Balance

Question 1

What is balance

Answer 1

the static or dynamic equilibrium of the body, relative to the support base. as long as the COM remains over the BOS balance Is maintained. Balance is not based on a fixed set of equilibrium reflexes but on a flexible, motor skill that can adapt with training and experience

Question 2

what do we need for balance

Answer 2

intact sensory receptors, intact PNS and CNS to transmit, receive and process sensory information/ motor output, intact MSK system to produce movement

Question 3

sensory receptors- carries 3 classes of information

Answer 3

exteroceptive- external environment- pain/ touch/ temp/ vision, proprioceptive- body position/ from muscle/tendon/joint capsule
interoceptive- internal pain, unconscious sensation from deep structures, vestibular

Question 4

types of sensory receptors

Answer 4

muscle spindles- wrap around intramural fibres of skeletal muscle, detect rate and amount of stretch on muscle
Golgi tendon organs- muscle tendon junction- detects tension
joint kinaesthetic receptors- sensory endings in joint capsules similar to integument and Golgi receptors

Question 5

vestibular system

Answer 5

located in inner ear, made up of 3 semi-circular canals and otoliths, semi circular canals pick up rotation ,nodding and side flexion. fluid in canals move and stimulate hairs that send info along nerves- as fluid moves- goes through vestibular nerve to brain

Question 6

vestibular pathways

Answer 6

vestibular afferent synapses on the vestibular nuclei in medulla and pons and sends info to cerebellum, if we move head- lose vestibular system, if eyes and vestibular system send contrasting info to brain- leads to dizziness

Question 7

need intact sensory pathway

Answer 7

dorsal columns- gracilis and cutaneous- touch/ position and vibrations, spinothalamic- pain and temp, spinocerebellar- proprioception

Question 8

need intact sensory central processing

Answer 8

sensory information to sensory cortex in parietal lobe. sensory cortex perceives different parts of the body in different place- sensory homunculus

Question 9

need intact motor central processing

Answer 9

motor cortex in the back of the frontal lobe links with the basal ganglia to produce different movements. different areas of the cortex ill stimulate different areas in the body, need intact in order to produce normal motor response, intact cerebellum that receives sensory and motor information and coordinates it, basal ganglia important- produce motor memory

Question 10

elements of balance

Answer 10

sensory reception- vestibular/ vision. body awareness/ proprioception
central processint- sensory input to sensory cortex/ motor initiation to motor output/ cerebellar coordination
motor output- muscles- strength/ power/ tone/ joints

Question 11

need intact motor pathway

Answer 11

corticospinal- lateral- motor info to limbs and anterior- motor info to axial muscles
vedtibulospinal- integration of head and neck and trunk with extremites
reticulospinal- lateral- facilitates flexion and inhibits extension medial does opposite
rubrospinal- controls fine movement
tectospinal- controls muscles

Question 12

need intact peripheral motor system

Answer 12

alpha motor neurone- take sensory info to muscles, muscle strength/length/power/endurance, joint range

Question 13

sensory input assessment

Answer 13

vestibular, vision, proprioception, somatosensory, rapid movement response, visual field, mirroring/ joint position sense, light and deep touch, sharp and blunt

Question 14

central processing assessment

Answer 14

tone- AROm and PROM- alpha motor neurone and descending pathways
initiation of movement- AROM and function
coordination and smooth movement- FTN/HTS and function- tells us about problem with cerebellum
reactive- function

Question 15

motor output assessment

Answer 15

tone- PROM/ reflexes, muscle strength- isometric and isotonic, joint ROM- AROM/PROM

Question 16

autonomic reactions

Answer 16

ankle strategy- as we move somebody and challengee balance- ankles should react, hip strategy- same as ankle- hips moves to keep COG over BOS, trunk and hip right reactions, protective and saving reaction, stepping reactions, no reaction

Question 17

balance mechanisms- steady state

Answer 17

reactive (feedback), compensatory, return stability after perturbation

Question 18

balance mechanisms- proactive (feed forward)

Answer 18

anticipatory, learned postural adjustments before movement

Question 19

function- physio role

Answer 19

to determine what the impairment problems are such as pain, ROM, sensation, strength, tightness, high/low tone

Question 20

cognition

Answer 20

we can balance and walk and talk and do number of tasks that involve cognition as well as balancing. this is duel tasking and requires the ability to split out attention and still achieve the task

Question 21

balance treatment- individual

Answer 21

through neurological assessment- identify impairments and address those problems

Question 22

balance treatment- task

Answer 22

analyse the task such as carrying an object and workout what needs to be addressed- e.g. change the way the object is carried, change the body position, adapt the object

Question 23

balance treatment- environment

Answer 23

determine if the environment can be changed to make the task easier e.g. raising the height of a chair to help sit to stand

Question 24

balance treatment

Answer 24

start with impairments e.g. increase strength of quads but put into functional activity e.g. sit to stand. progress the treatment by increasing the resistance for strength training or changing the task such as carrying a lighter object or changing the environment such as standing on a more unstable surface

Question 25

how to challenge balance

Answer 25

take away senses, reduce the BOS, raise the COG, encourage automatic reactions, add reactive or productive elements and add duel tasking

Question 26

outcome measures

Answer 26

rombers test, timed unsupported steady stand, functional reach, 180 turn, performance orientated mobility assessment, berg balance scale, get up and go, star excursion, Y balance test