Balance Flashcards
What is balance?
condition in which all forces acting on a body such that the center of mass (COM) is within the base of support (BOS)
What is the line of gravity?
sagittal plane alignment (falls close to joint axis
What are limits of stability?
greatest distance in any direction that a person can lean away from vertical w/o falling, stepping, or reaching for support
What is quiet stance?
Standing witha stable support surface and surroundings
What is perturbated stance?
standing during a brief displacement of the support surface or displacement of the COM over the BOS
What is the goal of balance assessment and training?
To reduce falling
What is the leading cause of injury related death, ER visits, and hospitalizations for those >65 yo?
falls
What are the important balance components need to be assessed?
mss funx
proprioception
vision
vestibular system
What are the parts of mss funx?
joint ROM muscle strength (out of 5) endurance posture coordination
What is proprioception?
internal sense of where one’s body is in space
What are proprioceptors and where are they located?
afferent receptors located in striated muscles, tendons, joint capsules
What can effect proprioception?
disease (DM, MG, MS, Guillain barre), aging, growth, and training
What is the difference between proprioception and kinestisia?
proprioception is sense of location, kinestisia is sense of motion
What does info does visual input provide?
objects and changes in the external environment, orientation of various body segments, orientation of body in space
What is focal vision?
localizing features in the visual field, conscious response to the environment
What is ambient vision?
input from the entire visual field, unconscious awareness of environment
What is used to assess vision?
Snellen, confrontation, navigation assessment
What is included in the vestibular system?
semicircular canals, otolith organs, vestibular ocular reflex
What do semicircular canals detect?
angular acceleration, sensitive to fast movements
What do otolith organs detect?
linear acceleration and head orientation, responds to slow head movements and positional changes of the head relative to gravity
What is VOR? (vestibular ocular reflex)
stabilization of gaze during head movements
How is the vestibular system tested?
movement, head positioning and then observed for symp of vestibular dysfunx such as dizziness, vertigo and nystagmus
What is the sensory weighting theory?
all sensory inputs contribute to the maintenance of posture
What system is “valued” in quiet stance?
proprioception is most important
What system is “valued” in pertubation?
1st proprioception, then vision/vestibular follow
What system is “valued” if proprioception is imparied or providing conflicting information?
visual
What is most important to the maintenance of balance?
muscles closes to BOS
What strategy is used in mild perturbation?
ankle strategy
What strategy is used in moderate perturbation?
hip strategy
What strategy is used in significant perturbation?
stepping strategy
What are the assessment components of balance PE?
cognition, strength, vision, balance strategies, vestibular func, home environment, use/need of assistive device, medication side effects, polypharmacy,
What are the grades for state and dynamic?
0: absent-unable to maintain balance
1: poor-requires handhold support and mod/max assistance; unable to move or accept challenge w/o loss of balance
2: fair-maintain balance w/ handhold support and occasional minimal assistance; can balance while turning head or trunk
3: good-maintain balance w/o handhold support but minimal sway; can balance while picking up object off floor
4: normal-steady balance w/o handhold support; accepts maximal challenge
What is the timed up and go (TUG) test?
start by sitting in a chair, rise, walk 10 ft, turn and return to chair
What are the indicators of TUG test?
30 sec impaired functional mobility and high fall risk
>= 12 sec is high risk
What is the 30 sec chair stand test?
of times a pt can rise to standing form a seated position in 30 sec with arms across chest
What are the indications of the 20 sec chair stand test based on?
age and gender
What is the 4 stage balance test?
4 different standing positions held for 10 sec each
What stance that cannot be held indicates a patient is at risk for falling?
tandem
What is the Berg balance scale?
more involved objective measure of static and dynamic balance (out of 56 points)
What is the functional reach test?
maximal distances one can reach forward beyond arm’s length
What are intrinstic risk factors for falls?
advances age, weakness, gait/balance abnormalities, vision, hypotension, chronic conditions
What are extrinstic risk factors for falls?
environmental barriers, obstacles, tripping hazards, medications, improper use of assistive devices
What are some assistive devices
cane, axillary crutches, loftstrand cruches, hemi-walker, walker
MSS balance training components?
stretching to inc ROM, strengthening interventions (land and aquatic), endurance activities, postural corrections, Tai Chi
Proprioception balance training components?
stimulation of receptors (joint mobilizations, weight bearing activities, weight shifting), challenging BOS (tandem stance, single leg stance, limit visual input), surface challenges (outdoor surfaces, foam, theraball, balance, discs, bosu ball), technology (biodex, wii type games)
Vision balance plan?
encourage regular eye exams, take precautions in the dark, home safety evaluation
Vestibular balance training components?
Dix Halpike maneuver for BPPV, mobility with head movements to help acclimate
What are some Rx that may effect balance
sedatives, sleep aids, anti-depressants, polypharmacy (4+ meds)
Who can you a balance patient to?
PT, OT, podiatrist, neurologist, geriatrician, ophthalmologist
