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Neuro > Balance > Flashcards

Balance Flashcards

1
Q

balance

A

state of physical equilibrium
maintenance & control of COG
achieving & maintaining upright posture
-integration of somatosensory, visual & vestibular (info in CNS)

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2
Q

postural control

A

ensures stability and orientation

control of head and other body parts relative to each other and the enviro

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3
Q

stability

A

ability to maintain the position of center of mass w/in stability limits
boundaries in which the body can maintain pos w/out changing the BOS

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4
Q

requirements of stability

A

sensory-assess position and motion of self or enviro
motor-generate forces to control body pos
cognitive/perceptual-anticipation and adaptation

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5
Q

sensory mechanisms for postural control-

somatosensory input

A

receptors in joints, muscles, ligaments and skin (proprioception and tactile)
input from ankles, knees, hips and neck provide balance info to brain

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6
Q

sensory mechanisms for postural control-

challenging the somatosensory system

A

exam pressure and vibration

observe pt when changing the standing surface (slopes, uneven, foam)

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7
Q

sensory mechanisms for postural control-

visual input

A

receptors allow for perceptual acuity: verticality; motion of objects and self; enviro orientation; movements of the head/neck; postural sway

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8
Q

sensory mechanisms for postural control-

challenging the visual system

A

examination of quiet standing w/eyes open (start with)
observe balance strategies to maintain COG w/ and w/out visual input
assessment of visual field cuts, hemainopsia, pursuits, saccades, double vision, gaze control and acuity is necessary

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9
Q

sensory mechanisms for postural control-

vestibular input

A

provides CNS w/info of the pos and movement of head in relation to gravity
-labyrinth

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10
Q

labyrinth

A

3 semicircular canals filled w/endolymph
-respond to movement of the fluid with head motion
2 otolith organs
-measure the effects of gravity and movement during acceleration/deceleration

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11
Q

sensory mechanisms for postural control-

challenging the vestibular system

A

exam of balance w/movement of head
test: Dix-Hallpike maneuver, bithermal caloric testing, assessment of nystagmus, head thrust sign, vestibulocochlear reflex
Place pt on unstable surface w/eyes closed

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12
Q

sensory mechanisms for postural control-

sensory strategies

A

quiet stance: all senses contribute
perturbed stance: adults - primarily somatosensory (speed of info to brain; int/ext perturbation)
children-rely on vision (other systems might not be fully functional)

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13
Q

motor mechanisms for postural control

A

generate, coordinate and apply forces necessary to control COG

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14
Q

motor mechanisms for postural control -

quiet stance

A

small amounts of postural sway (normal)

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15
Q

motor mechanisms for postural control -

alignment

A

ideal allows body to be maintained in equilibrium w/least expenditure of internal energy

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16
Q

motor mechanisms for postural control - postural tone

A

increased level of activity in antigravity muscles when standing upright

  • all sensory inputs
  • muscles active tonically during quiet stance (gastroc-soleus and tibialis anterior; glute med and TFL; iliopsoas and erector spinae) (gastroc for propulsion)
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17
Q

motor mechanisms for postural control - automatic postural strategies

A 
used to maintain COG and BOS
ankle
hip
suspensory
stepping
reaching
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18
Q

motor mechanisms for postural control - automatic postural strategies
ankle

A

small range, slow velocity, small perterbation

used first

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19
Q

motor mechanisms for postural control - automatic postural strategies
hip

A

hips move opposite of head; large, increased force or velocity perterbation
used second

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20
Q

motor mechanisms for postural control - automatic postural strategies
suspensory

A

lower BOS for challenging balance task

21
Q

motor mechanisms for postural control - automatic postural strategies
stepping

A

too fast/too extreme COG out of BOS so need to take a step

children will take a crossover step

22
Q

motor mechanisms for postural control - automatic postural strategies
reaching

A

too much of a force; reach and/or take a step

23
Q

central integration - adaptation

A

giving certain afferent (sensory) input higher priority based on accuracy in reporting body’s position and movements in space
normal adult: somatosensory > vision or vestibular
vision initially more important when learning new task

24
Q

central integration - anticipatory

A
  • based on previous experience, CNS figures out what sensorimotor processing & actions are needed
  • adaptable to diff conditions
  • postural activation patterns have 2 phases (preparatory & compensatory)
  • expectation plays a large role in amplitude of response
  • practice reduces the magnitude
25
Q

balance impairments - cognition

A

central or peripheral dysfunction

arousal, attention, memory, judgement, insight, motivation

26
Q

balance impairments - musculoskeletal

A

TKA, general weakness, orthopedic injuries

ROM, flexibility, alignment

27
Q

balance impairments - neuromuscular

A

hypertonicity (spasticity-velocity dependent change)

strength, tone, coordination

28
Q

balance impairments - sensory

A

vision, somatosensory, vestibular

29
Q

balance impairments - perception

A

motion perception - dizziness
stability limits- perceived vs. actual limits
fear factor, if they’ve fallen before

