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Spatial Awareness and Proprioception for Older Adults

Helping seniors regain balance and function through spinal stabilization.

Elderly couple walking down stairs to show importance of spatial awareness and proprioception

To help older adults regain lost stability, it’s vital to begin by building strength deep in the spine, not the limbs. Here’s why that’s so—and some exercises to get clients steady on their feet once more through spatial awareness and proprioception.

By adulthood, most of us have a fairly good ability to judge where our body is with respect to the objects around it and where our limbs are in relation to our body. This is one of the things that allows us to be safe as we move through the world. Without thinking about it, you can judge the height of an object you need to step over so your foot lifts high enough up and steps far enough out before landing back on the floor.

However, as people enter their senior years, the cognitive skills that allow for this type of movement can diminish. I like to describe it as having a “malfunction” of spatial awareness and proprioception. When these skills decline, older adults find they must coordinate cautiously through many daily activities such as taking steps forward and backward, using stairs, and turning around.

Fortunately, these skills can be relearned. As a fitness professional, you can develop a better understanding of the underlying mechanisms and create a movement program to help senior clients regain some of their safety and independence.

Spatial Awareness and Proprioception Defined

Spatial awareness and proprioception are often viewed as the same, but they are they are different skills.

Spatial awareness is a complex cognitive skill that allows us to be consciously aware of where the body is in space, how much room there is around it, and how far away the body is from objects in its surroundings.

Proprioception is more specific to knowing where the limbs are in space and the force needed for moving them in relation to the body. The sensory receptors that provide this constant feedback to the brain are called proprioceptors.

A simple example of the brain working with spatial awareness and proprioception is when you walk towards a chair and sit down. Both processes help the brain calculate the distance between you and the chair, and you walk accordingly. You begin taking smaller steps when needed, adjusting the speed of each step as you approach the chair. You calculate the turn, including the size and the direction of the steps required to place your body in the right position to prepare to sit. You calculate the height of the seat and coordinate where the body is in space before using the appropriate speed and force to lower into sitting position without slamming into the chair or falling to the floor.

I’ve posted a 15-second video of one of my stroke-recovery clients performing a reenactment of this sequence. You’ll see how it looks when his spatial awareness and proprioception were malfunctioning alongside a second video of his regained ability of these cognitive skills (Markley 2017).  This client followed a program of exercises like the one described in this article.

See also: Innovative Chair Exercises for Seniors

Getting to the Core of the Matter

Spatial awareness and proprioception work with the skeletal muscles in the body as they move the body through motion. It’s essential to strengthen the muscles that stabilize the spine and pelvic region and keep the body in proper posture so the limbs can move safely and efficiently. For safe and effective movement, these muscles must gain strength before the legs and arms can be strengthened to their full potential. The skeletal muscles also play a prime role in reaction time, which is another safety factor that can be improved with appropriate practice.

A weak deep core in the body is like an apple tree that has a hollow trunk. The tree’s trunk may appear normal, but it’s unstable because it is weak. The tree’s limbs cannot sustain the weight of many apples, and the tree cannot sustain itself in a windstorm.

In my years of studies, I have found research that states that the brain sends a message to the deep center of the body to stabilize the body, which happens microseconds before the limbs are going to move (Le Mouel & Brette 2017). If the center or core of the body is weak, it cannot obtain its best stabilization to keep the body at its safest while in movement. If the brain sends messages to those weak muscles, the communication with the legs and arms will function poorly—or malfunction.

Put more simply: Walking begins deep in the spine, not in the limbs. Therefore, it’s important to strengthen the core and spine from the inside out.

Muscles Involved in Spinal Stabilization

Let’s look at some important muscles and groups of muscles involved in spinal stabilization.

Multifidus Muscles

The Multifidus Group

Spinal Stabilization Muscles

The multifidus is a small and powerful group of muscles and stabilizes the spine. It begins to activate before the body moves, which helps to protect the spine (Kumar 2019). It’s one of the muscles in the spine that extends, abducts, adducts and rotates the spine.

For a person to gain a better spatial awareness, posture and balance, this muscle must be strong. It’s important to know this muscle is on the same neuromuscular loop with the transverse abdominis, the diaphragm and the pelvic floor muscles.

