Introduction to Totter (Strength and Balance)

The World Health Organisation, 1996, stated that

 “regular physical activity helps to preserve independent living” and “postpone the age associated declines in balance and co-ordination that are major risk factors for falls”

The World Health Organisation, 1996

It is vital that we include a variety of methods to address the consequences of reduced strength and poor balance.

Using the multifactorial falls risk assessment tool (MRAT) , we can assess the following

  • Falls history
  • Gait, balance, mobility, muscle weakness
  • Osteoporosis risk
  • Perceived functional ability
  • Fear of falling
  • Visual impairment
  • Cognitive impairment
  • Neurological examination
  • Continence
  • Home hazards
  • Cardiovascular examination
  • Medication review

and take into consideration, any or all of these factors that may have an impact on the risk or actual occurence of falls and potential for falls.

Local healthcare practitioners use the MFRAT to record the measures and include the strategies required, to address those issues that may be causing falls or potential falls.

Best practice includes taking and measuring baseline assessments in the form of both physical and mental/emotional assessments.

We suggest the use of the following;

A PAR-Q or Health questionnaire including a waiver of liability. In each session a verbal screening MUST be included at the beginning of every session to quantify if there have been any changes to condition, medications or falls . If there are any concerns, that participant must NOT be allowed to participate and should be referred back to their health care provider or GP.

Likewise, with vital preventative and curative medication eg inhalers, GTN, the participant must have brought the medication with them and if they haven’t they should NOT be allowed to participate in the class.

This is for their health and safety and to ensure that you are insured and following best practice guidelines.

Consider the impact to the class, the participant and yourself, if one of your participants had an angina or asthma attack in the middle of your class. Your whole attention must be given to that participant and the rest of the class will be left, possibly in a state of elevated heart rate, in distress and unable to warm down thoroughly. They will be at risk and it can be avoided.

Short FES-I which is the Short Falls Efficacy Scale International . A tool to score 7 everyday tasks in accordance to the level of concern that the participant feels about the risk of falling when performing the specific tasks.

Confbal – a tool to rate the confidence of the particiapant while performing 10 specific activities without assistance from another PERSON, with or without the use of their normal walking aid.

Functional grid – a functional assessment tool to measure the degree of flexibility, balance and strength

WEMWBS – The Warwick-Edinburgh Mental Well-being Scale (WEMWBS) is a scale of 14 positively worded items for assessing a population’s mental wellbeing. 

The initial assesments will give you a baseline measure. From this information, and using your knowledge of the groups abilities, you can then structure your sessions around the information gained from those assessments. We suggest an interim recording to assess any progress made and to allow instructors to address each specific need and to tailor the ongoing sessions to the participant’s individual needs. A final recording of the data will allow for a more accurate measure of progress and a very important collection of data for your records.

Collection of data, both quantitative and qualitative, will assist in any future bids for funding.

Data is, and has already been collected and we always work from that evidence base, to improve our practice and ensure that we are following the most current and up to date practices. It ensures health and safety of our participants and gives confidence to commissioners that we are following best practice guidelines and standards.

Physical Benefit
• Prevents and manages most chronic diseases and disabilities
• Helps to prevent cardiovascular disease
• Decreases blood pressure
• Increases the good cholesterol (high density lipoprotein
• Decreases triglycerides
• Improves glucose and insulin metabolism, which helps with
diseases like diabetes
• Increases bone density, which may lead to a reduced risk for
• Increases ability to perform daily activities (combing hair,
getting dressed)
• Increases strength to help maintain or increase independence
• Increases energy (playing with grandchildren, walking the
• Increases balance, which may reduce the risk of falls or
reduce the severity of a fall
• Improves body composition (decreases fat, increases muscle
• Helps to prevent and reduce pain associated with chronic
pain syndromes
• Decreases risk of injury and enhances immune function
• Increases mobility and gait

Psychological Benefit
• Enhances mood
• Decreases depression
• Increases cognitive function
• Increases feelings of personal control
• Improves quality of life
• Increases feelings of well-being
• Decreases stress
• Improves sleep