Balance Flashcards
What is postural control?
Involves controlling body’s position in space
Postural stability: balance
Postural orientation: ability to maintain appropriate relationship between body segments and between body and the environment
What is part of posture examination?
Alignment in sitting and standing using plumb line/grid: vertical, symmetrical?
Foot position/BOS
Use weight scales under each foot to check for even weight distribution
Use of force plates
Is initial position appropriate for functional tasks?
Is initial position efficient?
Is initial position stable?
What are the 5 types of balance scales?
Quiet standing: Romberg, sharpened Romberg, one legged stance test (OLST), postural sway
Active standing: functional reach, multi directional reach
Sensory manipulation: sensory organization test (SOT), clinical test of sensory interaction and balance (CTSIB)
Functional scales: berg, TUG, tinetti, dynamic gait, functional gait
Dual task: stops walking when talking, multiple task tests
What do the 5 balance scales look at?
Dual task: cognitive demands while trying to maintain posture
Functional: performance of whole body movement
Sensory manipulation: alter surface or visual condition to see how CNS can use inputs for postural control
Active: goal is to voluntary weight shift
Quiet standing: goal is to stand still
What were disadvantages and advantages to the KUSB balance scale study?
more detailed than fair, poor, good; doesn’t require equipment
Disadvantage: ceiling effect (no stepping over objects, dual tasks, etc)
What is description of patient performance for KUSBS scores?
0: performs 25% or less of standing activity (max assist)
1: supports self with upper extremities but requires therapist assistance, performs 25-50% of effort (mod assist)
1+: patient performs more than 50% of effort (min assist)
2: independently supports self with both UEs
2+: independently support self with one UE
3: independently stands without UE support for up to 30 sec
3+: independently stands w/o UE support for 30 sec or greater
4: independently moves and returns center of gravity 1-2 inches in one plane
4+: independently moves and returns center of gravity 1-2 inches in multiple planes
5: independently moves and return center of gravity in all planes greater than 2 inches
What determines which balance test is appropriate?
Purpose and population you are testing
Reliability, validity and ease of use
Modifications
Are normative data available for comparison
Combination of postural orientation, anticipatory, reactive task components
What are characteristics of the one leg stance test?
Steady state
Fold arms across chest, picks one leg and holds in hip neutral and knee flexed to 90 degrees, test both sides
Normal subjects can stand for 30 seconds
Clinical significance: single stance during gait
Good inter rater reliability
What are characteristics of the Romberg?
Steady state
Feet together, assess sway eyes open vs. eyes closed
Abnormal if excessive sway, loss of balance or stepping
Modification is the sharpened Romberg: more challenging, feet in heel toe position, eyes closed for 60 seconds
What are characteristics of functional reach test?
Functional performance measure: active standing balance Single item test Less than 10 inches is a high fall risk High reliability and variability Modifications: sitting, other directions
What are the functional reach norms?
20-40: 16.7 for men and 14.6 for women
41-69: 14.9 for men and 13.8 for women
80-87: 13.2 for men, 10.5 for women
What is the multi directional reach test?
Examine limits of stability in forward and backward but also medial-lateral direction
What are characteristics of the berg balance scale
Measures balance by assessing the performance of functional tasks
14 item scale, 5 point scale ranging from 0-4
0 indicates lowest level of function
Interpretation: 41-56 is low fall risk, 21-40 is medium fall risk, 0-20 is high fall risk
Has sitting component
Ceiling effect
What is relationship between the berg and falls?
Berg is single best predictor of fall status.
Relationship is nonlinear
In range of 56-54 each 1 point drop score is associated with a 3-4% increase in fall risk.
In range of 54-46 a 1 point change in the scores led to a 6-8% increase in fall risk
What is the Tinetti performance oriented mobility assessment? Scores?
Gait and balance sub scores: 3 point scale
25-28 is low fall risk, 19-24 is moderate fall risk, less than 19 is a high fall risk
Reliability/validity: TUG, one leg stance, functional reach, POMA- POMA has best test reliability and predictive abilities for fall risk in people aged 65 years and older
What are the different balance things the Tinetti looks at?
Steady state balance: sitting and standing balance
Proactive balance: arising, attempts to arise, sit down
Reactive balance: nudge
Sensory component: eyes closed
What are self reports of balance?
Perception/fear of falling is important risk factors
Activity-specific balance confidence (ABC) test
Falls efficacy scale
Dizziness handicap inventory
What were findings of stroke edge task force?
4 rating: berg (3 for acute care), functional reach, postural assessment scale
3 rating: ABC test, STREAM mobility scale, trunk impairment scale
2 rating: BEST test, brunnel balance test, falls efficacy scale, Hi mat, tinetti/POMA
1 rating: trunk control test