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To: Rachel Balsam, Inda Immega, Sharon, JM Sheng, Sid Roberts, and Dave Lynn and others who have problems with falling and balance. Re: Balance exercises to improve balance Here are the balance exercises: First, you need a piece of foam 3-5 inches thick. I bought mine at Jo Ann Fabrics for 15$. There are eight conditions: 1. Stand on a flat surface with eyes open and head looking forward. Stand quietly and try not to sway. 2. Same as #1 with eyes closed. 3. Same as #1 with eyes open but with head looking up at ceiling. 4. Same as #3--but with eyes closed. Now do the same 4 conditions on a piece of foam. Use one piece of foam first. Then go to two pieces of foam. Hold each condition for at least 20 seconds. Repeat 1-8 five times. Part II..Perturbation Training done on floor and on foam. 1. stand on floor and gently pull subject backward 5X. Tell subject to try to sway from ankles (stand like a pencil)...do not bend at hips. After having pulled backwards allow subject to recover from pull and return to vertical position. So you are trying to pull the person off-balance, but not quite far enough that they fall. Do this from the front (pushing) and from the back (pulling), with eyes open and closed. 5X eyes open, 5X eyes closed etc. 2. Same thing on foam (more challenging). Part III...Ski Jumper 1. Person leans forward, backward, left and right (...trying to lean as far as possible, using an ankle strategy (bend the eyes open) ankles and not the hips). Go as far as possible without falling. Hold each position for 5 seconds. The "normal" limit of stability is 8 degrees forward and 4 degrees backward. Try to go to your limit of stability without going beyond it. 2. Same thing as #1 on foam. Spotting: Be sure to have a helper/spotter with you when you do this training...especially when eyes are closed and standing on foam, the odds of increased sway/falling increase. Also when doing perturbation training. Be ready to catch person or to keep them from going too far from a vertical position. Be cautious at first. Read some of these references before you start, just to get to know some of the literature on balance training and then ask your doctor about it, or show them an article and ask them what they think. Keep a record of how many exercises you have done and when you started. Go for a balance test with your neurologist or physical therapist, before and during training to see if it's working...get an objective assessment. Good luck, Mark ([log in to unmask]). Also...try not to do training if you are experiencing heavy dyskinesia. References: 1. Koller et al. (1989). Falls and PD. Clinical Neuropharmacology, 12, 98-105. 2. Schenkman et al. (1989). Management of individuals with PD: Rationale and case studies. Journal of Physical Therapy, 69, 64-74. 3. Hu MH, Woolacott MH. (1994). Multisensory training of standing balance in older adults: I. postural stability and one-leg stance balance, Journal of Gerontology, 49, M52-M56. 4. Wolfson L et al. (1993). Training balance and strength in the elderly to improve function. Journal of the American Geriatrics Society, 41, 341-343. 5. Shumway-Cook A, Horak FB. (1990). Rehabilitation for patients with vestibular deficits. Neurology Clinics, 8, 441-457. 6. Smith-Wheelock et al. (1991). Physical therapy program for vestibular rehabilitation. The American Journal of Otology, 12, 218-225. 7. Koller et al. (1994). An algorithm for the management of PD. Neurology, 44, (Supplement) S1-S48. 8. Telian et al. (1990). Habituation therapy for chronic vestibular dysfunction: preliminary results. Otolaryngology Head and Neck Surgery, 103, 89-95.