The Great Hip Strategy
by Deirdre Thornton
The 2021 Tokyo Olympics are almost here! I am a huge fan of the sport of artistic gymnastics and I love to follow the USA Women’s Gymnastics team, especially during the Olympics. When I think about mobility and gymnastics, the image of a gymnast on top of a balance beam comes to mind.
A skilled gymnast like Simone Biles can spin, leap, and flip across a narrow beam, four feet off the floor and just four inches wide - approximately the width of your cellphone – and make it look like she is simply dancing along the floor. But, if the unthinkable happens and she misses a step, loses her balance, and starts to plummet to the mat – what do you often notice? You will likely see that gymnast fight to stay on the beam by bending forward and backward at the hip – although more often than not, lose the battle, and land on the mat below.
That somewhat uncontrolled, gesticulating movement is called the hip strategy and as you can imagine, it is not the most effective way for the body to stabilize its upright posture, regain balance, and prevent a fall. Wobbly toddlers begin their bipod journeys engaging the same hip strategy – they walk resembling little Frankensteins, with a wide stance and arms held out in front. When they lose their balance, their whole body pitches forward, bending at the hip – or folds backward, landing on a chubby bottom.
As the neurological system matures, older children and adults transition to using an ankle strategy for balance, especially during small balance challenges – such as keeping one’s balance while standing on a bus or train, walking on rough terrain, or even crossing a balance beam. You can try it out by standing and swaying from side to side, noticing how the muscles and stabilizing structures around your ankle joints are activated to keep you upright without having to move your arms or torso. Amazing!
The process of normal aging brings about the return of the hip strategy. From an evolutionary or survival standpoint, the hip strategy likely functions to bring the person’s center of gravity closer to the ground with arms outstretched to prevent serious injury (e.g., head or internal injury) when a fall is about to occur.
A person living with dementia (PLwD) is experiencing several changes at the same time that affect how they safely move about in and interact with once-familiar tasks and environments:
· profound changes in posture and mobility: C-shaped posture, shuffling gait, reduced pace
· slower visual processing speed and integration of visual data to make sense of the environment and recognizing potential obstacles
· gross body movements such as bringing the arms out in front to break one’s fall could be delayed resulting in injuries to head, hips, or shoulders
· concurrent physical conditions such as arthritis or Parkinsons disease further affect fluid mobility
At PAC, when talking about supportive environments, we often reference four Ss: Sensory, Space, Social, and Surface – to ensure that the environment matches the abilities of a PLwD. Here are some ideas to support a PLwD to assist with adapting to mobility changes.
· maintain functional mobility through exercises specific to promoting balance such as Tai Chi, riding a stationary bike, or leg lifts (under the supervision of a Clinician)
· ensure key areas are well-lit so that a PLwD can visualize obstacles and navigate spaces with greater ease
· reduce visual stimulation in areas where a PLwD is mobile (e.g., clutter) to limit distraction
· consider placing large sensory cues in key areas to assist a PLwD to travel in a straight line with an upright posture
· for a PLwD in later stages of the disease, provide interesting surfaces for sensory exploration between waist and shoulder height
· increase space for walking and turning by removing unnecessary objects and pieces of furniture
· keep frequently used items in visual range and within reach (e.g., between waist and shoulder height)
· approach a PLwD slowly from the front, within their visual range, and adopt a supportive stance (i.e., angled to one side) at the person’s level
· use the skill of Hand-under-Hand® (HuH) to provide support and stability while walking beside a PLwD and match their pace, especially in middle to late stages of the disease
· introduce a mobility aid such as a walker to promote safe mobility in a wider range of environments
· encourage footwear with thin, non-slip soles (i.e., as opposed to slippers or shoes with deep treads)
· remove area rugs and tripping hazards to reduce risk of falls
· keep floors clear of debris, shoes, clothing
· if installing new flooring, consider using solid colors rather than patterns
Even an Olympic gold medal can’t compete with forming meaningful relationships and connections by spending time together, moving, and supporting.