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Balance Education

ATRI Online Ed Information



$59 – 1-hour course

$84 – 1.5-hour course

$109 – 2-hour course

$159 – 3-hour course

$199 – 4-hour course

$275 – 6-hour course

$325 - 7-hour course

$375 – 8-hour course

$695 – Specialty Certificate Program (for Course Numbers 1611, 2237, 2311, 2318, 2319 only)


Once you have accessed the online course there is no refund available. If you cancel in writing within 3 months of purchase and have not accessed the course there is a 75% refund. This cancellation policy applies for all ATRI Online Education. Any cancellation policy you may see in the online registration process does not apply to ATRI Online Education.


No preparation is required for the courses. You may take time to review or ‘fast forward’ during the course.

How it works:

After you click below to register and pay for a course:

Your information will be sent to Linda Scott, who will register you on the Online Ed website and e-mail you your username, password and the link for your course. Linda’s e-mail is


After you begin taking the course:

You will be able to download and print the course handouts and materials as well as watch the course on your computer.

ATRI faculty members are often available for email questions after the course is completed. You will find their contact information in the course proceedings.

Click Here to Register and Pay for the Online Course(s) of your choice

Balance Course Information

1300 – Balance and Gait Training I

Beginner / 3-hour Workshop


Faculty: Sue Grosse, MS



Balance and gait training can be repetitious, and easily become tedious. Learn a variety of balance and gait training improvement activities for implementation in a group or with individuals, during exercise or therapy. Develop strategies for transfer of learning.  Establish progressions for applying skills learned in the aquatic environment to land activities of daily living. Whether you work with seniors, adults, teens, or tots you can add fun to functional. Everyone needs to maintain balance as they age. Gait training applies to original motor development, as well as rehabilitation. Package balance and gait training into all your activities with creative ideas from this workshop.


1) Investigate applications of balance and gait training for at least four age groups.

2) Compare and contrast applications of balance and gait graining for motor development vs. rehabilitation vs. habilitation.

3) Learn at least a dozen different balance and gait activities using poly spots.

4) Develop strategies for implementation of balance and gait activities during aquatic exercise and aquatic therapy for individuals as well as groups.

5) Outline a progression for transfer of balance and gait training skills from water to land activities of daily living.

1302 – Trunk-Centered Sit-to-Stand Skills

Beginner / 1-hour Land Workshop


Faculty: Maryanne Haggerty, MS, CES



This workshop will address the biomechanical advantages to a functional sit-to-stand and stand-to-sit skill.  This skill will be practiced with the emphasis on the neuromuscular efficiency of the lower extremity while maintaining core/trunk stability. Basic muscle imbalances will be addressed with flexibility for efficient neuromuscular recruitment. Eccentric muscular control will be emphasized with trunk stability.


1)   Address the basic roadblocks to an efficient sit-to-stand skill.

2)   Utilize corrective flexibility to lengthen the high-tone muscles.

3)   Trunk-centered stabilization techniques will be practiced with integrating movement.

4)   Practice reducing forces while decelerating to a seated position.

1303 – Gait Retraining

Beginner / 3-hour Workshop


Faculty: Connie Jasinskas, MSc


The goal of gait correction is to maximize mobility as efficiently as possible while minimizing pain or additional damage. This course will include a review of normal gait, common gait deviations and treatment techniques to minimize or correct abnormalities. Water is excellent medium for gait retraining because of “unweighting” in water, slower movements, decreased risk of falls or injury, allowing more repetitions for practice.


1) Review major components of “normal” gait providing basis for assessment of patient/client ambulation.

2) Become proficient in identifying gait deviations.

3)  Explore treatment techniques to address gait deviations in aquatic setting.

1312 – COREssentials for Balance

Beginner / 3-hour Workshop

Faculty: Laurie Denomme, B. Kinesiology



Balance is integral in everything we do and yet many people are challenged by the fear of falling. Through use of a dynamic systems approach, learn how to use specific movements to increase body awareness, coordination and reaction time for improved stability. Build capability and confidence for all activities by waking up the body’s internal system of detection and interpretation of movement. Experience fun-to-do, one- and two-footed exercises designed to keep the body strong, improve safety and maintain independence. Basic to advanced options will challenge you to stand your ground!


