Why is balance assessment important?
Numerous conditions can influence balance. Multiple body system is vital in upholding stability and coordinating movements. Some prevalent conditions relevant to physiotherapists and physiotherapy that can affect balance are:
ARTHRITIS: Arthritis can cause joint pain, stiffness, and swelling, reducing range of motion and impaired balance. 1
FRACTURE REHABILITATION: Fracture healing may result in temporary balance impairments due to immobilisation, muscle atrophy, and pain. Rehabilitation is essential for regaining balance and coordination. 2
OBESITY MANAGEMENT: Obesity can alter an individual's centre of gravity and increase the load on the musculoskeletal system, impairing balance and postural control. 3
SURGICAL REHABILITATION: Post-surgical patients may experience balance impairments due to pain, swelling, immobilisation, and muscle weakness. Rehabilitation is essential for regaining balance and functional mobility. 4
OCCUPATIONAL HEALTH: Work-related injuries or repetitive stress can lead to musculoskeletal imbalances, joint dysfunction, and pain, which may affect balance and coordination. 5
DEVELOPMENTAL: Developmental disorders can affect balance and coordination due to motor impairments, muscle weakness, and sensory processing difficulties. 6
SPRAINS, STRAINS AND TEARS: Sprains, strains, and tears of muscles, ligaments, or tendons can lead to localised pain, swelling, and reduced range of motion, which can, in turn, impair balance and coordination during weight-bearing and functional activities. 7
NERVE COMPRESSION: Nerve compressions, such as carpal tunnel syndrome or lumbar radiculopathy, can lead to sensory deficits, muscle weakness, and impaired proprioception, affecting balance and coordination. 8
JOINT INFLAMMATION: Joint inflammation, as seen in conditions like rheumatoid arthritis or osteoarthritis, can cause pain, stiffness, and swelling, leading to a reduced range of motion, muscle weakness, and joint instability, impairing balance. 9
JOINT DISLOCATION: Joint dislocations can cause pain, instability, and impaired range of motion, leading to difficulty bearing weight and maintaining balance. Rehabilitation often focuses on restoring joint stability and retraining balance and coordination. 10
What is the Balance Mat?
The Balance Mat is a patented lightweight “smart” rubberised floor mat that connects to a Windows 10 or Mac OS computer and uses fibre-optic cable sensors and proprietary algorithms to provide a real-time dynamic graph and score. Its operation involves a person standing in a sequence of four well-known balance assessment stances: normal, tandem, left foot, and right foot.
The Balance Mat Pro looks the same as the standard Balance Mat but has extra functionality in that each of the four tests can be conducted with the person having eyes closed and open. The eyes-closed tests make the Balance Mat Pro suitable for studying the correlation between balance ability and neurological conditions like dementia or Parkinson’s disease.
A single test in the normal, tandem and left- and right-foot positions take only 20 seconds to conduct each for each position. A full balance test requires only four or eight positions to be tested, depending on which model is chosen. Consequently, a full balance test provides results in minutes rather than the hours or even days that traditional force plates, inertial sensors or manual systems can take.
The Australian Therapeutic Goods Administration (TGA) approved the Balance Mat in December 2021 as a Class 1 medical device and has listed it on the Australian Register of Therapeutic Goods
(ARTG).
Value for Professional Practice
Incorporating balance and postural sway analysis in the assessment and treatment procedures of physiotherapists is essential for several reasons:
IDENTIFYING BALANCE IMPAIRMENTS: Assessing balance allows physiotherapists to identify deficits or impairments in a patient’s postural control, stability, and mobility. This is essential for determining the most appropriate and effective treatment plan.
ESTABLISHING BASELINE AND MONITORING PROGRESS: Balance assessments provide a baseline measurement that can be used to monitor a patient’s progress throughout their rehabilitation. Regular assessments help physiotherapists adjust treatment plans as needed to ensure optimal progress and recovery.
EVALUATING FALL RISK: Assessing balance is critical in determining a patient’s risk of falling. Fall prevention is a significant concern for older adults and individuals with certain medical conditions. Physiotherapists can use balance assessment results to develop targeted interventions to reduce the risk of falls and related injuries.
GUIDING EXERCISE PRESCRIPTION: Understanding a patient’s balance abilities helps physiotherapists design appropriate exercise programs that challenge and improve balance without causing undue risk of falls or injury.
