I swear my body responds quickly if people lose their balance during gait. Maybe my hands are prone to pick up the smallest change in their gait pattern from the smallest quiver of their musculature to the slightest hesitation to advance their assistive device.
In school, the first day, our instructor asked us to palpate a hair follicle that was folded in a piece of paper. Impossible, I thought at the time. Now I am not so sure. I know from experience that in an outpatient setting, one has to excel at palpation to accurately assess the patient and any deficits that may exist. However, that is not the only setting where small tremors in musculature tell a greater story.
While standing in the parallel bars doing LE exercises with one gentleman, I felt a tensing of his upper body before I saw him waver and collapse in the wheelchair thoroughly exhausted. I can also feel the resistance someone displays during a pivot transfer and determine how much assistance he will require. This may seem simple enough, until you begin to palpate a person tensing up for a transition from sit to stand, then stand to pivot on the mat table. The changes are often subtle and can result in a patient falling if you are not aware of what the person's body is doing during the transfer.
I have seen therapists grab a gait belt that is around someone and hold on for dear life throughout the session for fear of the patient falling. The gait belt then slides up around the patient's chest along with his shirt as he begins to stand and move around. To stand patients, I typically use their scapulae to bring them forward and up, standing in front of them. If I am next to them, I assist patients to stand either at the hips or with one hand on their upper back as they push up out of the chair. I can then palpate and get a better sense of what their overall body is doing and how they respond to the transfer. For example, how is their rotation at the trunk, does the pelvis move "freely" during the transitional activity or are the patients tight and unable to effectively flex, extend and rotate their upper body?
Do my super-sensitive hands find all the subtle cues? Absolutely not. Patients have fallen during gait with me and it was completely unexpected. But I do find that my ability to anticipate a patient having difficulties does have a direct correlation to palpating musculature that tenses up just prior to a loss of balance or difficult movement.