Balance Matters: A neuro physical therapist’s journey to make “Sense” of Balance

In this episode, get ready to spark your creativity as Jacob Weiss shares fun ways to engage individuals with coordination exercises.  He discusses how he developed HandEyeBody Method from over two decades of work researching the design of online tools for health and wellness, energizing audiences around the world as a professional juggler and keynote speaker, and teaching thousands of people and teams how to connect to their full potential through fun and accessible exercises.

Jacob Weiss, PhD, is the founder of HandEyeBody Academy, a social enterprise with a mission to help people learn how to move better, focus better, and function better, by teaching hand-eye coordination exercises that are creative, fun, and accessible for all abilities.

Since graduating from Princeton University and completing his PhD in Biomedical Informatics at Vanderbilt University, Dr. Weiss has developed and shared his interactive training programs with teachers, trainers, coaches, therapists, movement educators and organizations around the world.

Watch the interview in a video format here to see exercise examples.
To learn more about the coordination charts and exercises, go to HandEyeBody Academy - Hand-Eye Coordination Training & Professional Development

In this episode, we discuss some key elements when designing successful wellness programs.  Learn how Brett started and grew 110 Fitness and tips to help you incorporate new wellness programs into your practice.
Key elements:

1. Licensed instructors with specialized continuing education.
2.  Evidence-based programs: (How to stay up to date and be part of research).
3. Versatility of classes/programs to serve different interests.
4. Community outings to connect and decrease loneliness.

Brett Miller, PT, Founder and Owner of 110 Fitness
Home | 110 Fitness | Rockland MA Brett is the founder and owner of 110 Fitness in Rockland, Massachusetts, an all-inclusive wellness center as well as the largest wellness center in the world for individuals with Parkinson’s Disease. The mission of his wellness design is to set a new standard for the world in the “fight back” against Parkinson’s Disease through holistic and fitness-based approaches as well as breaking down all barriers for adults and children limited by disease or disability by sharing his exceptional mental and physical training and conditioning experience.  

Brett is a licensed physical therapist with 27 years of experience in all settings including sports therapy, acute and intensive care, long-term care, and wound care. He has worked in the fitness industry for 29 years with extensive experience in kickboxing, boxing, spinning, rowing, and strength and conditioning. He has worked as the strength and conditioning coach for world-class boxers and Olympic athletes focusing on injury prevention and rehabilitation. Additionally, he is the co-owner of Boston Orthotics, Inc. for the past 20 years. Brett also volunteered as an adaptive sports coach at New England Disabled Sports at Loon Mountain in Lincoln, New Hampshire for 18 years.    

Brett is a U.S. Army veteran and is proud to have served as a combat medic trainer for special operations.  He recently published, It’s A Beautiful Day To Save Lives: A Medic’s Journey to His Destiny. 

Brett serves as the co-chair for the Massachusetts Parkinson’s Registry as well as a Commissioner on the Massachusetts State Athletic Commission. He also serves as an ambassador for the Michael J. Fox Foundation for Parkinson’s Research and the Davis Phinney Foundation. He is a research consultant for the Cleveland Clinic and for innovative United States research companies as well as prominent Boston hospitals. Brett is proud to serve as a Legacy Guardian for the Til Valhalla Project and is an ambassador mentor for Hives for Heroes 

Articles to support designing wellness programs for individuals with PD

1. Ernst M, Folkerts AK, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson's disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2023 Jan 5;1(1):CD013856. doi: 10.1002/14651858.CD013856.pub2. PMID: 36602886; PMCID: PMC9815433.
2. Domingos J, Dean J, Fernandes JB, Massano J, Godinho C. Community Exercise: A New Tool for Personalized Parkinson's Care or Just an Addition to Formal Care? Front Syst Neurosci. 2022 Jun 30;16:916237. doi: 10.3389/fnsys.2022.916237. PMID: 35844246; PMCID: PMC9280427.
3. Moore A, Yee E, Willis BW, Prost EL, Gray AD, Mann JB. A Community-based Boxing Program is Associated with Improved Balance in Individuals with Parkinson's Disease. Int J Exerc Sci. 2021 Jun 1;14(3):876-884. PMID: 35096235; PMCID: PMC8758155.
4. Subramanian I, Farahnik J, Mischley LK. Synergy of pandemics-social isolation is associated with worsened Parkinson severity and quality of life. NPJ Parkinsons Dis. 2020 Oct 8;6:28. doi: 10.1038/s41531-020-00128-9. PMID: 33083522; PMCID: PMC7545190.

