Can you measure balance with your phone? Yes, using the Curovate app.

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Do you know if you have good balance? Measuring balance is a challenge both in a health care facility as well as at home. Most people do not have any method of independently assessing their balance. For many years I have tried to visually quantify standing balance when I see my patients in the clinic. This is the process; I ask my patient to stand on one leg and then with either their eyes open or closed I watch them balance. Then I count simple errors in their balancing such as their other leg touching down or moving their body to the side. Over a 30 second period I count these errors and more errors means poor balance. This is an okay method of measuring balance but there is a lot of individual variability from one physical therapist counting to another in terms of what each therapist counts as an error and this is called a lack of interrater reliability. The second issue with this visual scale is that this measure has a ceiling effect. A ceiling effect means that there is a maximum number of errors that are counted regardless of how many errors the person makes. For a 30 second test the ceiling is 10. This means if you made 10 errors or 35 errors during the 30 seconds your score is 10 in both cases. Clearly someone who made 35 errors has worse balance but they achieved the same balance score as someone who made 10 errors. Why is there a ceiling on a visual scale? This is an inherent limitation of visual balance scales because the scale is not sensitive enough to distinguish balance performance that results in greater than 10 errors. The other major issues is that patients go home and they have no way to reproduce this same visual test. At home the patient does not know if they are improving and they do not see any ongoing progress. The lack of feedback and insight into their balance results in people skipping their balance exercises entirely.

Balance exercises are critcial after many injuries including ankle sprains, ACL surgeries, knee replacements and hip replacements along with many other leg injuries and surgeries. Poor balance results in higher rates of reinjury in sports and physical activity and there are well documented balance deficits that occur after knee, ankle and hip surgeries and injuries. So if balance is so imp[ortant why don't people just do their balance exercises regularly? Well, to be honest most balance exercises are quite boring and repetitive. Add this to the fact that people have no way to assess or measure their progress it is not surprising that balance training is often neglected in the process of recovery and prior to returning to sports and physical activity.

As a physical therapist I first learned about digital health in a graduate class in 2011 and I wondered if the sensors in a smartphone could be used to measure standing balance. However, I had no idea if using these phone sensors could accurately measure balance. At the time I worked closely with two engineering graduate students and we created the very first version of an app called myAnkle to measure standing balance. After helping to create myAnkle I conducted research at the University of Toronto with 48 participants to measure their balance on eight different balance exercises, on the ground and on a balance board with their eyes open and closed. What we learned through this research was that myAnkle is capable of measuring balance and distinguishing between easier and harder balance exercises and identifying people who were better or worse at balance. I was intrigued by this research and my ability to work with engineers to develop solutions for problems that I knew my patients faced every day. This graduate class and the development of myAnkle is what led to my involvement in digital health and ultimately what led to me creating my company Curovate.

If the app myAnkle has been able to measure balance since 2011 why have you never heard of it? myAnkle started as a project in a graduate class and it was released to the Google Play Store in 2012. The app was then live in the Google Play Store through the hard work of undergraduate and graduate software engineering students who helped me further develop myAnkle. But eventually I ran out of favours and there was no one remaining who could support the software of myAnkle making the app unavailable in the Google Play Store. For me this was very sad because it was like the death of something that I had worked hard to build. Now that I work with a dedicated software team I was able to "revive" myAnkle. The new myAnkle app is now live in the Curovate App. To measure your balance simply download Curovate from the links below and then select Measure and you will see the option to "Measure Your Balance."

Now let's address why you would want to measure balance in the first place. Balance is something that is compromised after most lower leg injuries. In many cases people are unaware of their balance deficits or they only realize that their balance is poor when they sustain another injury. Balance training is critical to fully rehabilitate from injury or surgery as well as to prevent future injuries. Don't believe me? Try it yourself. If you have had an injury to one leg more than the other, download the Curovate App, measure your single leg standing for 30 seconds and compare it to your other leg. My guess is that your balance number will be worse on the leg where you have had more lower leg injuries or surgeries. myAnkle assigns a higher balance number, which is a measure of acceleration, for poor balance and a lower balance number for better balance. If that doesn't make sense let me explain it briefly. If your goal is to run really fast, a large number for acceleration, the measure of the rate of change of velocity with respect to time, is a good thing. Incidentally velocity is defined as the rate of change of position, which in this case is the rate of change in the position of your body. However, if your objective is to be stable, then a higher amount of acceleration is not a good thing. In this case we use myAnkle to measure acceleration and when you move more while trying to balance your balance number will be higher which indicates poor balance.

I encourage you to try myAnkle in the Curovate App and determine if you have one leg that needs some work on improving balance. Even in the absence of injury, improving your balance can help in preventing injuries, minimizing risk of falls and improving your overall stability.

Conclusion

This blog discusses a simple at-home method of measuring your standing balance. myAnkle, the app that was created in 2011, is now available as part of the Curovate App. To measure your balance at home with a simple objective measure that requires no sensors or wearables simply download the Curovate App from the links below and select "Measure" in the app to measure your balance.

If you need further personalized support to help you improve your balance check out our Virtual Physical Therapy page to book your 1-on-1 video session with a licensed physical therapist.