ASSESSING THE EFFECTIVENESS OF INTERVENTIONS: By regularly assessing a patient’s balance, physiotherapists can evaluate the effectiveness of interventions and modify treatment strategies as needed to ensure the best possible outcomes.
ENHANCING PATIENT EDUCATION AND AWARENESS: Balance assessments provide valuable information that physiotherapists can use to educate patients about their balance impairments and the importance of targeted exercises and interventions to improve their stability and reduce the risk of falls.
FACILITATING COMMUNICATION WITH OTHER HEALTHCARE PROVIDERS: Physiotherapists can use balance assessment results to communicate with other healthcare professionals, such as physicians or occupational therapists, to develop a comprehensive, multidisciplinary approach to managing a patient’s overall health and wellbeing.
Example Use Case 1
PATIENT BACKGROUND: A 72-year-old female patient visits a physiotherapy clinic with concerns about her balance and a recent history of falls. The patient has mild osteoarthritis in her knees and hips but no other significant medical conditions. The physiotherapist decides to use postural sway measurement with the Balance Mat as a novel approach to assess the patient’s balance and integrate the findings into a comprehensive treatment plan.
PROCEDURE:
1. The physiotherapist conducts a thorough assessment, including a detailed medical history, physical examination, and functional movement screening to identify potential balance impairments and fall risks.
2. The patient is asked to stand on the Balance Mat with their feet hip-width apart and eyes open. The Balance Mat records postural sway data during this assessment.
3. The patient is then asked to perform the same test with closed eyes. This allows the physiotherapist to assess the patient’s proprioceptive and vestibular contributions to balance.
4. The Balance Mat’s software analyses the postural sway data and provides the physiotherapist with detailed information about the patient’s balance and stability.
OUTCOME: The postural sway assessment reveals increased sway, indicating a higher risk of falls. Based on the assessment results and the patient’s medical history, the physiotherapist designs a comprehensive treatment plan that includes balance training exercises, lower extremity strengthening, and gait training. Additionally, the physiotherapist provides the patient with fall prevention education and strategies to improve her home environment.
INTEGRATION INTO WIDER TREATMENT PLAN:
1. The physiotherapist uses the postural sway data to set specific, measurable goals for the patient’s balance improvement.
2. The Balance Mat assessments are used regularly in the patient’s treatment plan to monitor progress and adjust exercise prescriptions accordingly.
3. The physiotherapist communicates the postural sway findings with the patient’s primary care physician and other healthcare providers to ensure a multidisciplinary approach to fall prevention and overall health.
FOLLOW-UP: The physiotherapist schedules regular follow-up appointments for the patient. During these appointments, the Balance Mat is used to reassess the patient’s postural sway, track improvements, and make necessary adjustments to the treatment plan. This information helps the physiotherapist evaluate the effectiveness of the interventions and ensures the best possible outcomes for the patient.
Example Use Case 2
PATIENT BACKGROUND: A 21-year-old female patient, an avid runner with a high level of physical fitness, is referred to a physiotherapy clinic by her general practitioner (GP) due to concerns about balance issues and occasional dizziness during exercise. The patient has no significant medical history but has been experiencing these symptoms intermittently over the past few months. The physiotherapist decides to use postural sway measurement with the Balance Mat as a novel approach to assess the patient’s balance and integrate the findings into a comprehensive treatment plan.
PROCEDURE:
1. The physiotherapist conducts a thorough assessment, including a detailed medical history, physical examination, and functional movement screening to identify potential balance impairments and exercise-related issues.
2. The patient is asked to stand on the Balance Mat with their feet hip-width apart and eyes open. The Balance Mat records postural sway data during this assessment.
3. The patient is then asked to perform the same test with closed eyes. This allows the physiotherapist to assess the patient’s proprioceptive and vestibular contributions to balance.
4. The Balance Mat’s software analyses the postural sway data and provides the physiotherapist with detailed information about the patient’s balance and stability.
OUTCOME: The postural sway assessment reveals subtle balance deficits, possibly contributing to the patient’s reported dizziness during exercise. Based on the assessment results and the referral from the GP, the physiotherapist designs a comprehensive treatment plan that includes balance training exercises, proprioceptive training, and tailored cardiovascular training to address the patient’s specific needs.
INTEGRATION INTO WIDER TREATMENT PLAN:
1. The physiotherapist uses the postural sway data to set specific, measurable goals for the patient’s balance improvement and exercise tolerance.
