4.19 Balance

Question 1

Morbid statistic about over 70 y/o and falling with a hip fx

Answer 1

70% chance of dying within the year

Question 2

What is balance?

Answer 2

maintaining COM over BOS

Question 3

COM locations: men/women

Answer 3

men: umbilicus
women: 2-3 in. lower (ASIS level)

Question 4

What does COM change with?

Answer 4

• height
• girth
• posture
• morphology
• weight distribution
• carrying a child or backpack

Question 5

posture issues that change COM

Answer 5

• FHP

- kyphosis

Question 6

morphology that may impact COM

Answer 6

• endomorph
• mesomorph
• ectomorph

Question 7

weight distribution and COM

Answer 7

• Sir Mix-a-lot
• Dolly parton
• Dunlap
• amputees

Question 8

base of support: things to consider

Answer 8

• foot position

- look at shoes, wear patterns

Question 9

What is the cone of stability?

Answer 9

can go forward, back, side⬌side without falling over in standing

Question 10

What is the cone of stability for most people?

Answer 10

12 in. A⬌P
16-18 in. laterally

*bigger in sitting than standing

Question 11

Why assess cone of stability?

Answer 11

can help determine how well they can sit and support themselves

Question 12

3 strategies for catching ourselves to regain balance

Answer 12

• ankle strategy
• hip strategy
• step strategy

Question 13

ankle strategy

Answer 13

DF/PF

Question 14

hip strategy

Answer 14

sticking out the butt

Question 15

step strategy

Answer 15

take a step forward

Question 16

Why are the catching strategies so important for stroke pts?

Answer 16

stroke pt may not be able to take a step, may not be able to dorsiflex

Question 17

basic idea of balance training

Answer 17

almost getting them to fall but they don’t

• can do a lot with BOS
• trying to get them strong in single leg stance, narrow stance, eyes closed, etc

*getting rid of the fear of those feelings of “falling”

Question 18

What 3 systems feed into the CNS for balance?

Answer 18

• vestibular
• visual
• somatosensory

Question 19

How to work on vestibular with pts?

Answer 19

can push someone and get their brain to better understand or habituate

Question 20

How does a pt habituate to PT that targets vestibular?

Answer 20

• keep putting them into the position until their body gets used to the signal (turns down the input in the processing area)
• tune it down like Bringman tunes out his wife and kids

Question 21

addressing visual issues

Answer 21

• glasses

- light

Question 22

somatosensory issues: what is the problem?

Answer 22

• not getting as much input

- pts either do too much or too little

Question 23

What is done for somatosensory issues (PT)?

Answer 23

Do the activity over and over again to get the signals stronger and better

Question 24

Why is HEP for balance difficult? What sorts of things might you incorporate?

Answer 24

you can’t be there with them

• close their eyes brushing their teeth
• simple things they can be safe with