1)  Improve balance by learning and understanding how the muscles, joints and proprioceptors relate and work together.

2)  Examine a 3-dimenstional movement strategy to create effective exercises.

3)  Progressively use buoyancy and resistance to maximize client potential.

4)  Determine personalized progressions using: range of motion, load, impact, speed and turbulence.

5)  Identify C.O.R.E. essentials to design safe and effective water exercise programs.

Connect the brain, body and spirit through 3D movement.

Optimize movement efficiency by treating everyone as an individual.

Reduce pain and stiffness while improving strength and stamina.

Empower clients to use buoyancy and resistance to reach obtainable goals.

1313 – GaitWay to Mobility - NEW!

Beginner / 2.0 credit hours
(Classroom Viewing Time: 1 hour / Pool Viewing Time: 1 hour)

Faculty: Melinda Pierce, PT, MS, CEEAA, ATRIC

COURSE DESCRIPTION: GaitWay to Mobility includes a brief review and analysis of current literature supporting the therapeutic value of water walking, assessment tools that support the use water walking as a therapeutic intervention, the use of goal-oriented gait and specific therapeutic gait techniques. Assessment techniques will be introduced during lecture. Therapeutic and wellness gait techniques will be practiced in the pool. Exploration of equipment options for progression will be considered in lecture and pool practical. Anyone whose land mobility would improve by balance, coordination and endurance activities can benefit from this fun and engaging aquatic program.

1) Identify the benefit of pool walking as it relates to land-based walking.
2) Describe the benefits of water walking based on current literature.
3) Apply the results of standardized assessment tools to design water walking interventions.
4) Adapt interventions appropriately as outcomes improve.
5) Explore equipment options for progression and variety.
6) Identify how and when to introduce “drag” to the program.

FACULTY:  Melinda Pierce, PT, MS, CEEAA, ATRIC, has been a physical therapist for over 40 years in hospital, outpatient, and geriatric settings with a primary focus on orthopedic and aging populations, and leading a rehabilitation team for a CCRC group. She has given numerous presentations to students, therapists, athletic trainers, patients, and the general public on musculoskeletal, aging, and aquatic topics. She holds an advanced master’s degree in musculoskeletal physical therapy, and certifications from ATRI and as an Exercise Expert for Aging Adults through the APTA Academy for Geriatric Physical Therapy. She is a reviewer for the Journal of Aquatic Physical Therapy. She shares her passion for Ai Chi through classes and an Ai Chi blog (

1500 – Balance for MS, TBI, Orthopedic Trauma

Beginner / 3-hour Workshop


Faculty: Mary Wykle, PhD, ATRIC



Multiple Sclerosis, Traumatic Brain Injury, and Orthopedic Trauma are very different, yet face many of the same challenges. Balance deficits, fatigue, cognitive impairment, depression, and loss of strength are inherent in all. All need specialized physical training.

Multiple Sclerosis is a chronic progressive nervous disorder resulting in life altering challenges. MS patients benefit from gentle, repetitive movement. Their ability to tolerate activity varies greatly.  Balance activities should be selected to provide body alignment awareness, range of motion, gentle strengthening, and improved endurance in a supportive setting.

Traumatic Brain Injuries are in the forefront of medical identification, treatment, and research. The number of young military veterans diagnosed with TBI has grown exponentially in the past few years.  Recent research on professional athletes, particularly football players, who have experienced repeated concussions are having the same challenges as they age. They have the need for balance, cognitive training, and challenge with coordination and aerobic activity. This same group often has been challenged with recovery from Orthopedic Trauma so progressive aquatic therapy provides a safe arena for reduced fear of falling, challenge activities, and progression therapy to increase muscle strength and imbalance.


