Balance

Question 1

Somatosensory Input

Answer 1

• provides proprioceptive information regarding length, tension, pressure, pain and joint position
• examination of pressure and vibration; observation of a patient when changing the surface they are standing on

Question 2

Visual input

Answer 2

• perceptual acuity regarding verticality motion of objects and self, environmental orientation, postural sway and movements of head and neck
• children rely heavily on this system for maintenance of balance
• examination of quiet standing with eyes open

Question 3

Vestibular input

Answer 3

• feedback regarding the position and movement of the head with relation to gravity
• semicircular canals respond to the movement of fluid with head motion
• Otoliths measure the effects of gravity and movement with regard to acceleration/deceleration
• examination of balance with movement of the head

Question 4

Vestibular Reflex (VOR)

Answer 4

• allows head/eye movement coordination
• supports gaze stabilization through eye movement that counters movements of the head
• maintains a stable image on the retina during movement

Question 5

Vestibulospinal reflex (VSR)

Answer 5

• attempts to stabilize the body and control movement

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

Question 6

Automatic Postural Strategies

Answer 6

automatic motor responses that are used to maintain the center of gravity over the base of support.

Question 7

Ankle Strategy

Answer 7

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

Question 8

hip strategy

Answer 8

• elicited by a greater force, challenge or perturbation through the pelvis and hips
• hips will move (in opposite direction of head) in order to maintain balance
• muscle groups contract in a proximal to distal fashion in order to counteract the loss of balance

Question 9

suspensory strategy

Answer 9

• used to lower center of gravity during standing or ambulation in order to better control the center of gravity
• ex: knee flexion, crouching, squatting
• often used when both mobility and stability are required during a task

Question 10

Stepping strategy

Answer 10

• elicited through unexpected challenges or perturbations during static standing or when the perturbation produces such a movement that the center of gravity is beyond the base of support
• the LE step or UE reach to regain a new base of support

Question 11

Peripheral vertigo characteristics

Answer 11

• episodic and short duration
• autonomic symptoms present
• precipitating factor
• pallor, sweating
• nausea and vomitting
• auditory fullness (fullness within the ears)
• tinnitus

Question 12

Central vertigo characteristics

Answer 12

• autonomic symptoms less severe
• loss of consciousness can occur
• neuro symptoms present including
• diplopia
• hemianopsia
• weakness
• numbness
• ataxia
• dysarthria

Question 13

Etiology of peripheral vertigo

Answer 13

• Benign Paroxysmal positional vertigo
• Meniere’s disease
• infection
• trauma/tumor
• metabolic disorders (DM)
• acute alcohol intoxication

Question 14

etiology of central vertigo

Answer 14

• meningitis
• migraine headache
• complications of neurologic origin post ear infection
• trauma/tumor
• cerebellar degeneration disorders (alcoholism)
• multiple sclerosis

Question 15

BPPV

Answer 15

• repeated episodes of vertigo that occur subsequent to changes in head position
• only lasts a few seconds
• noted while in recumbent position since it most commonly affects the posterior semicircular canal
• etiology: otoconia loosens and travels into posterior canal
• nystagmus is present
• can be treated successfully

Question 16

Dix-Hallpike Test

Answer 16

• determines if otoconia exist in the canal

Question 17

Central lesion nystagmus

Answer 17

direction: bidierectional or unidirectional
visual fixation: no inhibition
vertigo: mild
length of symptoms: chronic
etiology: demylination of nerves, vascular lesion, cancer

Question 18

peripheral lesion nystagmus

Answer 18

direction: unidirectional (movement is opposite of lesion)
visual fixation: will inhibit nystagmus
vertigo: significant
length of symptoms: varies, recurrent
etiology: menieres, vascular disorders, trauma, toxicity, infection of inner ear

Question 19

Berg Balance Scale

Answer 19

• 14 tasks
• includes static activities, transitional movements, dynamic activities in standing and sitting
• max score of 56 with score less than 45 indicating high fall risk

Question 20

Fregly-Graybiel Ataxia test battery

Answer 20

• 8 test conditions
• standing activities
• each condition is scored on pass/fail
• best suited for patients with high level motor skills since each condition is challenging

Question 21

Fugl-meyer sensorimotor assessment of balance performance battery

Answer 21

• designed to assess balance specifically for patients with hemiplegia
• seven items with max score of 14

Question 22

Functional reach test

Answer 22

- assess balance and risk of falling
NORMS
* 20-40 = 14.5-17.5in
* 41-69 = 13.5-15in
- 70-87= 10.5-13.5in

Question 23

Romberg test

Answer 23

• tests the patient in unsupported standing, feet together, UE folded,, looking at a fixed point strait ahead
• takes away vision
• challenges each system
• a patient receives a grade of normal if they can hold each position for 30 seconds

Question 24

timed up and go

Answer 24

• normal score is less than 10
• patients who require over 20 seconds to complete the process are at a limit of independence
• > 30 seconds are at a high risk of falling

Question 25

Tinetti performance oriented mobility assessment

Answer 25

• two sections
• first section assesses balance, second assesses gait
• max score is 28 with risk of falling increasing as score lowers
• total score less than 19 indicates high risk of falling