9/20b Balance Lab (Examination, Evaluation, Intervention)

Question 1

Why do we test balance?***

Answer 1

• gives us a baseline of where our patients are so we know how to prescribe appropriately
• looks at safety of our patient for fall risk
• helps us determine if we need to refer out
• VERY important for documentation of the person’s impairment for standard reimbursement

Question 2

Methods to test performance

Answer 2

• Usual Performance: what patients are like in everyday life (want patients when their in the worst conditions, so test with strategies that are like every day life)
• Best Performance: what patients are like in optimal conditions
• Dual Task: Doing two things at once, mental dual task imposes two tasks while thinking of something

Question 3

Impacts of speed TUG

Answer 3

when you say go at normal pace, patient may either go too fast or too slow…so in order to get them at their usual conditions, distract them with cognitive dual tasks

Question 4

Thresholds for fall risk

Answer 4

NOT beneficial unless patients are at extremes

• Minibest test out of 28 points
• BERG balance out of 54 points
• -below 46 were at fall risk
• -above 46 were not at fall risk
• -strictly used for insurance purposes

Question 5

Sensory systems that impact performance:

Answer 5

1. vision - impaired with aging
2. vestibular - impaired with aging
3. balance and tactile - impaired with aging
4. proprioception - NOT impaired with aging, but affected by diseases and at a much HIGHER fall risk

Question 6

Significance of proprioception

Answer 6

knowing where your body is in space

• -testing with the foot, the ability to know where your JOINT is in space rather than from stretch receptors and cutaneous feelings
• -After a fall, you NEED to test proprioception, if it is off then patient likely needs to be referred out to NEURO

Question 7

What is the difference between absent and impaired proprioception?

Answer 7

absent - doesn’t feel anything

impaired - keeps saying um and is NOT sure of themselves

Question 8

What is a way to compensate for lost proprioception?

Answer 8

VISION to help with movement and restoration.

Once proprioception is lost, it is very hard (almost impossible) to regain

Question 9

What are some examples of challenges for sensory orientation?

Answer 9

• adding a soft surface to walk on impacts vestibular system
• taking out visuals creates a 10-20% sensory decline
• anticipatory orientation helps to work on stability strength/force

Question 10

Short Physical Control Battery Test, BERG Balance test***

Answer 10

Progression of base of support/COM concept

• Regular stance, Semi ROMBERG/tandem stance, to Full ROMBERG/tandem stance
  1. After holding for 10sec, you can progress to the next level, if you can’t hold for 10 seconds for one, then progress to number 2.
  2. Then after progressing through the stances, do a gait speed test (amount of time to walk 4 meters at normal pace – <4.82 sec = 4, >8.7 sec = 1, unable = 0)
  3. Then chair stand test – Pre test( hold arms across chest and try to stand 1x) then 5 repeats of sit to stand as fast as possible (<11.19 sec = 4 points –highest, >16.7 sec = 1 point – lowest, unable to do it or >60sec = 0)
• don’t need to get into eyes closed/visual testing when just trying to determine the necessary device for the patient

Question 11

TUG***

Answer 11

Timed Up and Go - quality of movement observations in CASSS

• patients are allowed to use their assisted devices
• add cognitive tests to make closest to usual performance
• Steps:
  1. at go, stand up from chair,
  2. walk to the line on the floor at normal pace
  3. turn
  4. walk back to chair at normal pace
  5. sit down again

Question 12

Mini Best Test

Answer 12

Score (0=severe, 1=moderate, 2=normal)

1. Anticipatory: ability to maintain posture (often for around 30 seconds)
2. Reactive Postural Control: compensatory stepping and recovery with 1-step in the right direction
3. Sensory Orientation: change surfaces where standing and take out visuals
4. Dynamic Gait: maintains task speed and form when adding cognitive challenges/dual tasks

Question 13

Balance training

Answer 13

• Patients have to have their homeostasis challenged, if they don’t move out of their maintenance zone then they won’t improve
• Different ways to overload the system:
  1. Motor
  2. Sensory
  3. Cognitive
• ->MSK, Muscle Synergies, Sensory systems, sensory organization, cognitive strategies, cognitive resources
• MUST work at STABILITY LIMITS

Question 14

What are challenges with prescribing balance training?

Answer 14

it is difficult to come up with a concrete number for practice, but it’s important to think about the end goal - realistic but challenging

Question 15

distinguish between performance and learning for a patient***

Answer 15

• Learning is what he/she retains
• Learning is optimal when patient is struggling with performance
• Intrinsic motivation leads to much better participation and improved overall performance

Question 16

Functional reach test

Answer 16

• used in veterans
• measure of anticipatory postural control, but NOT effective
• Flexing muscles in anticipation of the movement
• High risk for falling when mean reach was <6in

Question 17

Is TUG an accurate measure of gait speed?***

Answer 17

YES