  1. Examine complications experienced by MS, TBI, and Orthopedic Trauma patients and the role of therapy- based training.
  2. Demonstrate basic exercises in the water based on yoga and similar protocols.
  3. Determine achievable outcome goals and adapt balance positions to meet each individual’s needs.
  4. Explore ways to use yoga, Ai Chi, and Ai Chi Ne to provide a supportive environment.
  5. Identify small steps to show progress in Activities of Daily Living.
1611 – Fall Prevention Specialty Certificate Program

Beginner / 15-hour Workshop


Recorded Course Time Break Down as Follows:

Day 1: Pool: 3 hours / Classroom: 2 hours / Classroom: 2.5 hours

Day 2: Classroom: 2 hours / Pool: 2 hours

Day 3: Pool: 2 hours / Classroom: 1.5 hours


Faculty: Ruth Sova, MS, ATRIC / Donna Lewen, BA, ATRIC / Sue Grosse, MS / Melissa Lewis, MPT, ATRIC



The Fall Prevention Specialty Certificate Program is a basic course that is predominantly action based with activities that you can implement immediately with your clients. The activities are evidence-based and include the full spectrum of low-function to high-function exercises.

During the land portion of the course, you will learn background information on fall prevention, balance scales, set goals based on that background, as well as individual client needs; and then try therapeutic exercises and aquatic therapy techniques that research shows (and we have found) beneficial. Equipment progressions and precautions; discussion of the best water depth, temperature and order of exercises; and when to modify exercises will be covered.

The following are focus segments for this course:

Balance and Gait Improvement:  Implementing fall prevention through balance and gait practice in isolation can be repetitious and tedious. Experience a variety of balance and gait training improvement activities for implementation in a group or with individuals. Develop strategies for transfer of learning to establish progressions for applying skills learned in the aquatic environment to land activities of daily living. This has valuable application to seniors, adults, teens, or tots. Everyone needs to learn, relearn or maintain balance. Gait training applies to original motor development, as well as rehabilitation.

Functional Integration:  Integrate the mind with the body and increase your clients’ balance, reaction time and coordination. Implement the Unpredictable Command Technique (UCT) into movement on land and water. Experience creative ways to use Tai Chi, UCT, Qigong and Yoga. Yoga for the feet offers simple ways to improve balance with foot exercises. We will try a Qigong technique for inner balance for land and water.

Pain Management:  Combining balance exercises with pain amelioration techniques can improve ADL function while maintaining or creating pain-free movement. This focus segment of the certificate course will give you a tools and concepts to help your clients improve or maintain status while managing any contributing discomfort. The pool segment will use portions of BackHab, Ai Chi, Feldenkrais®, and Ai Chi Ne techniques, Kinnaird exercises, and BackHab II Progressions. The pain management work is vertical and seated work with some ambulation.

Equipment Selection and Use: Fall prevention can be enhanced through activities using a variety of pieces of equipment. Working with or on a piece of equipment helps an individual strengthen core muscles, as well as develop kinesthetic and proprioceptive abilities. As we try specific activities for developing static and dynamic balance, we will discover how to design balance equipment-based progressions for clients of any age or function. We will use equipment to enhance the therapeutic process.

Course Materials:  Materials provided in this course include documentation forms, resource and research bibliography, a review of fall prevention and assessments, written exercises with some photos and illustrations, and descriptions of equipment use and availability.


  • Examine balance scales used to evaluate patients.
  • Investigate applications of balance and gait training for at least four functional age groups.
  • Compare and contrast applications of balance and gait training for motor development vs. rehabilitation vs.


  • Examine at least 20 different fall prevention activities using poly spots, wonderboards, squoodles, and


  • Select appropriate equipment based on client age, size, function and goals.
  • Evaluate progressions for implementing balance equipment in a total therapeutic process.
  • Experience the balance difficulties when using selected progressions from the BackHab II program.
  • Determine three safety procedures for implementation of equipment-based activities.
  • Outline a progression for transfer of balance and gait training skills from water to land activities of daily


  • Experience the fall prevention properties and appropriate application of UCT, Ai Chi, Ai Chi Ne, BackHab,

     Feldenkrais, Yoga, Tai Chi and Qigong.

  • Try simple foot exercises to improve balance.
  • Integrate pain techniques into a fall prevention session to improve outcomes.
  • Review the link between pain and balance.
1617 – Better Balance with the Clockwork Approach / Unpredictable Command Technique - NEW!

