Balance Flashcards
Define balance
Static or dynamic equilibrium of body, relative to support base
What 3 things do we need intact for balance?
Central processing
- sensory input to cortex. Motor initiation and output. Cerebellar coordination
Motor output
- muscles, tone, joints
Sensory reception
- vestibular and vision
- body awareness and proprioception
What are the mechanisms of balance
Feedback
(Sensory reception to CP)
Feed forward, learnt movement patterns
(CP to motor output)
Hip and ankle strats. Head and trunk righting actions. Protective and saving reactions.
(MO to SR)
How to test sensory inputs
Vestibular: rapid movement response
Vision: visual field test
Proprioception: mirroring and joint position sense
Somatosensory: L/D S/B
How to assess central processing
Tone: arom prom
Initiation of movement: arom and function
Coordination: FTN/HTS and function
Smooth movement: same ^
Reactive: function
Motor output assessment
Tone: prom / reflexes
Strength: isotonic and isometric
Rom: arom prom
How do we use cognition in balance
Through dual tasking
Balance outcome measures
Rombergs test
TUSS
Functional reach
180 turn
POMA
BBS
TUAG
Star excursion test
Y balance
How to progress balance treatment?
- reduce sensory input (sight)
- reduce bos
- raise cog
- encourage automatic reactions
- add reactive or proactive elements (feed forward and feed back)
- add dual tasking
How to assess balance? 3 systems.
- Sensory input
- vestibular (rapid movement response)
- vision
- proprioception (mirroring and JPS)
- somatosensory (LD SB)
- Central Processing
- smooth movement and coord (FTN HTS function)
- tone (aprom)
- initiating movement (arom and function) - Motor output
- Reactive (function)
- strength
- joint rom
Ways to get a patient to practice balance
One legged
On cushion
Dual tasking - catching
Eyes closed
Shoes off
Feet close together
Sensory input: what are the somatosensory receptors?
Muscle spindles: wrap around intrafusal muscle fibres. Detect velocity and stretch on muscle
Golgi tendon: in muscle tendon junction detects tension and joint position.
Ruffini and golgi type endings in joint detect vibration, pressure, pain
Sensory input: what are the cutaneous receptors?
Merkels discs: touch
Meisner corpuscles: mechanical pressure, touch, thermal
Pacinian corpuscles: deep pressure
Ruffini endings: pressure
Free nerve endings: pain
Sensory input: what detects visual stimuli
Rods and cones: light and motion
Optic nerve to occipital lobe: Picks up info
Sensory input: how does vestibular system gather info
3 semicircular canals: detect nodding, rotation, side flex, acceleration and deceleration.
Filled with fluid and small hairs that send info along vestibular nerve to synapse on vestib nuclei on medulla and pons to send to cerebellum
