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Test and Measures > Balance > Flashcards

Balance Flashcards

1
Q

Postural control

A

controlling body position in space for stability and orientation

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2
Q

Balance

A

ability to hold center of mass in relation to base of support

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3
Q

Center of gravity

A

vertical projection of the COM (slightly anterior to L2 in standing)

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4
Q

Base of support

A

area of body in contact with a support surface

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5
Q

Postural orientation

A

ability to maintain an appropriate relation between body segment and between the body and the environment

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6
Q

Limits of stability

A

internal representation of how far the body can move over its base of support before changing the support or losing balance

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7
Q

Anticipatory postural responses

A

active movement of the body’s COM in anticipation of a postural transition from one body position to another

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8
Q

Reactionary postural responses

A

active response to an external perturbation

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9
Q

Sensory interaction/orientation

A

ability to maintain balance during altering sensory conditions

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10
Q

Balance Examination: Systems Review

A

Cardiovascular
Integumentary
Neuromuscular
Musculoskeletal

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11
Q

Balance Examination: Body Functions and Structure

A 
ROM
Muscle Strength
Muscle Tone
Coordination
Cognition
Posture
Pain
Sensory Systems
-Somatosensory
--Light touch
--Proprioception/Vibration
---Pain
-Vision
-Vestibular
Perception
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12
Q

Motor Strategies

A

Ankle
Hip
Stepping

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13
Q

Balance Examination:Motor Strategies: Ankle

A
  • Control of postural sway from ankles and feet
  • Head and hips travel in the same direction at the same time with the body moving as a unit over the feet
  • When it is appropriate to use an ankle strategy?
  • -Firm surface
  • -Foot well supported
  • -Slow moving with minimal displacement
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14
Q

Balance Examination:Motor Strategies: Hip

A
  • Control of postural sway from pelvis and trunk
  • Head and hips travel in opposite directions
  • When is it appropriate to use a hip strategy?
  • -Foot not completely supported
  • -Quick and large displacements
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15
Q

Balance Examination: Motor Strategies: Stepping

A
  • Steps with the feet to establish a new base of support when the center of gravity has exceeded the original base of support
  • When is it appropriate to use a stepping strategy?
  • -When the other strategies are not sufficient enough to maintain equilibrium
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16
Q

Balance Examination: Clinical Test for Sensory Interaction in Balance (CTSIB)

A
  • Clinical version of the Sensory Organization Test that does not require computerized force plate
  • Designed to assess the patient’s ability to select and combine sensory information in different environments
  • Does not measure the integrity of the three sensory systems
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17
Q

Stages of Foam and Dome

A 
Condition 1:  Firm surface, eyes open
Condition 2:  Firm surface, eyes closed
Condition 3:  Firm surface, dome
Condition 4:  Foam surface, eyes open
Condition 5:  Foam surface, eyes closed
Condition 6:  Foam surface, dome
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18
Q

Where is somatosensory dominant?

A

Condition 1

Condition 2

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19
Q

Where is Vision dominant?

A

Condition 4

20
Q

Where is vestibular dominant?

A

Condition 3
Condition 5
Condition 6

21
Q

Balance Error Scoring System [Purpose and Population]

A
  • Purpose: Objective measure of assessing static postural stability (designed for the mild head injury population-concussion, to assist in return to sports play decisions).
  • Population tested: Concussion, mild TBI, ankle instability, vestibular disorders
22
Q

Balance Error Scoring System Conditions

A
  • 6 conditions each tested barefoot, eyes closed for 20 seconds each:
  • Double leg stance (feet together): Firm & Foam
  • Single leg stance (non-dominant foot): Firm& Foam
  • Tandem stance (non-dominant foot in back): Firm & Foam
23
Q

Scoring Balance Error Scoring System

A

Count number of errors (deviations) from proper stance:

  • Moving hands off the hips
  • Opening the eyes
  • Step, stumble or fall
  • Abduction or flexion of the hip beyond 30°
  • Lifting the forefoot or heel off of the testing surface
  • Remaining out of the proper testing position for greater than 5 seconds
24
Q

What do the Balance Error Scoring System mean?