Beginner / 3-hour Course
Faculty: Katrien Lemahieu, MSEN, ATRIC – Better Balance with the Clockwork Approach
Donna Lewen, BA, ATRIC – Unpredictable Command Technique

Better Balance with the Clockwork Approach
COURSE DESCRIPTION: The clockwork approach is a visualization technique on the large and small clock arrows of a clock, for both anchored moves and stepping skills to achieve better balance during proper alignment. It gives a great variation for muscle and mind connected exercises, helps participants achieve more efficient gait, balance and functioning, and it’s fun! In this workshop, many combinations will be learned and practiced, including the following:

  • Ab/adduct
  • Flex/extend
  • Internal/external rotation
  • Circumduction
  • Touches
  • Lunges


  • Loaded Movement Training
  • Deeper water
  • With turning and weight shifting
  • Heavy concept

Clinical purpose:

  • Balance
  • Coordination
  • Fall prevention
  • Tolerance to complete weight shifts and transfers
  • Trunk glide

1) Examine the clockwork approach.
2) Determine the essentials for balance and fall prevention.
3) Incorporate techniques of Loaded Movement Training.
4) Connect muscle and mind and vice versa through turns and shifts.
5) Apply the Clockwork Approach for different populations.

FACULTY: Katrien Lemahieu, MSEN, ATRIC, has 20-plus years of experience in aquatics and has been a presenter worldwide since 2005. She studied physical education and holds a degree in Special Movement Education with an emphasis in Motoric Remedial Teaching and a focus on pediatrics. She has developed three e-learning programs on aquatic fitness (AquaMagicMoves) and is CEO of two educational institutes for aquatics: Kataqua for aquatic fitness and ProOZo for swimming. She is the organizer of the annual European Aquatic Fitness Conference (EAFC).

Unpredictable Command Technique
COURSE DESCRIPTION: This workshop will focus on the Unpredictable Command Technique and integrate the Folstein Mini-Mental State Exam to challenge patients and clients to increase their proprioception, balance, and reaction time to decrease falls. We retrain our thought processes and learn to do tasks that we do not normally do in our regular activities. The reason for this is so that our mind and body can work together in case of an emergency.

We include the use of sensory information (smell, taste, touch, sight and hearing) and the central nervous system collects this information in order to provide awareness of movement or body position. Normally, knowing where we are is unconscious thought, but as we age, this can change. As we age, we take our proprioceptive skills for granted, and as a result, we notice that we can’t do the same things we did when younger. Sensory receptors in the joints, muscles and connective tissues gather information about the body’s position, process the information, and enable the central nervous system to make the appropriate response. For example, if you start to fall, proprioception allows the brain to know the fall is occurring, and what corrections need to be made to regain your balance. Messages are sent to the muscles to contract and avoid falling.

1) Implement the Unpredictable Command Technique into water aerobics and water walking.
2) Discover simple foot exercises to improve balance.
3) Implement techniques from the Mini-Mental State Exam in the pool.
4) Retrain our thought processes and learn to do tasks that we do not normally do in our regular activities so that our mind and body can work together in case of an emergency to prevent falls.

FACULTY: Donna Lewen, BA, ATRIC, has dedicated her life to aquatics for more than 25 years, and currently works with aging adults and persons with disabilities. She was an Arthritis Foundation Trainer for over 20 years, a consultant at Ability360, and an AquaStretch™ Facilitator/Trainer. She was the recipient of the 2016 ATRI Aquatic Therapy Professional Award, the 2012 ATRI Tsunami Spirit Award, and the 2013 Arthritis Foundation Regional Public Service Award-University of Pittsburgh Community Service Award. She continues her studies in Energy Medicine, and is a Reiki Master/Trainer. Beyond her active practice, she offers intuitive guidance and wellness coaching.

1623 – Dynamic Stability with PeyowTM Aqua Pilates

Beginner / 8-hour Workshop


Optional manual is available for this course:

The ATRI member code for the Peyow Aqua Pilates digital manual is PAPDS1623.8 (case sensitive)

Visit to find the link on the Home Page.

The cost to course participants is $15 US.


Faculty: Anne Pringle Burnell, AEA, ACE, AFAA


COURSE DESCRIPTION: Discover dynamic stabilization of the lumbo-pelvic region and scapular region using beginner and intermediate Pilates exercises adapted for the water. The workshop includes Pilates basic principles, traditional exercises, and aquatic adaptations for both shallow and deep water. Progressions offer modifications for each exercise and may be used in therapeutic classes, or for the general population.