Great discussion on neurorehabilitation perspectives.  We discussed are we addressing the client’s perspective?  What does the client want and what is their needs vs. what we think may be important.  In neurorehabilitation, the therapist is interested in how the person completes the activity, not just the task completion.  We talked the importance of observation skills and dived deeper into the Bobath model and current research, as well as compensatory movements, movement synergies and sensory integration.   
 
Bio: Julie Vaughan-Graham PT, PhD

Advanced IBITA Instructor (Honorary Life Member 2020)
Founder, Physio-Logic and iNeuroRehab
Assistant Clinical Professor (Adjunct), School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
Adjunct Lecturer, Department of Physical Therapy, University of Toronto, Canada

Julie graduated from St. Thomas’ Hospital, London, England in 1986 and has worked in the area of neurorehabilitation since 1988.  Julie emigrated to Toronto in 1991, initially taking a position at Lyndhurst, Spinal Cord Injury Centre, and then later opening her own private community neurorehabilitation practice, Physio-Logic, in Toronto in 1993.  

Julie completed her MSc in Neurological Rehabilitation at Leeds Metropolitan University, UK in 2010, and her PhD at the Rehabilitation Sciences Institute, University of Toronto in 2016.  Julie has had a number of post-doctoral positions and she holds an Assistant Clinical Professor (Adjunct) position in the School of Rehabilitation Science at McMaster University and, an Adjunct Lecturer appointment in the Department of Physical Therapy at the University of Toronto.

Julie recently founded iNeuroRehab, an e-learning platform for clinicians.  She is an Advanced IBITA instructor, and instructs post-graduate clinical neurorehabilitation courses across Canada and internationally.

Articles we discussed and published by Dr. Vaughan-Graham

After 55 Years of Neurorehabilitation, What Is the Plan? - PubMed (nih.gov)

Motor Control: A Conceptual Framework for Rehabilitation in: Motor Control Volume 26 Issue 4 (2022) (humankinetics.com)

Vaughan-Graham, J., Patterson, K., Brooks, D., Zabjek, K., & Cott, C. (2019). Transitions sit to stand and stand to sit in persons post-stroke: Path of centre of mass, pelvic and limb loading – A pilot study. Clinical Biomechanics, 61, 22-30. doi:https://doi.org/10.1016/j.clinbiomech.2018.11.004

http://www.sciencedirect.com/science/article/pii/S026800331830620X

 Michielsen, M., Vaughan-Graham, J., Holland, A., Magri, A., & Suzuki, M. (2017). The Bobath concept – a model to illustrate clinical practice. Disability and Rehabilitation, 1-13. doi:10.1080/09638288.2017.1417496

https://doi.org/10.1080/09638288.2017.1417496

https://www.tandfonline.com/doi/full/10.1080/09638288.2017.1417496

 Vaughan-Graham, J., Patterson, K., Zabjek, K., & Cott, C. (2017). Conceptualizing movement by expert Bobath instructors in neurological rehabilitation. Journal of Evaluation in Clinical Practice, 23(6), 1153-1163. doi:10.1111/jep.12742

