Balance Flashcards
Balance requires input from 3 systems
Relies on somatosensory, visual, and vestibular input.
Vestibuloocular reflex (VOR)
Allows for head-eye movement coordination. Supports gaze stabilization through eye movement that counters movement of the head, allowing a stable image on retina during movement.
Vestibulospinal reflex (VSR)
Attempts to stabilize body when head is moving and coordinate the trunk during upright postures.
Ankle Strategy
Elicited by small range and slow velocity perturbations. Muscles contract in a distal to proximal fashion.
Hip Strategy
Elicited by greater force, challenge, or perturbation. Hips will move in opposite direction from the head to maintain balance. Muscles contract in proximal to distal fashion.
Stepping Strategy
Elicited through unexpected challenges or perturbations that causes COG to move beyond BOS. Lower extremity steps or upper extremity reaches to regain new BOS.
Suspensory Strategy
Lowers center of gravity during standing or ambulation to better control center of gravity. Bending knees, squatting, crouching.
Peripheral Vertigo Characteristics
Episodic/short duration (a few seconds) Autonomic symptoms Precipitating factor (changes in head position) Pallor, sweating Nausea and vomiting Auditory fullness Tinnitis
Central Vertigo Characteristics
Autonomic symptoms less severe
Loss of consciousness can occur
Neurological symptoms: diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria
Benign paroxysmal positional vertigo (BPPV) leads to peripheral or central vertigo?
Peripheral
Meniere’s disease leads to peripheral or central vertigo?
Peripheral
Ear infection leads to peripheral or central vertigo?
Both
Trauma/tumor leads to peripheral or central vertigo?
Both
Metabolic disorders (diabetes) leads to peripheral or central vertigo?
Peripheral
Acute alcohol intoxication leads to peripheral or central vertigo?
Peripheral
Meningitis leads to peripheral or central vertigo?
Central
Migraine headaches leads to peripheral or central vertigo?
Central
Cerebellar degeneration disorders (alcoholism) leads to peripheral or central vertigo?
Central
Multiple sclerosis leads to peripheral or central vertigo?
Central
Congenital nystagmus
Typically mild and does not change in severity over lifetime
Spontaneous nystagmus (acquired)
Caused by imbalance of vestibular signals to oculomotor neurons that causes a constant drift in one direction that is countered by a quick movement in opposite direction. Usually occurs after acute vestibular lesion and will last approximately 24 hours.
Peripheral nystagmus (acquired)
Occurs with peripheral vestibular lesion and is inhibited when pt fixates vision on an object.
Central nystagmus (acquired)
Occurs with a central lesion of the brainstem/cerebellum and not inhibited when pt fixates vision on object
Positional nystagmus (acquired)
Induced by change in head position, usually stimulated by semicircular canals.
Gaze-evoked nystagmus (acquired)
Occurs when eyes shift from one position to another. Caused by inability to maintain stable gaze position. Usually indicates CNS pathology and associated with brain injury and MS.
Peripheral nystagmus direction
Unidirectional with fast segment of movement indicating the opposite direction of lesion
Central nystagmus direction
Unidirectional or bidirectional
Peripheral nystagmus with visual fixation
Inhibition of nystagmus and vertigo
Central nystagmus with visual fixation
No inhibition with fixation
Peripheral nystagmus length of symptoms
Minutes, days, or weeks but recurrent
Central nystagmus length of symptoms
May be chronic
Berg Balance Scale
Assesses fall risk using 14 tasks. Score of 45/56 indicates increased fall risk.
Fregly-Graybiel Ataxia Test Battery
Consists of 8 test conditions focused on balance. Each condition graded as pass/fail with normative data for comparison. Suited for patients with high level motor skills.
Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery
Assesses balance for patients with hemiplegia. Each of 7 items scored from 0-2, with 2 being a better score.
Functional Reach Test
Assesses standing balance and fall risk. 3 trials are performed and averaged.
Romberg Test
Assesses balance and ataxia. Balancing with feet together and eyes opened followed by eyes closed for 30 seconds each. Somatosensory or vestibular system may be affected when visual system is taken out for balance. If pt demonstrates ataxia and has a positive Romberg Test, this indicates sensory ataxia and not cerebellar ataxia.
Timed Up and Go Test
Assesses person’s level of mobility and balance. 10 seconds indicates independence, 20 seconds indicates limited functional independence and increased fall risk, 30 seconds indicates high fall risk.
Tinetti Performance Oriented Mobility Assessment
Assesses balance and gait. Score of 19/28 indicates high fall risk.
