the front, side and back targets.	Add more directions or increase reach distance.
Side steps along the counter	Step sideways, bring the other foot in, and continue for a few steps.	Take slightly larger steps or change direction.
Sit-to-stand	Stand up from a firm chair, then sit down with control. Keep the chair behind you.	Use less hand assistance or stand from a slightly lower chair.

Reactive stepping practice

Exercise	How to do it	Make it harder
Quick step on a sound cue/number cue	Stand beside the counter. When a phone timer or audio cue sounds, take one small step, then return to the starting position.	Use a less predictable cue timing or vary the step direction.
Direction-cue step	Use a recorded set of “forward,” “back,” “left” and “right” cues in a mixed order. Step in the called direction and return.	Respond more quickly, while keeping steps controlled.

Joint position sense

Exercise	How to do it	Make it harder
Knee position matching	Sit in a firm chair. Straighten the knee to a comfortable position, bend it, then try to straighten it to the same position again. Check visually at first.	Look less often while repeating the movement.
Ankle position matching	Sit with the foot supported. Point the foot gently up or down, return to neutral, then try to reproduce the same position.	Reduce visual checking if the movement stays controlled.
Comfortable trunk-position practice	Sit or stand and gently find a comfortable upright position. Move away from it slightly, then return to it.	Use a mirror less, and focus more on how the position feels.

Reaction time

Exercise	How to do it	Make it harder
Quick seated heel press	Sit in a sturdy chair. On a phone sound cue, quickly press one heel into the floor for 1–2 seconds, then relax.	Alternate heels in response to different cues.
Quick hamstring heel pull	Sit with a heel on the floor. On a cue, try to drag the heel backward without letting it move. Relax, then repeat.	Respond to cues at less predictable intervals.