https://doi-org.myaccess.library.utoronto.ca/10.1111/jep.12742

Jaimy Wahab PT, DPT, NCS is a neurologic and vestibular physical therapist. She is the founder/owner of the Balance and Neurologic Center of the Rockies and an affiliate instructor for the Doctor of Physical therapy program at Regis University.  She is an Affiliate Educator at Re+Active Education, an online, international continuing education platform, teaching advanced vestibular rehabilitation content. She became board certified as a Neurologic Clinical Specialist in 2007 and recertified in 2017. Current clinical interests include evaluation and treatment of patients with complex vestibular disorders, movement disorders, and functional neurologic disorders.  She has a special interest in treating visual motion hypersensitivity and functional dry needling in the person with spasticity and dystonia to optimize outcomes and quality of life. She has been an invited panel member for the Brain Injury Hope Foundation. She has been involved in research regarding peripheral neuropathy and Parkinson’s Disease as well as Dual task with Parkinson’s Disease at Regis University.  

Katherine Deines, PT, DPT, NCS is a neurologic and vestibular physical therapist and owner/founder of STEP UP Physical Therapy in Colorado. She achieved her competency in vestibular rehabilitation through Emory University in 2002. She became a board certified neurologic clinical specialist in 2007 with recertification in 2017. Teaching experience includes assisting in the neurologic and vestibular coursework for the University of Colorado Doctor of Physical Therapy program. She is an affiliate educator with Re+Active Education, an online continuing education platform, teaching advanced vestibular rehabilitation content. The popular course, A Positive Spin on Dizziness, reached an international audience. Her clinical research with Regis University investigated peripheral neuropathy in Parkinson’s Disease. Current clinical interests include the evaluation and treatment of those with complex vestibular disorders with a special interest in visual motion hypersensitivity and those with movement disorders including Parkinson’s Disease, dystonia, and functional neurologic disorders. She is passionate about improving the function and quality of life of her patients. 

References:

Optic flow, Visual dependence, visual vertigo (dizziness-and-balance.com)

• O'Connor SM, Kuo AD. Direction-dependent control of balance during walking and standing. J Neurophysiol. 2009 Sep;102(3):1411-9. doi: 10.1152/jn.00131.2009. Epub 2009 Jun 24. PMID: 19553493; PMCID: PMC2746770.
• Thompson JD, Franz JR. Do kinematic metrics of walking balance adapt to perturbed optical flow?. Hum Mov Sci. 2017;54:34-40. doi:10.1016/j.humov.2017.03.004
• Wolf C, Lappe M. Vision as oculomotor reward: cognitive contributions to the dynamic control of saccadic eye movements. Cogn Neurodyn. 2021 Aug;15(4):547-568. doi: 10.1007/s11571-020-09661-y. Epub 2021 Jan 25. PMID: 34367360 

Classic texts say that tai chi will help you become 
“Strong as an oak, flexible as a willow, and [mentally] clear as still water.”

It’s often called meditation in motion. Scientific studies are showing more and more health benefits that you can get from this practice.

 
Dianne Bailey, CSCS, FAS, CTCI

As a fitness professional, martial artist, and owner of a successful personal training studio in Denver, Dianne is passionate about creating the best opportunities for the mature adult to enjoy health and fitness. This passion has led her to create a system for learning Tai Chi which will empower fitness professionals to be able to offer this amazing form of exercise to their clientele and help others learn this wonderful form of “movement meditation.”  

Dianne is the author of three books:
 Eating Simply  

Open the Door to Tai Chi . . . Tai Chi for the Everyday Person

Healthy, Happy and Fit – Ageless Exercise to enjoy Your Best Years Yet

Dianne is a CSCS, a Functional Aging Specialist and a Certified Tai Chi Instructor. She has presented the benefits of Tai Chi at the Functional Aging Summit, ICAA Conference and Fitness Fest. In her engaging, easy-going yet commanding style, she hopes to encourage people to include Tai Chi in their offerings.

Here are some Tai Chi resources.

New 30 Days of Tai Chi.  Here is the link to Day 1.

A link to Diane's presentation, 'Who can use Tai Chi' 

 Tai Chi for Balance - VeDA (vestibular.org)

Articles: (So many choices)

Wang LC, Ye MZ, Xiong J, Wang XQ, Wu JW, Zheng GH. Optimal exercise parameters of tai chi for balance performance in older adults: A meta-analysis. J Am Geriatr Soc. 2021 Jul;69(7):2000-2010. doi: 10.1111/jgs.17094. Epub 2021 Mar 26. PMID: 33769556.

