Exercise 9: Single-Leg Balance in the Solo-Step

Setup: Fit the patient into the Solo-Step harness and connect the lanyard to the trolley on the overhead track. Position the patient directly beneath the track with adequate space to stand freely. Adjust the lanyard length to allow natural upright standing while ensuring the system can engage immediately if balance is lost. No assistive device should be within reach unless clinically indicated, as the Solo-Step serves as the primary safety support.

Starting Position: Have the patient stand tall with feet together and core lightly engaged. Instruct the patient to extend both arms straight out to the sides at shoulder height, forming a T position. This arm position widens the patient’s base of stability and provides natural balance assistance throughout the exercise. Instruct the patient to find a fixed focal point straight ahead and maintain their gaze on it throughout.

The Exercise:

1. Cue the patient to slowly shift their weight onto the standing leg, distributing it evenly through the entire foot: heel, ball, and toes.
2. Instruct the patient to slowly lift the opposite foot off the ground, bending the knee to raise the foot a few inches. The raised leg should not touch or rest against the standing leg.
3. Maintain an upright trunk, keep the arms extended in the T position throughout, and keep the standing knee soft rather than locked. Avoid allowing the hip to hike or the trunk to lean to either side.
4. Hold the position for the prescribed duration, beginning with shorter holds of 10 to 20 seconds and building toward 30 to 60 seconds as balance improves.
5. Gently return the raised foot to the floor, reestablish a stable base, and repeat on the opposite leg.
6. Complete the prescribed number of holds on each side.

Progressions: As balance improves, the therapist can advance the exercise by increasing hold duration, having the patient turn their head side to side while balancing to challenge the vestibular system, lowering the arms from the T position to the sides to reduce balance assistance, introducing a reaching task with one arm while maintaining the opposite arm extended, adding a foam pad or balance disc under the standing foot to increase proprioceptive demand, or progressing to an eyes-closed variation to further challenge the balance systems.