Balance Flashcards
Postural Control
Controlling the body position in space for stability and orientation
Balance
Ability to hold COM in relation to BOS
Center of Gravity
Vertical projection of COM
-Neuro POV = slightly anterior to L2 in standing
Base of Support
Area of body in contact with a support force
Postural Orientation
Ability to maintain an appropriate relation b/w body segment and b/w the body and the environment
Limits of Stability
Internal representation of how far the body can move over its BOS before changing the support or losing balance
Anticipatory Postural Responses
Active movement of the body’s COM in anticipation of a postural transition from one body position to another
Reactionary Postural Responses
Active response to an external perturbation
Sensory Interaction/Orientation
Ability to maintain balance during altering sensory conditions
Balance Examination Contents
1) Taking a History
2) Systems Review
3) Tests & Measures (ICF model)
Taking a History
Chief complaint Medical history Recent history of falls Medication Confidence level
Systems Review
Cardiovascular
Integumentary
Neuromuscular
Musculoskeletal
ICF Model
Health Condition
Body Functions/Activities/Participation
Environmental/Personal Factors
Body Functions and Structure
ROM Muscle Strength Muscle Tone Coordination Cognition Posture Pain Perception
Sensory Systems used to hold balance
1) Somatosensory: Light touch, Proprioception/Vibration, Pain
2) Vision
3) Vestibular
Ankle Strategy
- control of postural sway from ankles and feet
- head and hips travel in same direction @ same time with the body moving as a unit over the feet
- Use when…
1) Firm surface
2) Feet well supported
3) Slow moving w/ min displacement
Hip Strategy
- Control of postural sway from pelvis and trunk
- Head and hips travel in opposite directions
- Use when…
1) Feet not completed supported
2) Quick and large displacements
Stepping Strategy
-Steps with the feet to establish a new BOS when COG has exceeded the original BOS
- Use when…
1) The other strategies aren’t enough to maintain equilibrium
Clinical Test for Sensory Interaction in Balance (CTSIB) AKA “Foam & Dome”
- does not require computerized force plate
- selects and combines sensory information in different environments
- Does NOT measure the INTEGRITY of the 3 sensory systems
Sensory Weighting: Firm Surface
70% Somatosensory
20% Vestibular
10% Vision
Sensory Weighting: Unstable Surface
10% Somatosensory
60% Vestibular
30% Vision
“Foam & Dome” Conditions
1) Firm, EO
2) Firm, EC
3) Firm, dome
4) Foam, EO
5) Foam, EC
6) Foam, dome
usually do not test 3) or 6)
Condition 1 & 4 passed…Condition 2 & 5 failed
What are they relying on?
What sensory system(s) would need to be examined further?
Relying on…Vision
Need to examine…Somatosensory & Vestibular
All conditions passed except Condition 5 failed
What are they relying on?
What sensory system(s) would need to be examined further?
Relying on…Somatosensory & Vision
Need to examine…Vestibular
Condition 1) Firm, EO
Somatosensory is dominant
Condition 2) Firm, EC
Somatosensory is dominant
Condition 4) Foam, EO
Vision is dominant
Condition 5) Foam, EC
Vestibular is dominant
Balance Error Scoring System (BESS)
- assesses static postural stability
- designed for the mild concussions…to assist in return to sports play decisions
-population tested: concussion, mild TBI, ankle instability, vestibular disorders
BESS testing conditions
6 conditions: barefoot, EC for 20 seconds each:
- DLS(feet together) (firm/foam)
- SLS (non-dominant foot) (firm/foam)
- Tandem (non-dominant foot in back) (firm/foam)
BESS errors
- Hands off the hips
- Opening eyes
- Step, stumble or fall
- ABD/flex of hip > 30°
- Lifting forefoot/heel off surface
- Out of test position >5 sec
Score 0-60…low score=better balance
7-9 points for detectable change
SLS (Anticipatory)
- Knee flex 90°
- Arms crossed
-Document: # attempts, time, visual observations
Romberg/Tandem Romberg (Anticipatory
- feet together (Romberg) & EO
- Repeat test with EC
- One foot in front of other (Tandem Romberg)
- Normal = hold 30 seconds
- Document: # attempts, time, visual observations
Activity Balance Tests
- Berg
- Tinetti
- Functional Reach
- TUG (normal, manual, cognitive)
Participation Balance Tests
-Activities Based Confidence Scale
Berg Balance Scale
-14 items to assess common ADL’s safety
- Each test = 0-4
- Max. score = 56
- Score < 36 = fall risk
-Need 3-8 points for detectable change!
Tinetti
-2 subscales to screen for balance and mobility skills in older adults and determine likelihood of falls
1) Balance (9 tests)
2) Gait (7 tests)
- Each test scored 0-2
- Score 19-24 = Mod fall risk
- Score < 19 = High fall risk
**Need 4 points for detectable change!
Functional Reach
- Max distance reaching forward beyond arm’s length while maintaining fixed BOS in standing
- Examines limits of stability in forward direction
- Pt. stands next to wall, shoulder flex 90°, make a fist and lean forward
- 3 trials, average of the last 2
**3 to 9 cm for detectable change!
Activities Based Confidence Scale
- 16 item questionnaire
- Balance self-efficacy
-Rate confidence performing a variety of home and community based functional activities
- Scores 0-100
- High scores = greater confidence
Timed Up and Go (TUG)
-Stand up from a chair, walk 3 meters as quickly and safely as possible, cross a line marked on the floor, turn around, walk back, and sit down. The patient may use AD.
> 15sec = 90% fall prediction
TUG Manual
Same as TUG but patient must walk holding a cup filled with water
TUG Cognitive
Same as TUG but patient asked to complete the test while counting backward by 3’s from a randomly selected number between 20 and 100
(can also ask the patient to recite alternating letter of the alphabet “a-c-e” aloud)
Body Structure/Function Balance Tests
CTSIB BESS Single Leg Stance Romberg Tandem Romberg