30
Q

neurological impairments on balance -

sequencing

A
  • normal-distal to proximal pattern
  • Proximal to distal (CP) results in less torque pd and large shifts in COM
  • delays in recruitment of proximal synergy results in excessive movement at hip and knee (low muscle tone0
  • co-contraction (TBI, DS, parkinson’s, CP) results in a general stiffening of body (common in children, people in pain or who’ve fallen before)
31
Q

neurological impairments on balance -

scaling

A

forces generated need to be scaled to the degree of instability
normal-use a combo of feedback and feedback forward control mechanism (exaggerated responses - pusher’s syndrome)
cerebellar lesions create both excess torque and overcorrection of sway

32
Q

neurological impairments on balance -

timing

A

abnormally long delays in onset of postural responses (CVA, DS, CP)
common in pt’s with abnormal muscle tone

33
Q

neurological impairments on balance -

adaptation

A

normal control can adapt responses to changing tasks and enviro demands
fixed stereotypical patterns reflect a loss of movement flexibility and adaptability (CVA, CP, PD)

34
Q

neurological impairments on balance -

anticipatory

A

postural adjustments are used in protective manner to stabilize before movement
upper motor neuron lesion - heavily dependent upon previous experience and learning (CVA, CP, DS, PD)

35
Q

strong, level 1 evidence supports use of -
berg balance assessment
it assess what

A

changes in static and dynamic sitting and standing balance

36
Q

strong, level 1 evidence supports use of -
activities-specific balance confidence scale
it assess what

A

changes in balance confidence

37
Q

strong to moderate evidence supports use of

A

functional gait assessment - changes in dynamic balance while walking
not balance measures:
10m walk test - changes in gait speed
6 min walk test- changes in walking distance

38
Q

best practice evidence supports use of

A

5 times sit-to-stand - assess sit to stand transfers

39
Q

minimal detectable change (MDC)

A

“a statistical estimate of the smallest amount of change that can be detected by a measure that corresponds to a noticeable change in ability”

clinical bottom line: the MDC is the min amount of change in a pt’s score that ensures the change isn’t the result of measurement error

40
Q

minimal clinically important difference (MCID)

A

represents the smallest amount of change in an outcome that might be considered important by the pt or clinician
clinical bottom line: the MCID is a published value of change in an instrument that indicates the min amount of change required for your pt to feel a diff in the variable you are measuring

41
Q

why do we need the assessments

A 
assist in goal setting
provide motivation
guide treatment
justification for treatment for reimbursement
evidence based practice
42
Q

berg balance assessment

A

assess pt’s risk for falling
14 items (static activities, transitional movements and dynamic activities in sitting and standing positions)
ICF: activity
use once or ongoing to monitor

43
Q

fugle-meyer sensorimotor assessment of balance performance battery

A

assess balance specifically for pt’s with hemiplegia
7 items
ICF: activity
-even with high score, may not have normal balance
-not best took for predicting fall risk

44
Q

functional reach test

A

assess standing balance and risk for falling
single task screening tool, do it 3x
ICF: activity
score below range has an increased risk for falling
20-40 yrs: 14.5-17 in
41-69: 13.5-15 in
70-87: 10.5-13.5 in

45
Q

romberg test

A

assessment tool for balance and ataxia (cerebellar or sensory base)
ICF: activity
1-feet together, standing, arms across chest, eyes open
2-same, but eyes closed
if positive test- pt demos ataxia indicating sensory ataxia
if negative test- cerebellar ataxia

46
Q

timed up and go

A

dynamic measure for identifying risk for falls
ICF: activity
TUG-verbal instr: stand up from chair, walk 3m as safely as possible, cross line on floor, turn around, walk back and sit down
can use device, but not another person
<10 sec - independent
>20 sec - limit for func indep; may have increased risk
> 30 sec - high fall risk

47
Q

tinetti performance oriented mobility assessment

A

screen pts & identify if there is an increased risk for falling

1st: assess balance through sit to stand vice versa w/armless chair, immediate standing w/eyes open and closed, tolerating slight push in standing & turning 360.
2nd: assess gait at normal speed and at rapid

48
Q

dynamic gait index

A

ability to modify balance while walking in the presence of external demands
ICF: activity
-can be performed w/ or w/out assistive device

49
Q

10 m walk test

A

assess walking speed in m/sec over short duration
ICF: activity
reasonable to use in geriatrics, parkinson’s, SCI, TBI, stroke

Neuro (7 decks)

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