Hu C, Qin X, Jiang M, Tan M, Liu S, Lu Y, Lin C, Ye R. Effects of Tai Chi Exercise on Balance Function in Stroke Patients: An Overview of Systematic Review. Neural Plast. 2022 Mar 9;2022:3895514. doi: 10.1155/2022/3895514. PMID: 35309256; PMCID: PMC8926482.

Zhang T, Lv Z, Gao S. Tai Chi Training as a Primary Daily Care Plan for Better Balance Ability in People With Parkinson's Disease: An Opinion and Positioning Article. Front Neurol. 2021 Dec 24;12:812342. doi: 10.3389/fneur.2021.812342. PMID: 35002945; PMCID: PMC8739955.

Li G, Huang P, Cui SS, et al. Mechanisms of motor symptom improvement by long-term Tai Chi training in Parkinson's disease patients. Transl Neurodegener. 2022;11(1):6. Published 2022 Feb 7. doi:10.1186/s40035-022-00280-7

Guo G, Wu B, Xie S, et al. Effectiveness and safety of Tai Chi for chronic pain of knee osteoarthritis: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2022;101(2):e28497. doi:10.1097/MD.0000000000028497

Winser SJ, Tsang WW, Krishnamurthy K, Kannan P. Does Tai Chi improve balance and reduce falls incidence in neurological disorders? a systematic review and meta-analysis. Clin Rehabil. (2018) 32:1157–68. 10.1177

Zou L, Han J, Li C, Yeung AS, Hui SS-C, Tsang WWN, et al. . Effects of tai chi on lower limb proprioception in adults aged over 55: a systematic review and meta-analysis. Arch Phys Med Rehabil. (2019) 100:1102–13. 10.1016/j.apmr.2018.07.425 

Mandy Shintani
Mandy Shintani is an occupational therapist, gerontologist and the founder of Urban Poling. Her mission is to inspire all towards active living and wellness through innovative pole designs and education.  As an avid proponent of life long fitness, she has experienced herself how Urban Poling fuels a healthy and fun lifestyle that includes, using poles with other exhilarating activities such as snowshoeing, hiking and adventure travel, which she is passionate about.  As a therapist, her design of the patented ACTIVATOR Poles was rooted in her desire to create a tool that would revolutionize mobility and rehabilitation programs.  She is an international presenter and is considered to be one of the leading experts on this activity.  She was a finalist at the YWCA Women of Distinction Awards in the category of Innovation and Entrepreneurship.

Resources:
https://urbanpoling.com/activator-and-urban-poling-research/

Learn about vestibular rehab technology, infrared video goggles from Helena Esmonde, the co-founder of Vestibular First.  

Dr. Helena Esmonde, PT, DPT, NCS, is co-founder of Vestibular First, a company that makes affordable, FDA-cleared Insight Infrared Video Goggles as well as vestibular education tools. Helena has been treating patients with dizziness, vertigo, and imbalance for 15 years and passed the Emory Vestibular Competency Exam in 2015. She became certified to treat Cervicogenic Dizziness in 2016 and achieved Board Certified Neurologic Clinical Specialist designation in 2018. Helena has taught continuing education courses on concussion, BPPV, balance assessment, and visual vertigo treatment, serves as a teaching assistant at the University of the Sciences in Philadelphia, and regularly presents at the Balance Center rounds at the Hospital of the University of Pennsylvania and the Penn Medicine Mind Your Brain Conference. Vestibular First provides Helena the best opportunity for number one goal of helping others, with already well over a quarter million patients served by vestibular care via their technologies.
References:

Education - Vestibular First: List of articles demonstrate how infrared video goggles and related technologies have been used in the diagnosis and treatment of vestibular disorders.  

