Balance

Question 1

Where are somatosensory receptors located?

Answer 1

Joints, muscles, ligaments, and skin to provide proprioceptive information regarding length, tension, pressure, pain, and joint position.

Question 2

T or F: Tactile input from the ankle, knees, hips, and neck provide balance information to the brain.

Answer 2

True

Question 3

How do you challenge the somatosensory system?

Answer 3

Examination of pressure and vibration; observation of a patient when changing the surface they are standing on

(E.g.—uneven surfaces, standing on foam, slopes)

Question 4

Why are visual receptors important?

Answer 4

Allows fro perceptual acuity regarding verticality, motion of objects and self, environmental, orientation, postural sway, and movements of the head/neck.

Question 5

What population relies heavily on visual input for balance?

Answer 5

Children

Question 6

How do you challenge the visual system?

Answer 6

Examination of quiet standing with eyes open; observing balance strategies to maintain COG w/ and w/o visual input.

Assessment of potential visual field cuts, hemianopsia, pursuits, saccades, double vision, gaze control, acuity is necessary.

Question 7

What is the importance of the vestibular system?

Answer 7

Provides the CNS with feedback regarding the position and movement of the head what relation to gravity.

Question 8

What structures are apart of the vestibular system?

Answer 8

Labyrinth which consists of 3 Semicircular canals filled with endolymph and two otolith organs

Question 9

What is the purpose of the semicircular canals?

Answer 9

Respond ot the movment of fluid with head motion

Question 10

What is the main function of the otoliths?

Answer 10

Measures the effects of gravity and movement with regard to acceleration/deceleration

Question 11

How do you challenged the vestibular system?

Answer 11

• Examination of balance with movement of the head
• testing such as Dix-Hallpike maneuver, bithermal caloric testing, assessment for nystagmus, head trust sign
• testing of the vestibuloocular reflex

Question 12

What are the 2 balance reflexes?

Answer 12

Vestibuloocular Reflex (VOR)+ Vestibulospinal reflex (VSR)

Question 13

What is the function of the VOR?

Answer 13

Allows for head/eye movement coordination

Question 14

What does the VOR support?

Answer 14

Supports gaze stabilization through eye movement that counters movements of the head. This maintains a stable image on the retina during movement

Question 15

What is the function of the VSR?

Answer 15

VSR attempts to stabilize the body and control movement

Also assists with stability while the head is moving as well as coordination of the trunk during upright postures

Question 16

List the automatic postural strategies.

Answer 16

1. Ankle Strategy
2. Hip Strategy
3. Suspensory Strategy
4. Stepping Strategy

Question 17

Describe the ankle strategy.

Answer 17

• 1st strategy to be elicited by a small range and slow velocity perturbation when feet are on the ground
• Muscle groups contract in a distal to proximal fashion to control postural sway from the ankle joint

Question 18

How is the hip strategy elicited?

Answer 18

Elicited by a greater force, challenge or perturbation through the pelvis and hips

Question 19

Describe the hip strategy.

Answer 19

The hips move (in opposite direction from the head) in order to maintain balance

Muscle groups contract in a proximal to distal fashion in order to Counteract the loss of balance

Question 20

When is the suspensory strategy used?

Answer 20

Used to lower the COG during standing or ambulation in order ot better control the COG.

(E.g.—knee flexion, crouching or squatting)

Question 21

When is the suspensory strategy often used?

Answer 21

Used when both mobility and stability are required during a task (such as surfing)

Question 22

When is the stepping strategy elicited?

Answer 22

Elicited through unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the COG is beyond the base of support.

The LE step or the UE reach to regain a new BOS