Introduction to STABLE

Specific Training According to BaLance Evaluation (STABLE) is an genuine approach to measure individual balance abilities, focus exercises towards specific limitations and monitor change.

Prescribing exercises in STABLE, three principal factors must be taken into consideration: 

  • The patients´ history and personal preferences
  • The patients´ Impairments of body structures and functions
  • The patients´ abilities within six domains of balance

STABLE graphics

History and personal preferences

The patients´ history and personal preferences should be considered because each patient may have good or bad experiences with exercising or with specific exercises or physical activity in general. Further, the patient can report specific challenging or symptom provoking activities, contexts or movements which might not become evident in the physical examination, but nevertheless should be addressed in the treatment.

Impairments of body structures and functions

Limitations in physical function can be a consequence of various impairments of body structures, which often interact. To improve functional limitations it can be necessary to target specific impairments of body structures with specific exercises or other interventions. E.g. limitations in reaching out over ones base of support can be caused by vestibular impairment or neuropathy in lower extremities and can be improved with exercises designed to improve stability limits, but if the patient has severe low back pain or impaired range of motion in any joint involved in the reaching task, first priority might be exercises or other interventions to improve local joint range of motion and diminish the pain.

Abilities within six domains of balance

Quantifying the patients´ relative abilities within six domains of balance is a core property in STABLE. Six clinical measures are applied to measure the six domains of balance: 

  • The "adjusted sit to stand test (aSTS)" is applied to measure "power"
  • The "maximum reach test is (mReach)" is applied to measure "stability limits"
  • The "turn and touch test (TAT)" is applied to measure "anticipatory turning"
  • The "reactive four square step test (rFSST)" is applied to measure "reactive stepping"
  • The "test of reference frame interaction in balance (TRIB)" is applied to measure "sensory orientation"
  • The "cognitive timed up and go (cTUG)" is applied to measure "cognitive-motor interaction"

The score of each measure quantifies the patients´ balance ability within the target domain. By plotting the scores relative to the normative score of each measure a personal balance profile is produced. This profile shows:

  • How is the patients´ ability within each balance domain (i.e. how "good" or "bad" does the patient perform within each domain relative to other patients)
  • How is the the patients´ "overall" balance ability (i.e. how "good" or "bad" does the patient perform in all domains overall)
  • How is the patients´ relative abilities between the six domains (i.e. in which domain(s) does the patient perform "worse" and does the patient perform relatively better in some domain(s)) 

The overarching premise of STABLE is that exercises are prescribed to target the most compromised balance domain(s), because this/these domain(s) are the “the weaker link of the chain” and eventually define the patients´ overall balance ability and to which degree the patient is in risk of falls.

In some situations prescribing exercises targeting a domain less compromised can be preferred. For instance, if the patient is too affected by fear of falling to practice exercises related with the most compromised domain or if considering the other principal factors in STABLE (i.e. patients' history, personal preference and impairments of body structures) indicates that prioritizing other exercises is preferable. It is recommendable though, eventually to target the patients' most compromised domain(s) at some time when regarded appropriate in the process of rehabilitation.  

Currently, we offer two methods for producing the STABLE balance profiles. The profiles can be produced "manually" by plotting the patients´ scores relative to the normative values. Additionally, the balance profiles can be produced on this website applying the online calculator.