2. The Balance Mat assessments are used regularly in the patient’s treatment plan to monitor progress and adjust exercise prescriptions accordingly.
3. The physiotherapist communicates the postural sway findings with the patient’s GP and other healthcare providers to ensure a multidisciplinary approach to the patient’s overall health and fitness.
FOLLOW-UP: The physiotherapist schedules regular follow-up appointments for the patient. During these appointments, the Balance Mat is used to reassess the patient’s postural sway, track improvements, and make necessary adjustments to the treatment plan. This information helps the physiotherapist evaluate the effectiveness of the interventions and ensures the best possible outcomes for the patient. The physiotherapist also informs the GP of the patient’s progress and any changes to the treatment plan.
Example Use Case 3
PATIENT BACKGROUND: A Patient Background: A 45-year-old male patient visits a physiotherapy clinic after recently suffering from a fractured ankle. The patient has been using crutches and a walking boot and the orthopedic surgeon has recommended physiotherapy to help restore strength, range of motion, and balance. The physiotherapist decides to use postural sway measurement with a balance assessment tool as a novel approach to assess the patient’s balance and integrate the findings into a comprehensive treatment plan.
PROCEDURE:
1. The physiotherapist conducts a thorough assessment, including a detailed medical history, physical examination, and functional movement screening to evaluate the patient’s ankle injury, strength, and range of motion.
2. The patient is asked to stand on a balance assessment tool with their feet hip-width apart and eyes open. The device records postural sway data during this assessment.
3. The patient is then asked to perform the same test with closed eyes. This allows the physiotherapist to assess the patient’s proprioceptive and vestibular contributions to balance and any residual effects of the injury on balance.
The balance assessment tool’s software analyses the postural sway data and provides the physiotherapist with detailed information about the patient’s balance and stability.
OUTCOME: Based on the balance assessment results and the overall evaluation, the physiotherapist identifies balance impairments and develops a targeted treatment plan. The plan includes exercises to improve ankle strength, range of motion, balance and functional activities that simulate everyday tasks to help the patient regain confidence in their mobility.
INTEGRATION INTO WIDER TREATMENT PLAN:
1. Balance training progression: Based on the postural sway measurements and other assessment findings, the physiotherapist designs a progressive balance training program. This program includes static and dynamic balance exercises, starting with simple tasks and gradually increasing in complexity and difficulty as the patient’s balance and ankle function improve.
2. Gait retraining: The physiotherapist incorporates gait retraining exercises into the treatment plan to address any gait abnormalities caused by the ankle fracture and subsequent immobility. The balance assessment results inform the physiotherapist about potential balance challenges during walking, allowing them to design targeted interventions to optimize the patient’s gait pattern.
3. Patient education and home exercise program: The physiotherapist educates the patient about the importance of balance training and provides them with a home exercise program tailored to their specific needs. The postural sway measurements help the physiotherapist to select appropriate exercises and monitor the patient’s progress, ensuring the home program remains practical and up-to-date.
FOLLOW-UP: The physiotherapist schedules regular follow-up appointments for the patient to monitor his progress. Postural sway measurements are taken during these appointments to track improvements in balance and stability. This information helps the physiotherapist assess the treatment plan’s effectiveness1, make necessary adjustments, and provide ongoing support to the patient as they work towards a full recovery and return to their normal activities.
Costs of Implementation
COST OF THE BALANCE MAT DEVICE: The initial cost of purchasing it varies depending on the specific model and any additional features, such as integrated sensors or advanced analytics capabilities. Budgetary cost: $3,300
SOFTWARE AND HARDWARE REQUIREMENTS: The Balance Mat may be supplemented by additional data analysis, interpretation, and storage software. This software is subscription-based, which will incur ongoing costs. Additionally, there may be hardware requirements, such as a compatible computer or tablet, to run the software and interface with the Bhardware requirements, such as a compatible computer or tablet, may be required. Additional data analysis, interpretation, and storage software may supplement the Balance Matalance Mat. Estimated cost: $500 - $1,500 (initial setup) + $396/year (software subscription).
STAFF TRAINING EXPENSES: To effectively integrate the Balance Mat into the clinical workflow, staff members may require training using the device and interpreting the data. This may include on-site or online training sessions provided by the Balance Mat manufacturer or an authorised third-party training provider. Estimated cost: $500 - $2,000.
