Balance

Question 1

Balance Ax

Answer 1

Berg balance scale: sit to stand, transfer, reaching while standing…

Time Up and Go Test: test sit-stand, turning, stand-sit

Question 2

What to assess about balance?

Answer 2

Sitting balance (Static + dynamic)
Standing balance (Static + dynamic)
Retropulsion (the tendency to lose your balance by leaning backward) esp. for PARKI

Question 3

Dynamic Sitting Balance Activities During ADLs

Answer 3

• Lower body dressing, which can include donning/doffing socks and shoes, as well as threading pants. This also incorporates reaching to low surfaces along with challenging balance
• Bathing, including lower body bathing if possible. If lower body ADLs are too challenging, you can grade this down for the patient to focus just on upper body bathing edge of bed
• Other upper body ADLs in unsupported sitting: grooming, upper body dressing, while reaching in multiple planes to retrieve the item

Question 4

Dynamic Sitting Balance During I-ADLs

Answer 4

• Laundry management in sitting (either edge of bed or wheelchair-level), which can include reaching for the floor to retrieve and place clothing items in multiple planes. This can be done with or without the use of a reacher
• Meal preparation sitting in the wheelchair, while adding in reaching for dishes, pots, pans, food items

Question 5

Dynamic Standing Balance During Basic ADLs

Answer 5

• Side-stepping in out and out of the tub with the wall or grab bar (if they will have), if your patient is going home to a tub
• For a less difficult activity, you can have your patient side-step over the lip of a walk-in shower if they are going home to a walk-in shower
• Toilet sit-to-stands without the use of their hands
• Grooming at the sink in standing with reaching out of base of support for items.

Question 6

Dynamic Balance During Instrumental ADLs

Answer 6

• Making the bed in standing, including stripping the sheets and putting on clean sheets for an extra challenge
• Retrieving or putting away clothing or linens from high surfaces (the closet) or lower surfaces (the nightstand, low dresser drawers, even the floor)

Question 7

PARKI balance concern

Answer 7

because of freezing, stooped posture, shorter steps, narrow base of support, poor trunk control

Question 8

Ataxia balance

Answer 8

because of cerebellum, wide base of support