Balance Flashcards
Usual Examination findings associated with Balance Deficits - Subjective
- History of disruption/impairments to visual, vestibular or somatosensory system
- Medical diagnosis affecting motor control or processing
- Use of assisted device
- Past fall and/or fear of falling
- Pain
- Multiple medication use (more than 2)
Usual Examination findings associated with Balance Deficits - Objective
- Functional movement screen
– (CASSS: Control, Amount, Symmetry, Speed, Symptom reproduction)
– Aberrant motion, poor dissociation, guarding, limited strategies - Sensory screening
– Poor proprioception or body awareness, poor protective sensation (monofilament test), - Mobility restrictions ( maybe joint, soft tissue, neuro)
- Deficits in strength, force production, endurance
- Fall risk identified on balance outcome measures for balance
- Vision/vestibular deficits
Examples of impairments identified in exam will determine the goals of the intervention
- Environmental risk
- Fear of falling
- Poor static (isometric) control
- Poor dynamic control
- Lack of dissociated movement
- Cone of stability
- Influence COM (limb loss)
- Influence BOS
- Lack of balance strategies
- Reaction time
- ROM limitations
- Proprioception/body awareness
- Force production and endurance
- Refer as needed
Identify risk factors
____ may be very different even though they have the same diagnosis
intervention
____ is often associated with falls due to the urge to need to get to the bathroom
incontinence
Common patient education - fall risk
- Decrease clutter – create clear pathways
- No loose rugs or other tripping hazards (pets, cords, furniture placement)
- Night lights or well-lit pathways
- Keep items that are used often in a convenient location (Consider how reaching challenges center of mass)
- Help patient’s problem solve home obstacles and routines
- Consider a fall alert system or have a check-in plan with a family member
- Prioritize patient safety (Appropriate use of assisted device and educate and create safer movement strategies)
Staggered stance ____ the base of support
quadruples
How would you educate patients to pick up an object off the floor?
- Squat
- Step
- Feet with the part
- Tandem stance
What are some ways you can address risk factors?
- Address risk factors with education
- Decrease/change risk factors with interventions
- Refer to appropriate providers
– Optometry, vestibular rehab, AA – counseling, MD for diagnosis/medications - Appropriately build patient confidence
– Graded exposure to fearful situations
Safety with balance interventions - In the clinic
- GAIT BELT
- Environment(distractions)
- Assistance with devices
- Assistance from provider
- Level of guarding
- Obstacles
A kitchen chair is…
NOT a solid base of support.
5 Variable of motor control that apply to balance
- Gravity
- Planes of Motion
- Joints to Ctonrol
- Base of Support
- Motor Control (assisted to patient controlled)
Variables to manipulate motor control for balance
Planes of Motion
Joints to Control
Stability (stable vs unstable)
Speed of Contraction
Concentration
Motor Control (assisted to patient controlled)
Clues an intevention is to difficult
- Patient frustration
- Poor quality of movement
- Symptoms
- Unsafe
- Patient is holding there breath/can hold a conversation
Clues an intervention is too easy
- Patient goes too fast
- Tells you they feel too easy
- High levels of success rate
- Talking a lot/easily distracted
Example of patient progression with poor lumbopelvic dissociation
Example of patient progression with no trunk strategy