1)  Define Pilates 6 principles.

2)  Utilize 25 shallow water exercises from the Peyow Aqua Pilates technique.

3)  Experience 10 unilateral dynamic stabilizing exercises.

2014 – Evidence-Based Fall Prevention using Ai Chi

Intermediate / 3-hour Workshop


Faculty: Ruth Sova, MS, ATRIC



Falls are prevalent, dangerous, and costly. About one in three seniors over age 65, and nearly one in two seniors over age 80, will fall at least once this year, many times with disastrous consequences. As our nation’s population ages, the rate of falls is rising. Yet falling, and fear of falling, may be reduced by using slow movement coordinated with diaphragmatic breathing. This course will give you the protocol, documentation form and evidence for Ai Chi application in balance, ROM and musculoskeletal issues. The research shows that slow, fluid, rhythmic movement with controlled breathing can positively affect postural stability and falls in the elderly. If you’re in an ‘evidence-based clinic’ or if you need something new to try for your clients with balance and ROM issues, try Ai Chi. It works!



1) Experience Ai Chi with a fall prevention focus.

2) Review research supporting Ai Chi use for balance, ROM and arthrokinematic pain.

3) Receive a sample protocol to use or modify for your clients.

4) Examine a documentation form for fall prevention.

5) Consider the link between stress, muscle tension and falls.

2203 – Integrated Balance

Intermediate / 3-hour Workshop


Faculty:  Donna Lewen, BA, ATRIC


This workshop will teach you ways to integrate the mind with the body, ultimately increasing your clients’ balance, reaction time and coordination. Creative ways to use the Unpredictable Command Technique in an aquatic exercise program and aquatic walking program will be demonstrated. We’ll start with yoga for the feet and show you simple ways to improve balance with foot exercises. The foot exercises are especially beneficial for those with bunions or prior to or following a bunionectomy. The course will end by learning a new Qigong technique for inner balance.


1) Implement the Unpredictable Command Technique into water aerobics and water walking.

2) Discover simple foot exercises to improve balance.

3) Explore Pan Gu Shengong, a relatively new form of Qigong, which has been in the United States for only the past ten years. Take this practice to the water.

2204 - Interactive Posture

Intermediate / 3-hour Workshop


Faculty: Beth Scalone, PT, DPT, OCS


Interactive Posture introduces static postural assessment and reviews key muscles influencing human posture. By comparing ideal alignment with common postural syndromes, this course presents specific program design in postural correction. Pool lab will focus on postural correction exercises, verbal cues and common performance errors.


  1. Describe ideal body alignment in the frontal and sagittal planes.
  2. Assess prime muscle groups that influence posture and alignment.
  3. Recognize common postural syndromes and describe muscle impairments associated with each syndrome.
  4. Examine 10 basic dynamic movement tests.
  5. Explore aquatic postural correction exercises based on findings of dynamic and static postures.
  6. Promote proper alignment of pool exercises through verbal cues and demonstration.
2219 – Balance and Core Strength

Intermediate / 4-hour Workshop


Faculty: Connie Jasinskas, MSc

COURSE DESCRIPTION: This session will address common issues affecting balance and explore vertical aquatic exercise techniques to improve balance and core strength. Research-driven, clinically proven training strategies will be used to stimulate and improve relevant systems. Practitioners requiring core strengthening exercises will discover useful techniques to help clients train functional core strength, while challenging and improving balance.



1)  List common issues affecting balance and core strength.

2)  Assess research and clinical examples related to this issue.

3)  Relate identified issues to pool exercises designed to challenge and improve balance and core strength.

4)  Experience functional, vertical/inclined core strengthening exercises.

5)  Practice exercises to progressively challenge balance.

6)  Experience exercise progressions from sub-acute to post-rehab.

2223 – Progressive Balance Activities

Intermediate / 1-hour Course

Faculty: Melissa Lewis, MPT, ATRIC



Provide balance techniques beginning with the basics and progressing to move advanced and functional balance activities. This course will use only the properties of water to challenge and improve a client’s balance, proprioception, and stability. Specific populations will be addressed during this course. With an understanding of the properties of water and a creative mind, any combination of activities can be utilized to design a fun, safe, and effective balance protocol.


1)  Develop and implement a basic balance protocol with progressions.