It’s best if all these muscles are functioning properly: They need to perform jobs individually and as a team. If the transverse muscle is weak, the pelvic floor, multifidus and diaphragm cannot gain the proper strength needed for a healthy, functioning body.

Transverse Abdominis

The Transversospinalis Group

Another important group of muscles is the transversospinalis group. It consists of the rotatores, the semispinales, and the multifidus (Hewett & Bohdanna 2012). They help with stabilizing the spine and play a key role in body awareness and proprioception.

If the deep stabilizers of the spine are not doing their job, then the other muscles such as the psoas and the quadratus lumborum try to take over. This often leads to injuries and more weakness elsewhere throughout the spine and the body. The previous illustration shows just some of the muscles that can stay weak and be prone to injury if the deep core of the spine is weak.

See also: Program Workouts for a Healthy Spine

How to Strengthen the Deep Stabilizers

 Now how can we achieve the goal of strengthening such things as proprioception and spatial awareness? Here are some ideas on equipment, exercises, and tips.

Start by Raising the Bar

For starters, you’ll need to find a wall on which you can secure a bar for your clients to hold onto for balance during these exercises. It must be anchored to the wall and able to support the amount of weight that you’ll be placing on it during sessions. This type of bar is an essential exercise tool when training a weaker aging client who is having spatial awareness, proprioception and balance issues.

Why a bar instead of a countertop or furniture? A flat surface like a counter and an unstable surface like a chair back can still leave your client more at risk of falls. With a bar, they also feel safer. They have a sense of control that they do not have without it. This leaves their mind and body to focus on good posture and the exercise instead of the fear of falling. This is essential because the body needs to retrain the brain to contract the muscles needed to stand and balance with proper form and function.

The grabbing of the bar also helps build back quick reaction time. Reaction time plays a crucial role in everything we do. When we trip or stumble, the brain needs to respond quickly to know where objects are in the environment so it can communicate quickly throughout the body and to the hands so we can catch ourselves or otherwise rebalance. While balancing on an unstable surface, the arms, legs, and the center of the body will retrain to coordinate in movement together, thus improving reaction time.

Unsafe gripping will also limit the exercises clients can do, as well as their advancement. Please remember some medications and medical diagnosis may also prevent a client from achieving certain goals. If appropriate, communicate with your client’s medical team to ensure they have the clearance to perform the types of exercises you have planned.

Setup and Cuing Instructions

 The following instructions for form and cuing will be used for both of the bar exercises described below.

Get into starting position. Stand up tall in front of the bar, with feet on the floor, a balance pad, a balance disc or a BOSU® ball, depending on client ability/needs. These rubber unstable surfaces add extra stimulation of the central nervous system, which is composed of the brain and spinal cord. This is necessary to train for spatial awareness and proprioception.

Tip:  I have trained stroke survivors, seniors, athletes, and kids. My experience is the BOSU ball achieves the best results. If the client is small, regardless of age, use a child-size BOSU ball. Using a balance board will not achieve the same results.

Be aware of feet placement. Know what the toes and feet are doing. Keep them placed evenly, and do not roll feet out or in. Being aware of feet placement helps retrain the brain in connecting consciously to where the feet are in space. After enough practice, the brain will begin to respond subconsciously again. If you feel your body weight tipping into your heels, press the front of your feet toward the floor.

Feet on Bosu

Tip: It’s helpful if the client has a good pair of shoes that give the proper foot and ankle support at all times, but particularly while performing exercises.

Hold the bar as needed. Hold bar for safety as needed to balance but not with enough of a grip to overtake the body’s function to balance. Hands can grip loosely, hover close above the bar or to remain at the sides of the body—whatever is safest and works best of the client.

Engaging Core

Engage the core. Consciously engage the abdominal muscles to activate them. This is needed to stabilize.

Tip: Be sure clients do not engage the glutes. Often clients engage their glutes when walking for a sense of safety and control. This, however, is dysfunctional for standing, stabilization and walking.

Tip: When determining how many times a day or the timing of these exercises, base it on the individual client. Remember: When babies learn to stand and walk, they do not practice only once a day or 2 days a week. You are rebuilding cognitive skills in the way the body naturally developed them in childhood. It’s best to have them practice daily—and as much as possible.