MAINTENANCE AND UPDATES: The Balance Mat and associated software may require periodic maintenance to ensure optimal performance and compatibility with any new technological advancements incorporated. Depending on our warranty and updated policies, this may involve additional costs. Estimated annual budget: $500.
Total Estimated Costs:
INITIAL SETUP BUDGET: $3,000 - $7,500 (including the device, software, hardware, warranty and training expenses)
ONGOING COSTS: $200 - $800/year (including software subscription, maintenance, and updates)
Just so you know, these costs are budgetary and may vary depending on the specific Balance Mat model, software, hardware, and training options chosen for a particular clinical setting.
Return on Investment
The Balance Mat offers a significant potential return on investment (ROI) for physiotherapists by providing numerous benefits that can improve patient care, reduced healthcare costs, and enhance clinical decision-making.
IMPROVED PATIENT OUTCOMES: Using a balance mat to assess and monitor a patient’s balance and postural sway allows the physiotherapist to tailor treatment plans more effectively, ultimately leading to better patient outcomes. Satisfied patients are more likely to recommend the physiotherapist to others, potentially increasing the client base.
ENHANCED CLINICAL EFFICIENCY: A balance mat can provide objective, quantitative data on balance, enabling the physiotherapist to track progress and make data-driven decisions about treatment plans. This efficiency may reduce treatment times and improve patient throughput, allowing the physiotherapist to see more clients and increase revenue.
DIFFERENTIATION FROM COMPETITORS: Incorporating advanced technology like a balance
mat into the practice can help differentiate the physiotherapy clinic from competitors, making it more attractive to potential clients and referral sources such as physicians or other healthcare professionals.
EXPANDED SERVICE OFFERINGS: The balance mat can be used to assess balance and stability in various populations, including older adults, athletes, and individuals recovering from injury or surgery. This versatility enables the physiotherapist to offer specialised balance and fall prevention programs, which can attract new clients and generate additional revenue streams.
INCREASED CLIENT RETENTION: By providing clients with a more comprehensive and individual approach to their rehabilitation, they may be more likely to continue attending sessions, complete their prescribed treatment plans, and return for future services.
INSURANCE REIMBURSEMENT: Some insurance companies may reimburse physiotherapists for using balance assessment tools like the balance mat, providing an additional source of income.
MARKETING TOOL: The balance mat can be a marketing tool, demonstrating the physiotherapist’s commitment to evidence-based practice and cutting-edge technology. This can help build a strong reputation and brand image, attracting more clients in the long run.
Case Study - Integrating Balance Mat in a Comprehensive Concussion Monitoring Trial in South Australia
OVERVIEW: The Balance Mat has been introduced as a critical component in a large-scale concussion baseline monitoring program in South Australia. This program’s primary goal is to quickly establish a foundational data set encompassing participants from various sports levels, including professional and junior athletes. The Balance Mat’s unique ability to measure an athlete’s postural sway provides a baseline that can be used to monitor the effects of concussions over time for each individual.
METHODOLOGY: Advanced Neuro Rehab (ANR) in Adelaide has initiated the program, employing a combination of tools and methods, such as the Balance Mat, Virtual Reality headsets from Neuroflex, eye movement measurement, and questionnaires. The testing is conducted at major sports venues, with athletes being assessed using the Balance Mat in the tandem stance position.
EXPANSION AND COLLABORATION: The program is set to expand, involving numerous physiotherapy practices across South Australia, all of which will be required to purchase the Balance Mat as a part of the monitoring kit. By early 2024, the goal is to expand the program nationally.
PILOT TESTING: In January and February 2023, 94 North Adelaide Football Club athletes’ balance was assessed using the Balance Mat on three separate occasions. The tandem stance balance scores were ranked from lowest to highest for the 93 athletes tested. Results demonstrated a range of postural sway, with the lowest score of 2.3 indicating excellent balance and the highest score of 26.4 reflecting poor balance.
What does the Balance Mat cost?
Balance Mat
• Balance Mat operating software enabling four sequential tests per person tested.
• Graphs and summaries showing individuals with good, fair and poor balance and any results of concern flagged (e.g., falls risk, severe weakness in tandem stance, significant differences in left- and right-footed stances).
To own: $3,000 ($3,300 incl. GST)
To trial (10 weeks): $300 ($330 incl. GST) *
Balance Mat Pro
• The Balance Mat Pro operating software enables eight sequential tests per person
• Provision of graphs and summaries showing individuals with good, fair and poor balance and any results of concern flagged (e.g., falls risk, neurological problems, severe weakness in tandem stance, significant differences in left- and right-footed stances).