2)  Create at least three unique balance exercises that could benefit a specific client population.

3)  Be aware of safety issues and concerns to be addressed when designing a balance protocol.

2328 – Trunk-Centered LE Movement

Intermediate / 3-hour Workshop


Faculty: Maryanne Haggerty, MS



This course will focus on trunk-centered stability as the foundation for mobility of the lower extremity. The how-to-do techniques of building a progressive foundation for movement will be broken down into practical application for immediate use in the clinical setting.   Inner core stabilizers of the lumbar, pelvic, and hip areas will be activated with movement of the lower extremity. Neuromuscular efficiency will be experienced in the pool with a variety of exercise and equipment experiments. Flexibility issues will be addressed for trunk and lower extremity for balanced length tension relationships to improve postural integrity and movement. The how and when to progress trunk centered movement of the lower extremity for increased functioning will be addressed in relation to the lumbar, hip, knee, and ankle areas.


1)  Experience trunk-centered stabilization techniques with the integration of the deep core stabilization system with the lumbar, hip, and pelvic areas integration with scapular stabilization.

2)  Explore proficiency in lower extremity movement and mobility with stabilization of the trunk.

3)  Determine flexibility and range of motion for muscle imbalances of the trunk and lower extremity.

4)  Evaluate progressions for trunk-centered movement of the lower extremity.

2611 – Seated Core Adaptations

Intermediate / 1.5-hour Workshop


Faculty: Anne Pringle Burnell, ATRIC

COURSE DESCRIPTION: Exercises based in Pilates, functional fitness and yoga are adapted for the seated client. Practical lab for ROM and core conditioning: UE, trunk, postural, and diaphragmatic breathing in a chair or wheelchair using body weight, toning balls (for unilateral work), and flex bands (UE/LE). Includes three exercise chart progressions for groups or semi-private classes.



1)  Determine eight basic exercise modalities for Pilates and functional training.

2)  Explore 15 toning ball exercises.

3)  Examine 15 Pilates flex band exercises.

3206 - Effective Balance and Mobility Protocols - NEW!

Advanced / 3.0 credit hours

(Classroom Viewing Time: 90 minutes / Pool Viewing Time: 90 minutes)

Faculty: Beth Scalone, PT, DPT, OCS, ATRIC


Balance is essentially motor control, meaning we have to be able to maintain our center of gravity over our base of support in not just static positions but as we move about. There are several body systems that contribute to balance and motor control. Lecture will focus on the various systems that influence balance to assist the aquatic therapist in developing an efficient and successful aquatic exercise program based on which systems are involved in a client’s balance and mobility issues. Current aquatic therapy research is summarized with clinical significance reviewed to allow the aquatic therapist to make evidence-based clinical decisions.

The pool lab portion of the course will present various aquatic balance activities/protocols and progressions for functional mobility, based on the individual body systems related to balance.


  • Describe the different body systems that influence balance.
  • List common impairments and mobility challenges related to each body system influencing motor control.
  • Apply current research into clinical decision-making process in respect to aquatic exercise and individuals with balance impairments and functional limitations.
  • Instruct, cue and progress a specific aquatic exercise program to address individual balance and functional mobility impairments.

FACULTY: Beth Scalone, PT, DPT, OCS, ATRIC, is a licensed physical therapist with many years of experience in orthopedic and aquatic therapy. As the owner of North County Water and Sports Therapy Center in San Diego (, she continues with hands-on clinical care in addition to her role as educator. Since graduating from the University of Connecticut in 1991, Beth has belonged to the American Physical Therapy Association and has achieved certification as a Clinical Specialist in Orthopedic Physical Therapy. In January 2006, she graduated from Boston University with a Doctor of Physical Therapy degree. Additional certifications include Certified STOTT Pilates™ instructor and Master Instructor for the Burdenko Method.

Beth not only provides continuing education for health care professionals, she is an adjunct faculty in the San Diego Mesa College PTA program, teaching Orthopedic Rehabilitation and Introduction to Pathology courses. She also provides the learning module/instruction on aquatic therapy to the University of St. Augustine San Diego Campus DPT program. She is the recipient of the 2010 ATRI Tsunami Spirit Award and the 2012 ATRI Professional Award.