Here are the issues. I have trained several seniors with all different ailments, surgeries, etc. However, this woman is in good overall health, previous dancer, no weight concerns but has become extremely dependent on her walker.
She apparently has fallen 4 times in the past, and suffered a broken hip, had a hip replacement, and has developed a great fear of being independent, however, would like to not depend on her walker and wants to work of course on balance, stability, coordination, strengthening, but how do I help her with exercises in her walker to slowly doing exercises without? She also suffers from Vertigo.
She begins training with me next week. I’ve got her for one hour a week and just need ideas, please! Advice, anything!
this is a really difficult situation because her greatest challenge is overcoming her fear. You did not write where you will be training her, and I did not get any clues by looking at your profile or website.
I assume that you have a physician’s clearance. I also assume that you have a good understanding of what kinds of exercises to do for balance and stability.
The top priority is to provide her with an environment in which she feels safe. I would try to have her do as much as possible standing but always with back up to sit down or hold on if necessary. You should also always be nearby to have a hand on her back or lightly on her body for reassurance. Establishing trust is the first step. She should always be successful in what you ask her to do.
After that, it’s baby steps, literally. Have her move from one place to another without the walker but being able to hold on to something. Walk with her across the room hand in hand, then finger to finger, then side by side with your hand on her back, then side by side. You get the idea. She probably has a cane. move towards that if possible.
If you do not succeed, don’t consider it as failed. You can strengthen all you want but the fear factor is one that is the most difficult to overcome. She wants to do it, though, and that is a great starting point.
I wish both of you good luck.
I don’t turn away too many clients, but in this case I probably would. I could be wrong but it sounds like she could use an Occupational Therapist at this stage. Once she gets over her fears and gets steadier on her feet, then I would think about taking her on – consulting closely with the Therapist. Good luck Dawn – I hope things work out.
Bottom line – assess via perhaps Tinetti Gait and Balance Assessment and get them moving and challenging them in different environments, tep by step. This person is 71 not 171.
The worst you could do is nothing.
Please see the Journal of Aging Research http://www.hindawi.com/journals/jar/2012/708905/
In a systematic literature review, Rubenstein and Josephson  reported that the above mentioned intrinsic circumstances (i.e., muscle weakness, gait and balance disorders) are the second most common cause for falls in older adults. Muscle weakness induces reduced levels of strength, particularly of the lower extremities , and is thus responsible for a performance decrement in activities of daily living (e.g., climbing stairs) . Further, the ability to generate force rapidly declines more precipitously in advancing age than maximal strength [13, 15] and is, in a fall-threatening situation, more relevant for preventing a fall than the capacity to produce maximal strength [16, 17].
In terms of fall prevention, we suggest to perform a combination of power training/high velocity strength training with multifaceted BT including multi-task and perturbation-based BT because this combinatory training regimen counteracts a large number of intrinsic fall-risk factors.
Do what you do best, protect, inspire and co-create movement!
It is really too bad you cannot get her in a pool! I work with a lot of people who currently use walkers- although they are not as dependent on them as this woman is, the water has helped them greatly to make small movements away from using them all the time. (I mean this in a good way not bad, since most of them had a situation where they had fallen previously and rely on the walker on land as a sense of security).
I do have to say though I agree with some of the above comments. Since I work in a setting where I am surrounded by Physical Therapists I do feel like that would be helpful to her in order to get her mentally ready to not use the walker since it sounds like more of a mental thing vs. a physical need for it.