Balance Flashcards
Definition
process by which the body’s equilibrium is controlled for a given purpose
postural adjustments that occur in an attempt to maintain the centre of mass over the base of support
Essential Components of Balance
- sufficient postural extension
- ability to keep COG over BOS
- ability to perform anticipatory reactions
- ability to perform compensatory reactions
- ability to perform protective reactions
Systems involved in maintaining balance
neuromusculoskeletal sensory cerebellar cognitive and perceptual vestibular
Neuromusculoskeletal System
Deficits in - muscle length - muscle strength - joint range - motor control cause impairments in balance reactions
Sensory System
Visual input - dominant sensory influence, helped to understand and then respond to environment
Proprioceptive input - provides info about body position in space
Cutaneous input - info about surfaces and unexpected touch
Cerebellar System
adjusts and corrects ongoing movement If dysfunctional... - hypotonia/trunk instability - decreased volitional movement - general ataxia - weakness and incoordination of the trunk and limbs - nystagmus/visual disturbances
Cognitive and Perceptual System
previous experience effects balance performance
need to be able to recognise the environment and situation in order to make according postural adjustments
controls the sense of verticality
Vestibular System (reflexes)
provides information about the position and motion of the head/body
Vestibulospinal reflex - controlled by otoliths, register head position in relation to gravity and linear acceleration
Vestibuloccular reflex - controlled by the semi-circular canals, detect angular acceleration in the three planes of movement, differentiate between movement of the head and the environment
Equilibrium Reactions
part of the vestibulospinal reflex
the fine changes that occur in postural muscle activity as a body moves or attempts to maintain posture against gravity
Righting Reactions
balance responses that are activated when there is displacement of the COG outside of the BOS
Protective Responses/Saving Reactions
activated when the COG is displaced outside the BOS and the ER and RR are insufficient to regain balance
Assessing balance - qualitative measures
Observe posture/alignment in static position
observe weight distribution in static position
observe their ability to maintain their position safely/independently
internal displacement during dynamic balance
observe external displacement both slow and fast
look for their ability to use their protective responses
impact on overall function
Assessing balance - objective measure
Berg Balance Scale - numerous Romberg test Brunel Tinetti Functional Reach - dynamic balance Sensory Integration Test measurements of postural sway - static standing balance Trunk Impairment Scale - sitting balance TIMED FUNCTIONAL TASK INCREASING DISTANCE - reach
Common compensations for poor balance
trunk fixation/stiffened body overuse of UL weight bearing overuse of head rather than trunk to try to maintain COG over BOS reliance on rails/aids overuse of hip flexors adopts a fixed posture
Retraining Balance
Improve proximal stability and prevent fixation
Incorporate functional tasks
Modify the environment/task to ensure pt can use normal movement patterns of movement and avoid compensations
need sufficient challens
Sit to stand Incorporate head movement into a static posture Work on weight transfer Reaching Turning ADLs Use steps/obstacles Work on rough ground/uneven ground High level gait tasks Incorporate any sport specific skills