·   Huh YE, Kim JS. (2013). Bedside evaluation of dizzy patients. Journal of Clinical Neurology. 9 (4): 203-213. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840130/

https://dizziness-and-balance.com/disorders/visual/visual_dependence.htm

Alaina Newell, PT, DPT
Board Certified Clinical Specialist in Oncological Physical Therapy
Board Certified Clinical Specialist in Women's Health Physical Therapy

Alaina received her Doctorate of Physical Therapy from the University of Pittsburgh in Pittsburgh, PA in 2012. She completed her Women’s Health residency at UPMC and joined the team in 2014. She is one of the few Board Certified Clinical Specialist in Oncology as well as Women’s Health Physical Therapy. She is also a Certified Lymphedema Therapist from the Lymphology Association of North America. She enjoys treated a wide variety of oncological diagnoses from melanoma, pancreatic, bladder, ovarian to breast cancer as well as Women’s Health needs secondary to oncological diagnosis including urinary urgency, gastrointestinal dysfunction, pelvic pain and postural dysfunction.

Alaina is passionate about approaching each patient’s individual needs and desires to improve their daily function and quality of life. She integrates her understanding of the foundational understanding of the neuromuscular, integumentary, musculoskeletal, cardiovascular systems with her advanced training in gastrointestinal and urogynecological system to approach each patient. She has a strong emphasis in restoring the body to its natural alignment to allow it to optimally function. Alaina is the Pelvic, GI & Sarcoma Cancer Clinical Coordinator at Oncology Rehab as well as sitting on Oncology Rehab's Breast Cancer and Chemotoxicity & Cancer Exercise teams.

Resources:
Oncology Rehab - Home
PORi - Oncology Rehabilitation Courses - Home

-          Aggithaya MG, Narahari SR, Ryan TJ. Yoga for correction of lymphedema's impairment of gait as an adjunct to lymphatic drainage: A pilot observational study. Int J Yoga. 2015 Jan;8(1):54-61. doi: 10.4103/0973-6131.146063. PMID: 25558134; PMCID: PMC4278136.

-          Doruk Analan P, Kaya E. Postural Stability in Patients with Lower Limb Lymphedema. Lymphat Res Biol. 2019 Dec;17(6):647-650. doi: 10.1089/lrb.2019.0004. Epub 2019 Jul 19. PMID: 31329503.

-          Forner-Cordero, Isabel & Furtado, Fabianne & Cervera-Deval, Juan & Forner-Cordero, Arturo. (2016). Ground reaction force patterns during gait in patients with lower limb lymphedema. Acta Fisiátrica. 23. 10.5935/0104-7795.20160038.

-          Forner-Cordero, Isabel & Forner-Cordero, Arturo & Maldonado-Garrido, D. & Cervera-Deval, J.. (2009). Biomechanical study of the gait in patients with lower limb lymphedema. European Journal of Lymphology and Related Problems. 20. 1-6.

-          Yoosefinejad AK, Hadadi M, Eslamloo P. Evaluating the responsiveness of the fullerton advanced balance scale in patients with lymphedema secondary to breast cancer surgery. Lymphology. 2019;52(2):61-70. PMID: 31525827

Music can lift moods, help with studying, and make workouts more productive and enjoyable. I know I enjoy working out to music, I run further and push myself more when I listen to music.

While all of those ways of listening to music are important, there is a difference between recreational music, therapeutic music, and clinical music therapy. 
Today we are going to learn from Sarah, a board-certified music therapist about the benefits of music therapy. 

Sarah's 2 tips to non- music therapists

1.       Create a rhythm using words and then get your metronome to match it and try to emphasize the most difficult part.

2.       Consider double priming, especially if someone is moving below 60 beats per min.

Listen to learn more...

Sarah Thompson, MM, MT-BC, CBIS  is a board-certified music therapist who has used music to influence movement for 17 years. She specializes in working with survivors of neurologic injuries and individuals living with neurologic diseases. She is the founder and CEO of Rehabilitative Rhythms and is currently a PhD student. She is a lifelong learner who is passionate about providing evidence-based practice in healthcare while keeping compassion and patient satisfaction a top priority. 