To own: $4,500 ($4,950 incl. GST)
To trial (10 weeks): $600 ($660 incl. GST) *
Features common to both systems
• Free delivery
• 600mm x 700mm Balance Mat
• USB cable (note that a Windows 10 or Mac OS computer is to operate the system)
• Choice of running Balance Mat system and saving results online or offline
• Access to Balance Mat test results system
• Ability to see and record patterns of movement for each person tested and capture their biodata
• Ability to de-identify data for custom analyses
Trial the Balance Mat for 10% of the total cost
We offer approved customers a 10-week trial of the Balance Mat.
Email the Balance Mat Product Manager, Ian Bergman, at ian.bergman@balancemat.
com.au. Ian will then discuss the trial arrangements with you, including special training and client requirements.
Each trial will expire ten weeks trial after the date of payment. We will contact you to arrange for full payment or product return. Should you wish to return the system after the ten weeks trial, we request that you cover the return charges.
Note that the 10% trial fee is not refundable.
Delivery is free and will be within four to six weeks of your payment being processed.
References
1. Juhl, C., Christensen, R., Roos, E. M., Zhang, W., & Lund, H. (2014). Impact of exercise type and dose on pain and disability in knee osteoarthritis: a systematic review and network meta-analysis of randomised controlled trials. Arthritis & Rheumatology, 66(3), 622-636. https://doi. org/10.1002/art.38290
2. Reference: Handoll, H. H., & Elliott, J. (2015). Rehabilitation for distal radial fractures in
adults. The Cochrane Database of Systematic Reviews, 2015(9), CD003324. https://doi.
org/10.1002/14651858.CD003324.pub3
3. Reference: McGraw, B., McClenaghan, B. A., Williams, H. G., Dickerson, J., & Ward, D. S. (2000). Gait and postural stability in obese and nonobese prepubertal boys. Archives of Physical Medicine and Rehabilitation, 81(4), 484-489. https://doi.org/10.1053/mr.2000.3780
4. Reference: Piva, S. R., Teixeira, P. E., Almeida, G. J., Gil, A. B., DiGioia, A. M., & Levison, T. J.
(2011). Contribution of hip abductor strength to physical function in patients with total knee arthroplasty. Physical Therapy, 91(2), 225-233. https://doi.org/10.2522/ptj.20100122
5. Reference: da Costa, B. R., & Vieira, E. R. (2010). Risk factors for work-related musculoskeletal disorders: A systematic review of recent longitudinal studies. American Journal of Industrial Medicine, 53(3), 285-323. https://doi.org/10.1002/ajim.20750
6. Reference: Smits-Engelsman, B., & Hill, E. L. (2012). The relationship between motor coordination and intelligence across the IQ range. Pediatrics, 130(4), e950-e956. https://doi. org/10.1542/peds.2012-0345
7. Reference: Waterman, B. R., Owens, B. D., Davey, S., Zacchilli, M. A., & Belmont, P. J. (2010). The epidemiology of ankle sprains in the United States. Journal of Bone and Joint Surgery, 92(13), 2279-2284. https://doi.org/10.2106/JBJS.I.01537
8. (Balakatounis et al., 2008) Reference: Balakatounis, K. C., & Angoules, A. G. (2008). Low back pain and sciatica prevalence and intensity reported in a Mediterranean country: ordinal logistic regression analysis. Orthopedics, 31(7), 650-656. https://doi.org/10.3928/01477447-20080701-21
9. (Ferrigno et al., 2011) Reference: Ferrigno, C., Wimmer, M. A., Trombley, R. M., Lundberg, H. J., Shakoor, N., & Thorp, L. E. (2011). A reduction in the knee adduction moment with medial thrust gait is associated with a medial shift in the centre of plantar pressure. Journal of Biomechanics, 44(16), 2811-2816. https://doi.org/10.1016/j.jbiomech.2011.08.012
10.(Golanó et al., 2013) Reference: Golanó, P., Vega, J., de Leeuw, P. A., Malagelada, F., Manzanares, M. C., Götzens, V., & van Dijk, C. N. (2013). Anatomy of the ankle ligaments: a pictorial essay. Knee Surgery, Sports Traumatology, Arthroscopy, 21(5), 1060-1069. https://doi. org/10.1007/s00167-012-2136-3
