Trust Falls

People recovering from falls can regain balance and confidence with the Aquatic Berg technique.

Byline: Andrea Salzman, MS, PT

For many people, falls are a constant threat. And because of this looming concern, people rein in their movements. 

They stop risking normal tasks such as climbing the stairs, or walking down a steep driveway, or picking up items off the floor. They are too afraid of the consequences to move without a walker or cane and probably should be.

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A severe fall on land can create a downward health spiral. A broken bone can lead to immobility, which can lead to pneumonia, which can even end in death. No wonder people are scared to move without their trusty, four-wheeled walker.

But for balance to improve, it must be challenged. People must be provided the opportunity to risk and to lose without fatal consequences. That's where your pool comes into play. In the pool, patients may be challenged beyond their limits of stability without the fear of consequences.

To achieve this effect, I have adapted the Berg Balance Test into an aquatic balance training program. Obviously, the "Aquatic Berg" is not a specialty technique such as Watsu or the Halliwick Concept. It is not a new standardized aquatic test. We are not performing the test itself. It is just a clever way to harness the 14 different tests of balance into a training regime in the pool.

Therapists do not need extensive training sessions or certification programs to incorporate these task simulations into the water. However, the Aquatic Berg provides an excellent tool to help therapists challenge many of the different ways that people lose their balance.

If you want to incorporate balance training into your therapy bag of tricks, it's best to have many different depths in your pool. You will need a depth shallow enough for your patients to sit on a bench or chair without trouble. You'll also need water that is shallow enough to enable patients to lean over and pick up items off the bottom of the pool. A depth of 3 feet or less is optimal for both these tasks; 2.5 feet is even better. You'll also need chest-deep water (4 feet to 5 feet) to perform tasks such as single limb standing.

Therapists will need certain items to perform permutations of the Berg in the pool. These include sinkable toys (such as dive sticks) to practice leaning over and picking up items; a chair (one with arms, one without) to practice transfers; an aquatic step to perform tapping of the foot; and a stopwatch or clock to time task completion. It's also helpful to have a colored stripe or contrasting tile line on the pool bottom to perform tightrope walking or tandem standing tasks.

Comfortable water temperatures (approximately 90 to 94 degrees Fahrenheit) are helpful for therapy because water that's too cool will chill patients during this non-aerobic session. However, any temperature above 85 degrees will work just fine. The environment should allow patients to hear the therapist without difficulty.

All health-care providers who perform balance training as part of their scope of practice may integrate aquatic proprioception drills, including the Berg, into their repertoires.

However, clinicians should be wary of cookie-cutter applications of the Berg elements in water. The water provides a powerful training medium, but balance drills should be tailored to address actual balance deficits. It is not enough to lazily follow the elements of the Berg by rote and hope to stumble upon a suitable proprioceptive challenge. The skilled clinician must experiment and determine which (if any) elements of the Berg create the best training application for each individual case.

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