Resources : 

www.PossibleWithMusic.org

http://www.jessicagrahn.com/

Grahn, J. A., & Brett, M. (2007). Rhythm and beat perception in motor areas of the brain. Journal of cognitive neuroscience, 19(5), 893-906.

Leow, L. A., Parrott, T., & Grahn, J. A. (2014). Individual differences in beat perception affect gait responses to low-and high-groove music. Frontiers in human neuroscience, 8, 811.

Thompson, S., Hays, K., Weintraub, A., Ketchum, J. M., & Kowalski, R. G. (2020). Rhythmic Auditory Stimulation and Gait Training in Traumatic Brain Injury: A Pilot Study. J Music Ther. doi:10.1093/jmt/thaa016

Heather discusses posture assessment purpose and priorities:

1.  Posture for optimal breathing and speaking patterns. 
2. Posture for optimal head position and movement in space                                                                     
3. Posture for optimal trunk movement and responsiveness in locomotion and direction change, and upper trunk support for skilled upper extremity function.

In terms of ’tips’ or a focused approach to improvement where posture, balance, and reduced fall risk are involved, I have two pillars on which I build recommended programs:

1.  First, one must have the basic equipment or infrastructure with which to work. This is where working towards optimal posture, sufficient range of motion, maximizing proprioception, ability to accurately perceive gravity and velocity, and enough strength to move limbs in space comes in. Notice that I put strength last on the list. 
2. Second, we work towards flexibility and speed in sensory re-weighting in response to changing environmental demands. Since the human brain is naturally programmed to rely on vision above all other sensations, this may require limiting vision. 

• Aimi L. Forsyth, BAppSc (Phty), Serene S. Paul, PhD, BAppSc (Phty)(Hons), Natalie E. Allen, PhD, BAppSc (Phty) (Hons), Catherine Sherrington, PhD, MPH, BAppSc (Phty), Victor S. C. Fung, PhD, MBBS (Hons), and Colleen G. Canning, PhD, MA, BPhtyFlexed Truncal Posture in Parkinson Disease: Measurement Reliability and Relationship With Physical and Cognitive Impairments, Mobility, and Balance. JNPT  Volume 41, April 2017
• Jacobs, Jesse & Henry, Sharon & Horak, Fay. (2018). What If Low Back Pain Is the Most Prevalent Parkinsonism in the World?. Frontiers in Neurology. file:///C:/Users/Erica%20DeMarch/Downloads/What_If_Low_Back_Pain_Is_the_Most_Prevalent_Parkin.pdf
• Van der Jagt-Willems HC, de Groot MH, van Campen JP, Lamoth CJ, Lems WF. Associations between vertebral fractures, increased thoracic kyphosis, a flexed posture and falls in older adults: a prospective cohort study. BMC Geriatr. 2015;15:34. Published 2015 Mar 28. 

Heather Campbell, PT, DPT, OCS has 43 years of experience integrating musculoskeletal and neurologic recovery. She earned her physical therapy degree from University of North Carolina at Chapel Hill, a master’s degree in motor control and exercise physiology from University of Denver, and a doctorate from University of Montana. Early in her career she qualified for a manual therapy competence certificate, and Board Certification as an Orthopedic Physical Therapy Specialist.
Dr. Campbell has served on faculties of first professional and post-professional academic programs in physical therapy, medicine, and dentistry, as well as giving local, national and international professional education seminars. She currently serves as affiliate faculty at Regis University. With a career emphasis in musculoskeletal spine care, she focuses on postural, visual and vestibular interdependence and how to influence  central sensory processing for recovery after injury or neurologic disease. Her expertise in concussion management links cervicovestibular assessment to all other components in a multidisciplinary approach to care.

She awarded Colorado’s Outstanding PT of the Year in 2019 for her tireless efforts in promoting the return to play legislation, and she consulted in creating the PT department and program for the Marcus Institute for Brain Health in 2017-2018