Balance Flashcards
Postural control
control the bodys position in space for stability and orientation between body segments and the environment, appropriate for a task
Postural stability
maintenance of COM within BOS
Postural orientation
Ability to maintain relationship between body segments and between body and environment for a task
Aging and postural control
MSK: Decreased ROM in LE, loss of spinal flexion flexibility leads to flexed posture
NM: Decreases in vision, somatosensory, vestibular functions, multisensory deficits
Peripheral vestibular structures
Vistibular end organ
CN VIII
Basilar artery
Anterior inferior cerebellar artery
Otoliths
Utricle- horizontal
Saccule- vertical
detects linear motion, tonic discharge, push/pull relationship
Semicircular canals
Anterior, posterior, and lateral
perpendicular relationship
angular motion detection
tonic discharge
push/pull relationship
Vertebrobasilar system (blood supply)
PICA supplies the inferior vestibular nuclei and inferior portion of the cerebellum
Basilar artery supplies pons and superior vestibular nuclei
Vestibular Ocular Reflex
stabilize gaze during movemebt
VOR gain normal is 1:1 head:eye movement
VOR is intact and mature by 1 year of age
Vestibulo-Spinal Reflexes
Coordinated head and body movements to maintain head in upright position
Lateral VSR: adjusts limb movement for balance
Medial VSR: cervical connections, branches to extraocular muscles
Central processing
Adaptive strategies change with demands of task and environment
Anticipatory strategies pretune sensory and motor systems based on prior learning
Postural control strategies
Ankle: driven by somatosensory system
Hip: driven by vestibular system
Stepping: driven by vestibular system
Purpose for testing balance
Screen for fall risk
Basic screen of large populations
Compare to normative data for large populations
provide an individualized training program for improvement and fall risk reduction
Activities of balance confidence- ABC scale
out of 16
100% confident in all
50-80% somewhat impaired
<50% likely homebound
Falls efficacy scale FES
Score 10-100
>70 fear of falling
>80 increased risk of falling
Timed up and go TUG
< 20s independently mobile
>30s needs assistance for mobility
>12s fall risk
BERG Balance scale
0-56
age 60-69: 55
age 70-70: 53-54
age 80-90: 50-53
POMA
Balance and gait, out of 28
<19 high fall risk
19-24 medium fall risk
25-28 low fall risk
Intervention Vertically (pusher syndrome)
Orient to perturbed position, use intact senses to re-calibrate missing or dysfunctional senses
steady state and stability interventions
vertical position feedback, reaching activities, head righting skills
Anticipatory balance control intervention
repeated sit to stand
walking on toes
lateral weight shifts
Reactive postural control
reflexes
ankle/hip strategies
stepping strategies
Cephalocaudal progression of control
birth: lacking head control
3 months: emerging anticipatory and reactive postural response in neck muscles
6-8 months: steady state control for independent sitting
10 months: postural response in standing
15 months: postural response in walking
3 years: visual –> somatosensory control of balance
10-12 years: mature postural control
Postural control in children with CP
increased excursion and velocity of postural sway
difference in balance strategies
Kids best test
Ages 7-18
27 tasks
all domains
Pediatric balance scale
Ages 2.5-13.5
14 items
all domains except reactive
Early clinical assessment of balance
Children with CP ages 1.5-12
13 items
all domains except sensory/orientation
Segmental assessment of trunk control
children and adults with CP 3+ months
static, active, and reactive control across 7 segemtenal areas
only steady state and postural domains