Exercise: Balancing at the Bar

Balancing at the Bar

This exercise simply has the client practice balancing while maintaining a proper posture from head to toe. As clients are doing this, they will move around and may need to either hold onto or grab the bar to stabilize, if they can’t do so on their own. Here are some useful cues:

  1. Begin in starting position, described above.
  2. Hold bar for safety as needed to balance but not with enough of a grip to overtake the body’s function to balance. Hands can grip loosely, hover close above the bar or to remain at the sides of the body—whatever is safest and works best of the client.
  3. Check and readjust posture. As the bar is grabbed to balance, create and maintain proper posture. Do not release the abdominal muscles, bend the legs, or collapse the upper body toward the bar. Do not allow the feet to roll out or in.

Exercise: Squat-to-Stand at the Bar

Squat to Stand

 Often clients with weakness do not stand up completely before they begin to take steps. This is something important they need to be aware of in everyday life, and performing a squat-to-stand motion can help increase overall awareness. Be sure to place a chair under a weaker client for safety, if needed.

  1. Begin in starting position, described above.
  2. Holding the bar as needed, squat down to a comfortable depth.
  3. Complete the stand-up motion after each squat.

Tip: When a client can do these balance exercises without a bar, you can add all sorts of safe movements, bands, free weights and other modifications. Be creative, while being safe.

See also: Balance and Stability

Encourage Clients’ Awareness of Their Successes

I’ve trained clients between ages of 70 and 95 improve their golf game. And look at this active 104-year-old. The changes in 3 months were an amazing surprise!

Client Success

In a matter of weeks to months, your clients can see results in their everyday movements, too, such as being able to stand up to put on their pants, feeling safer and steadier when walking, having better posture throughout the day, feeling stronger in their sports, and more. Ask clients questions to draw out what daily habits have become easier or feel better to them. This can help them become more aware in another way: aware of how much their spatial awareness and proprioception have improved!

 

Image location courtesy of Dan McKinney YMCA; Model: Pam Sites



Proprioception, Deconstructed

The word “proprioception” comes from two words. First is the Latin word “proprius,” meaning “one’s own.” The other half of the word comes from “reception” meaning the process by which one translates input from the body’s sensory receptors into a coherent and unified picture of one’s environment (Merriam-Webster 2022a, 2022b).

Signs of a Spatial Awareness Malfunction

Not sure if you would recognize the symptoms of an aging clients’ movements when their spatial awareness is malfunctioning? Here are a few things they may be expressing or doing.

  • feeling afraid of falling in everyday activities
  • walking slower, shuffling their feet, and with poor posture
  • tripping or falling on stairs, steps or items on the floor

References

Hewett, T., & Bohdanna, T. 2012. Rehabilitation considerations for the female athlete. Physical Rehabilitation of the Injured Athlete, 143–154.

Kumar, A. 2019. Muscle that influence the lumbar spine, smallest yet most powerful: Lumbar multifidus. Biomedical Journal of Scientific & Technical Research, 13 (3).

Le Mouel, C., & Brette, R. 2017. Mobility as the purpose of postural control. Frontiers in Computational Neuroscience, doi.org/10.3389/fncom.2017.00067.

Markley, T.L. 2017. Stroke recovery: Re-gaining spatial awareness Gary Ogara. Video. Accessed Mar. 15, 2022: youtu.be/z_GlX4SSOa8.

Mastropaolo, J. 1975. Kinesiology for the Public Schools, (4th ed.). San Gabriel, CA: Paramount Academy.

Merriam-Webster. 2022a. Proprioceptor. Accessed Mar. 15, 2022. merriam-webster.com/dictionary/proprioceptor.

Merriam-Webster. 2022b. Receptor. Accessed Mar. 15, 2022. merriam-webster.com/dictionary/receptor.

Restak, R. n.d. Optimizing Brain Fitness. Online Course. The Great Courses: thegreatcourses.com/courses/optimizing-brain-fitness.

Zhou, B., et al. 2015. Effects of neuromuscular joint facilitation on bridging exercises with respect to deep muscle changes. Journal of Physical Therapy Science, 27 (5), 1417–19.

 

Tracy L. Markley

Tracy L. Markley is IDEA’s 2021 Personal Trainer of the Year, an award-winning author of nine books, a radio host, and CEC course author. She is owner of Tracy’s Personal Training, Pilates & Yoga Studio. Learn more at tracymarkley.com.

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