13. Balance and Gait Flashcards
Upper extremity tests in standing
bilateral shoulder flexion
apley scratch test
lower extremity standing tests
bilateral 1/4 squat
half squat
full squat
single leg stance
toe walking/heel walking
what are the three balance systems
neurosensory
central processing
musculoskeletal
to acquire information about where the body is relative to the BOS- includes visual, somatosensory, and vestibular
neurosensory
to determine in advance an effective response
central processing
effector components, resources to carry our the needed movement for response (strength, core, ROM)
musculoskeletal
body balance is controlled by which 3 sensory systems?
vestibular, visual, proprioceptive
important components of visual
acuity
contrast sensitivity
peripheral vision
depth perception
which cranial nerve is in charge of visual
optic, CN 2
what sensory components provides information about the environment
visual
which sensory component provides info about the relative location of body parts in space
somatosensory
components of somatosensory
tactile- touch/pressure receptors
joint, tendon, muscle proprioceptors
which sensory components helps posture and balance control
vestibular
what are the anatomical components of the vestibular system
semicircular canals
otolith organs- utricle and saccule
vestibular n- CN 8
vestibular nuclei in brainstem
integration and processing of sensory info in order to generate a motor response
central processing
time required to complete central processing
latency
T or F: central processing important for resolving sensory conflict
T
time required to generate a central processing response
reaction time
2 types of postural responses
automatic (feedback)
anticipatory (feed forward)
automatic postural motor strategies progression
ankle strategy
hip strategy
stepping strategy
reaching strategy
ankle strategy:
used when disturbances are _____. ______ common strategy used. small adjustments _______ to ______. muscle activation is from _______ to ________
used when disturbances are small. most common strategy used. small adjustments anterior to posterior. muscle activation is from distal to proximal
hip strategy:
used when disturbances are larger and ______, when the support surface is ______ or ______ in size. muscle activation is from _____ to ______.
used when disturbances are larger and faster, when the support surface is compliant or reduced in size. muscle activation is from proximal to distal
stepping strategies:
occur when the COM is displaced ______ the limits of the ____.
occur when the COM is displaced beyond the limits of the BOS
T or F: if stepping strategy is not an option or failing, a reaching strategy can be used when a nearby object is there
T
what make up the effector components, in order to execute a response?
lower extremity ROM, muscle strength, endurance, power, coordination
in older adults, ________ and _______ are reduced by aging or disease
redundancy and reserves
T or F: aging is a diagnosis
F
risk factors for fear or falling
at least one fall
female
older
consequences for fear of falling
decline in physical and mental
increased risk of fall
progressive loss of health related quality of life
components of the balance assessment
- assessment of movement strategy for postural response
- exam of sensory organization
- tests to quantify balance
what is the type of assessment you should use to look at older patients and their function?
biopsychosocial model
4 conditions of the mCTSIB (modified Clinical Test of Sensory Interaction in Balance)
eyes open firm surface
eyes closed firm surface
eyes open, compliant surface
eyes closed, compliant surface
tests to quantify balance- which tests functional balance?
static balance
dynamic balance
psychological aspects
dynamic balance!
tests of static balance
mCTSIB
romberg test
semi-tandem
sharpened romberg
single leg stance
ALL timed tetsts
Single leg stance high fall risk cut off time
5 seconds
types of functional balance tests
active standing
reactive balance
anticipatory balance
dynamic balance
functional balance: active standing tests
functional reach
berg balance scale
step test
functional balance: reactive balance test
nudge/push test
functional balance: anticipatory balance test
catching test
functional balance: dynamic balance test
4 square step test
DGI (dynamic gait index)
TUG
tinetti balance and gait
physical performance test
geriatic society rec for balance and gait
TUG- with cognitive effort
berg balance
tinetti performance- oriented mobility assessment
self report questionnaires
MFES: Modified Falls efficacy scale
ABCs: activity balance confidence scale
fear of falling avoidance behavior questionnaire
downfall of BERG balance screen
does not effective capture gait issues, especially important in stroke populations
gait performance measures
functional gait assessment
dynamic gait index
what populations would you use sitting balance scale for?
