Balance

Question 1

Balance definition

Answer 1

“ability to maintain bodies position in equilibrium”
or
Ability to maintain bodys centre of gravity over base of support

Question 2

Centre of Gravity

Answer 2

hypothetical point at which bodys mass appears to be concentrated from which gravity appears to act - slightly infront of S2
alters w/body shape/weight distribution/position

Question 3

Base of support

Answer 3

perimeter of the contact area between body and support surface.
Base of support differs on foot placement

Question 4

Integrated balance system

Answer 4

Sensory input ——-integration of input——-motor output

Question 5

Sensory input

Answer 5

Visual system - eyes - head position and direction and speed of movement.

Vestibular system - ears- receptors in inner ear
head position mvmt and acceleration with respect to gravity and inertial forces.

Somatosensory system
specialized nerve ending -mechanoreceptors
capsules, ligaments, muscles, tendons and skin
Proprioception - maade up of 2 components - joint position sense and sense of limb movement -

Question 6

Integration of input

Answer 6

integrated and processed
cerebellum
basal ganglia
supplementary motor area

Question 7

motor output

Answer 7

corrective strategies
hip
ankle
and stepping

Question 8

Ankle strategy

Answer 8

commonly used
small and slow cog displacements

posterior displacement - backwards sway = ankle dorsiflexes - quads and abdominals contract

Anterior displacement
- forwards sway
ankle plantar flexes = Contraction PF, hamstrings and trunk extensors

Question 9

Hip strategy

Answer 9

Larfer and rapid displacements
Posterior displacement - pelvis moves forward - hamstrings and spinal extensors contract

Anterior displacement - pelvis moves backwards - contraction abdominals and quadriceps

Question 10

Stepping strategy

Answer 10

COG displacement is too great for ankle or hip strategy so step forward to increase BOS

Question 11

Causes of impaired balance - 7

Answer 11

Lower limb pathology - ACL, ankle, Knee
spinal pathology - low back pain
visual deficits
vestibular system injury - head injury, virus
Brain injury - stroke, tumour
Neurological conditions - MS, Parkinsons
Ageing

Question 12

Balance Training

Answer 12

Improve balance measures
Reduce risk of injury
programmes which require patient to maintain balance during progressively more difficult static and dynamic activities

Question 13

How to progress a balance programme (11)

Answer 13

Supported - unsupported 
Bilateral  -- unilateral 
large BOS/ Small base of support
Partial/fully weight bearing 
Stable/ unstable surface 
Visual input/ no visual input - challenging somatosensory system 
Static/dynamic 
No head/limb movement vs head/limb mvmt 
no distraction/ distraction 
stay within base of support / outside of base of support 
no pertubation/ pertubation

Question 14

Dosage

Answer 14

Healthy adults
ACSM - 2-3days a week
at least 20-30mins per session

Patient - probably find this difficult so start with less

Question 15

Safety

Answer 15

Simple and safe exercises
stay close to patient - at side and slightly behind
perform exercises in parallel bars or next to stable objects that can be held - raised plinth
gait belt?
2 people for v.unstable
Mats under wobble boards etc
remove obstacles and unsafe objects

Question 16

Contraindications

Answer 16

Disrupts healing process or surgical repair
increases pain
increases inflammation
patients are inheritantly unsafe in balance challenged position - cognitive impairment

Question 17

Adaptations

Answer 17

decreases cortical brain activitiy and more in subcortical activity
decrease excitability of spinal reflexes - over react more than required causing lots of wobbles therefore less unwanted reflex joint oscillations
muscular activation controlled less by spinal reflexes and more by supraspinal centers improve motor control

Question 18

Balance outcome

Answer 18

Berg balance
Boomer
Timed up and go