Balance Flashcards
What 2 elements are there in balance?
Center of gravity and base of support
When does compensation occur?
If sway exceeds the limits of stability
What is postural stability?
If sway is within limits of stability
What a normal anterior/posterior sway?
12 degrees from most posterior or anterior position.
What is a normal amount of lateral sway?
16 degrees
What happens when sway exceeds boundaries?
Initially, compensation is employed to retain balance, and a smaller sway envelope is created.
What are the 3 sensory systems that contribute to balance?
- Visual
- Somatosensory
- Vestibular
What are the 6 somatosensory contributions to balance?
- Free nerve endings
- Ruffini endings
- Paciniform corpuscles
- Golgi-mazzoni corpuscles
- Golgi ligament endings
- Muscle spindles
What is the visual component of balance?
- Sensory information regarding the position of the head relative to the environment, and orients head to maintain level gaze
What is the vestibular component of balance?
- Provides information regarding orientation of the head in space and acceleration
What brain areas contribute to balance?
- Cerebellum
- Basal ganglia
- Supplemental motor area
What type of response strategy is used when the displacements are small?
Ankle strategy.
How does the ankle strategy work?
Displaces COG by rotation about the ankle joint.
How does the ankle respond to a posterior displacement of COG?
- Dorsiflexion
- Contraction of anterior tibialis, quadriceps, and abdominals
How does the ankle respond to a anterior displacement of the COG?
- Plantar flexion
- Contraction of gastrocnemius, hamstring, and trunk extensors
When is the hip strategy employed?
- When ankle motion is limited
- Displacement is greater
- Standing on unstable surface disallows ankle strategy
- Perturbation is rapid and near limits of stability
How does the hip respond to posterior displacement of COG?
- Backward sway
- Activation of hamstrings and paraspinals
How does the hip respond to anterior displacement of COG?
- Forward sway
- Activation of abdominals and quadricep muscles
When is the stepping strategy employed?
- If displacement is large enough, a forward or backward step is used to regain postural control
What are the 3 phases of motor learning?
- Cognitive phase
- Associative phase
- Autonomous phase
What is the cognitive phase?
What to do
What is the associative phase?
How to do it better
What is the autonomous phase?
Just do it
What types of traumatic injury can affect balance?
- Eyes
- Inner ear
- Peripheral receptors
- Spinal cord
- Cerebellum
- Basal ganglia
- Cerebrum
- Ankle
- Hip
- Back
What non-traumatic pathologies can affect balance?
- Degenerative joint disease
- CVAs
- Tumors
- Visual field loss
- Age
What are 4 measures of the effect of training on balance?
- Increased LE strength
- Increased scores in balance measures
- Reduces effect of, or exposure to risk factors for falling in the elderly
What are 3 categories of balance evaluation categories?
- Balance during functional activities with or with assistive devices
- Balance in static or dynamic situations with or without the use of assistive devices
- Safety during gait locomotion, or balance
What 3 causes should the evaluation differentiate between?
- Biomechanical
- Motor
- Sensory
What is the 5 step progression of impaired balance examination and evaluation?
- Standing with eyes open - fixed platform
- Standing blindfolded - fixed platform
- Sway-referenced vision - fixed platform
- Normal vision with sway - referenced support
- Absent vision with sway-referenced support
- Sway-referenced vision and support
What is the base treatment for balance?
Strength
What is the modular element for balance treatment?
Motor control
What is the cognitive/ affective element for balance treatment
Fear
Describe the progression graded balance interventions.
- Weight shifts on stable surface
- Increase sway
- Increase surface challenges
Describe the progression of posture training as it relates to balance.
- Begin with core stability for COG control and a sense of trunk posture
- Begin in supine or seated position
- Use variety of arm positions, unstable surfaces, single leg stances, etc.
Describe the progression of movement training as it relates to balance.
- Add movement patterns to acquired stable static postures to increase balance challenge
- Add anterior/ posterior sway to increase stability limits
- Add trunk rotations and altered head positions to alter vestibular input
- Use PNF techniques during trunk rotation
- Step back/ forward assists in re-stabilization exercises
What types of patients are trained for balance the most in the clinic?
The elderly
Where may active individuals carry out their balance activities?
- At home
- At the local health club
Describe a basic progression for all balance therex.
BOS: Advance from wide to narrow base
Posture: Stable to unstable posture
Visual: Close the eyes
COG: Greater disruption to elicit hip or stepping strategy
Progress to dynamic activities, unstable surfaces, and unstable movement patterns
What are contraindications and precautions for balance training?
- Persons who are inherently in balance challenged positions
