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!
Dawn, I see you are in GA? It is very likely that there is someone certified to work in a pool setting with her otherwise you could get certified in the future. Working in the water is fantastic! Check out the AEA (Aquatic Exercise Association). Or the Aquatic Therapy and Rehab Institute. 🙂 For my job all they required was that I was certified in Personal Training, however, I have also gone to the AEA pool conference last year and learned about aquatic therapy- though I was the only personal trainer there that I know of (every one else were therapists) I did learn a lot about working in the water. Plus I do it everyday. 🙂
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.
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!
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.