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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
balance impairments - cognition
central or peripheral dysfunction | arousal, attention, memory, judgement, insight, motivation
26
balance impairments - musculoskeletal
TKA, general weakness, orthopedic injuries | ROM, flexibility, alignment
27
balance impairments - neuromuscular
hypertonicity (spasticity-velocity dependent change) | strength, tone, coordination
28
balance impairments - sensory
vision, somatosensory, vestibular
29
balance impairments - perception
motion perception - dizziness stability limits- perceived vs. actual limits fear factor, if they've fallen before
30
neurological impairments on balance - | sequencing
- 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
neurological impairments on balance - | scaling
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
neurological impairments on balance - | timing
abnormally long delays in onset of postural responses (CVA, DS, CP) common in pt's with abnormal muscle tone
33
neurological impairments on balance - | adaptation
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
neurological impairments on balance - | anticipatory
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
strong, level 1 evidence supports use of - berg balance assessment it assess what
changes in static and dynamic sitting and standing balance
36
strong, level 1 evidence supports use of - activities-specific balance confidence scale it assess what
changes in balance confidence
37
strong to moderate evidence supports use of
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
best practice evidence supports use of
5 times sit-to-stand - assess sit to stand transfers
39
minimal detectable change (MDC)
"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
minimal clinically important difference (MCID)
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
why do we need the assessments
``` assist in goal setting provide motivation guide treatment justification for treatment for reimbursement evidence based practice ```
42
berg balance assessment
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
fugle-meyer sensorimotor assessment of balance performance battery
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
functional reach test
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
romberg test
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
timed up and go
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
tinetti performance oriented mobility assessment
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
dynamic gait index
ability to modify balance while walking in the presence of external demands ICF: activity -can be performed w/ or w/out assistive device
49
10 m walk test
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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