Spinal cord pts
self report questionnaires tests for what?
the psychological aspects of balance
review the gait cycle
stance portion in what percent of the gait cycle
60%
phases of the stance portion of the cycle
initial contact
loading response
midstance
terminal stance
preswing
foot contacts the ground/heel strike
initial contact
weight shift occurs: from initial contact to other foot lights off the ground
loading response
both ankles aligned in frontal place; from other foot off ground to midswing
midstance
from ankle alignment to just prior of IC of swing leg
terminal stance
from initial contact of swing leg to just prior to lift off of stance leg
preswing
swing portion of cycle is what percent of the cycle?
40%
progression of swing phase
initial swing
mid swing
terminal swing
lift off of stance leg from ground to max knee flexion
initial swing
from max knee flexion to vertical tibia position
mid swing
from vertical tibia to just prior of initial contact
terminal swing
double limb support is ___% of the gait cycle
20
double limb support happens when
at beginning and end of stance phased
single limb support happens ___% of gait cycle
80
this happens when the opposite foot is in swing, and increases with increased speed
single limb support
arm swing: the arm _______ the leg in ____ should move _____ to offset spinal rotation; arm swing ______ with increased gait speed and step length
the arm opposite the leg in swing should move forward to offset spinal rotation; arm swing increases with increased gait speed and step length
assistive device is ______ the affected side
opposite
assistive device is _______ the affected side, if the patient has neuro deficits and cannot hold it on opposite side
same side
maximal hip flexion needed for any of the stances of gait
25
maximal hip extension need for any of the stances of gait
20
where does a DF limitation show
midstance
how would a patient with limited dorsiflexion compensate in midstance?
increased knee flexion
in terminal stance, if iliopsoas is tight, what motion will the pelvis do?
rotation backwards
largest amount of knee flexion needed for gait
60
largest amount of ankle plantarflexion needed for gait
15
largest amount of dorsiflexion needed for gait
10 degrees of dorsi
which muscles bring the leg forward
iliopsoas, rectus femoris, adductor magnus
muscles in the front!
anterior view- what can you see during gait
knee valgus/varus
hip drop/hike
ankle supination/pronation
pelvis movement
distance the foot advances in relation to the other
step
horizontal distance between heels
step width
distance from one foot to the same foot
stride length
number of steps taken per minute
cadence
the speed that one ambulates
velocity
what gait is this? what happens?
circumduction gait
trunk and pelvis rotate anteriorly
circumducting the leg out to the side of the body
what gait is this? what happens?
foot drop
toes drag against the ground during swing phase
loss of dorsiflexion
which gait is common after a stroke or TBI?
foot drop
what gait is this?
trendelenburg gait
pelvis drops excessively on contralateral leg side with each step
compensated trendelenburg
pt leans towards stance side to stop pelvic drop
what gait is this? what happens?
hemiplegic gait
paralysis or weakness of entire side of body
antalgic gait
ambulating against or to avoid pain
ataxic gait
range of motion/strength are not compromised, just a lack of coordination
what gait is this? what is happening
scissor gait- narrowing or even crossing over of the legs as they walk
tightness of hip adductors
what ortho issue can cause foot drop
fibular issues- fracture, etc
what is scissor gait associated with
cerebral palsy or other neuro
what gait is this? what is happening?
parkinsonian gait/ festinating gait
shuffling the feet with flexion of the trunk, weight of body on balls of feet
hip hiking is
elevation of ipsilateral pelvis during swing
what is knee hyperextension in relation of gait
rapidly thrust knee into hyperextension after limb contacts the floor
what is steppage gait
excessive hip and knee flexion to clear swing limb
what is vaulting gait
rapid ankle PF during stance to clear opposite limb