A
  • Score of 0-60 (lower scores indicate better balance and less errors)
  • MDC – 7 to 9 points
  • BESS
25
Q

Single Leg Stance (Anticipatory)

A

-Person stands with knee flexed 90° (legs should not be touching each other)
-Arms crossed around shoulders
-Norms
-Document:
Number of attempts
Time
Visual observation during trial

26
Q

Romberg/Tandem Romberg (Anticipatory)

A

-Person stands with feet together (Romberg) and eyes open
-Repeat the test with eyes closed
-Person stands with one foot directly in front of the other (Tandem Romberg)
-Normal is the ability to hold the test position for 30 sec
-Document:
Number of attempts
Time
Visual observation during trial

27
Q

Activity Balance Measures

A

Berg Balance Scale
Tinetti Performance Oriented Mobility Assessment
Functional Reach
TUG, TUG manual, TUG cognitive

28
Q

Participation Balance Measures

A

Activities Based Confidence Scale

29
Q

Berg Balance Scale

A
  • 14 test items intended to assess a person’s ability to perform common ADLs safely
  • Items are scored from 0 to 4, maximum score is 56
  • MDC: 3-8 points
  • In home Berg Balance Assessment
30
Q

Berg Balance Scale Cut-offs

A

Older adults:

  • History of falls and Berg < 51 or no history of falls & Berg < 42 predictive of falls (91% sensitivity, 82% specificity) (Shumway-Cook et al, 1997)
  • Score of < 40 on Berg associated with almost 100% fall risk

CVA: 45/56

31
Q

Tinetti Performance Oriented Mobility Assessment (POMA)

A
  • Consists of 2 subscales to screen for balance and mobility skills in older adults and determine likelihood of falls
  • -Balance (9)
  • -Gait (7)
  • 16 items total
  • Scored: 0-2
32
Q

Tinetti Scores

A

General

  • Score 19-24 are at moderate risk of falls
  • Score <19 are considered high risk for falls
  • MDC: 4
33
Q

Functional Reach

A
  • Define max distance one can reach forward beyond arm’s length while maintaining fixed BOS in standing
  • Examines limits of stability in forward direction
  • Person stands near wall with feet parallel, raises arm nearest wall to 90° of shoulder flexion, makes a fist and leans as far forward as possible
  • Three trials, average of the last two
  • MDC: 3 to 9 cm
34
Q

Functional Reach Cut-off

A
  • < 6 inches predictive of increased risk of falls in community dwelling elderly
  • <18.5 cm (75% sensitivity, 67% specificity) in frail elderly
  • PD:
    25. 4 cm (30% sensitivity, 92% specificity)
    30. 1 cm (56%sensitivity, 77% specificity)
35
Q

Activities Based Confidence Scale

A

-16 item questionnaire
Measure of balance self-efficacy
-Subjects rate their confidence performing a variety of in home and community based functional activities such as walking in a variety of environments, reaching, picking things up from the floor.
-Scores range from 0-100 where higher scores indicate greater balance confidence

36
Q

Activities Based Confidence Scale Cut-off

A
  • <67% fallers and non-fallers
  • <69% PD
  • <81% CVA

-MDC: For Parkinson’s is11-13%

37
Q

Timed Up and Go

A

Individuals are given verbal instructions to 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 any assistive device.

38
Q

TUG manual

A

the client must walk holding a cup filled with water.

39
Q

TUG cognitive

A

Same as TUG, but individuals are asked to complete the test while counting backward by threes 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)

40
Q

TUG Scores

A

> 15 sec gave a 90% prediction rate for faller

41
Q

Examination of Balance: Documentation

A

-Subjective: History of falls, close falls& Fear of falling

Objective:
Name of the test
Trials (if applicable)
Use of assistive device (if applicable)

Assessment: Interpretation of score

-Plan:Implementation of balance into plan of care

42
Q

Body Structure/ Function

Tests and Measures

A 
CTSIB
BESS
Single Leg Stance
Romberg
Tandem Romberg
43
Q

Activity Tests and Measures

A 
Berg
Tinetti
Functional Reach
TUG
TUG manual
TUG cognitive
44
Q

Participation Tests and Measures

A

Activities-Specific Balance Confidence Scale

45
Q

SAFETY of Balance Test

A
  • Guarding closely

- Gait belt

Test and Measures (8 decks)

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