Exercise 13: Lunges onto 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, positioned at a distance that allows the patient to step onto it comfortably with a full lunge stride. Adjust the lanyard length to allow full downward movement during a lunge 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 stand tall approximately one stride length behind the BOSU ball with feet hip-width apart, core lightly engaged, and arms relaxed at their sides or extended slightly forward for counterbalance. Instruct the patient to look straight ahead, find a fixed focal point, and take a moment to feel secure in the harness before initiating the movement.

The Exercise:

1. Cue the patient to take a controlled step forward, landing the lead foot on the center of the BOSU ball dome with the arch of the foot positioned over the highest point of the surface.
2. As the foot makes contact with the dome, instruct the patient to immediately engage the ankle, knee, and hip stabilizers to control the instability of the surface beneath them.
3. Lower into the lunge by bending both knees simultaneously, keeping the front knee tracking directly over the foot and not extending past the toes, while the back knee lowers toward the floor.
4. Keep the chest up, the trunk upright, and the hips squared forward throughout the descent.
5. Pause briefly at the bottom of the lunge to establish control and stability on the BOSU ball surface.
6. Drive through the heel of the front foot to push back up to standing, stepping back off the BOSU ball to the starting position.
7. Alternate legs with each repetition, or complete the prescribed number of repetitions on one side before switching, as directed by the therapist.

Progressions: As strength, balance, and confidence improve, the therapist can advance the exercise by increasing the depth of the lunge, adding a brief hold at the bottom of each repetition, flipping the BOSU ball flat-side up to increase the instability demand, incorporating light hand weights to increase the resistance load, or adding an overhead reach or trunk rotation at the bottom of the lunge to introduce a more complex coordination challenge.