Exercise 14: Squats on BOSU Ball in the Solo-Step

Setup: Fit the patient into the Solo-Step harness and connect the lanyard to the trolley on the overhead track. Place the BOSU ball dome-side up directly beneath the track. Adjust the lanyard length to allow for the full downward movement of a squat while ensuring the system can engage immediately if balance is lost. Ensure the BOSU ball is fully and properly inflated before use.

Starting Position: Have the patient step onto the center of the BOSU ball dome with feet shoulder-width apart, positioning the feet near the second or third ring of the dome to ensure a centered stance. Instruct the patient to stand tall with the chest up, core lightly engaged, and toes angled slightly outward. Arms should be extended straight out in front at chest height for counterbalance. Instruct the patient to find a fixed focal point straight ahead and take a moment to feel the surface beneath them and establish balance before initiating the movement.

The Exercise:

1. Cue the patient to initiate the squat by pushing the hips back and bending at the knees simultaneously, as though lowering toward a chair behind them.
2. Instruct the patient to keep the chest up, the trunk upright, and the knees tracking over the feet throughout the descent. Actively engage the stabilizing muscles of the ankles, knees, hips, and core to manage the movement of the dome beneath the feet.
3. Lower to the prescribed depth, which may be a quarter squat, half squat, or full squat, depending on the patient’s strength, range of motion, and clinical goals.
4. Pause briefly at the bottom of the movement to establish control and stability before rising.
5. Drive through the heels to return to a full standing position, maintaining balance on the dome throughout the ascent.
6. Repeat for the prescribed number of repetitions.

Progressions: As strength, balance, and confidence improve, the therapist can advance the exercise by increasing squat depth, adding a brief pause at the bottom of each repetition, incorporating light hand weights to increase resistance, introducing a head turn or cognitive dual task while squatting to challenge the vestibular system, progressing to a single-leg squat on the dome, or flipping the BOSU ball flat-side up to increase the instability demand further.