Perturbation Training

Perturbation training is pushing the patient’s limb or body in order to cause instability that the patient is asked to resist.  An example of this that I used to do is at the shoulder.  I would have the patient lay on their back and hold their arm straight up in the air.  Then I would push the arm in all different directions and say to the patient “don’t let me move you.”  So the patient would try to resist my pushes.  Perturbation training is rarely done in neuro physical therapy.  Or maybe it’s done more often than I think, but it’s not done soon enough.  My last post talked about falling and how falls are a necessary evil for our recovery.  Dean commented that therapists need to push and shove patients when they are learning to walk and I agree.  Most PTs would be horrified to try this.  PTs are all about safety, safety, safety.  Well when you have a stroke, absolutely everything is incredibly unsafe no matter what we’re taught.  I think all that safety stuff should still be taught but therapy sessions should be focused on not safe stuff instead of safe stuff.


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14 replies

  1. By the way, disclaimer – don’t listen to me.

  2. I am perturbed. With you telling me not to listen to you. How dare you.

  3. My inpatient PT was a sarcastic, cynical, pushy, smartass. We got along great. One thing she liked to do was have me stand facing her with the back of my legs against the padded platform while she tried to push me over backward. I made it interesting by insulting her. Each time I remained standing I would call her a wimp, a wuss, a sissy. Invariably she would get irritated and her pushes would turn into shoves. I miss her.

  4. my older very wild son was my best rehab. Pushing, wiggling, wild, and crazy…he’s a pt without training. I got my best therapy at home. Send every survivor home with a wild two year old….you will see amazing progress. And yes I was perturbed most of the time. It was so hard it seemed unfair, but in hindsight it helped me tremendously!

  5. I don’t know if this is common or not but my therapist had me stand on a balance board while she batted balloons at me, outside my normal range of reach (sometimes with my arms completely extended) and I would return her volleys. I found it very helpful!

  6. Amy,
    My therapists would say, “don’t let me move you” but I still move. I hated the balance board too! There’s something to be said about pt safety versus real life. In stores and other places, other people don’t give a crap.

  7. Good post today, Amy. I am just about at the point to go caneless at home entirely.My balance is good. My left leg is now strong enough that it doesn’t threaten to give out. Any pointers? Marta

    • Hmmmm. pointers……..Well the old PT in me would say definitely still take the cane into the community with you for a while after you stop using it at home. Holding a cane, even if you don’t really use it, makes all those other people that don’t give a crap be a little more cautious around you.



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