Balance and Falls Prevention

Question 1

how can contextual or environmental factors influence mobility?

Answer 1

First phase of functional mobility
intervention takes place in the accessible environment of the hospital room or therapy clinic.

Second phase of intervention takes into consideration the actual environments to which the client will be returning

Realistic training takes place using simulated environments set up in the therapy clinic or around the treatment facility.

Third phase of intervention addresses community mobility and must consider the client’s definition of his or her community and the chosen or available modes of
travel

Question 2

what is balance required for?

Answer 2

activities in sitting or standing,
including ability to transition from sitting to
standing and to walk

Question 3

what can falls lead to?

Answer 3

• high medical costs
• decline in quality of life
• fatalities

Question 4

what is the physiological basis of balance?

Answer 4

• Centre of gravity
• Base of support
• Limits of stability
• Postural adjustments

Question 5

what is balance?

Answer 5

the ability to control the
Centre of Mass (CM) over the Base of
Support (BOS) within the Limits of
Stability

Question 6

what is the limit of stability?

Answer 6

The area where the CM may be moved over any BOS without the loss of equilibrium

Question 7

what 3 ways can CoG be displaced?

Answer 7

1. By an external force applied to the
   body, as occurs during contact sports
2. By external movement of the support surface, as occurs when we sit or stand in a moving vehicle
3. During performance of activities
   requiring self-initiated movement of
   the head, limbs, or trunk

Question 8

how can we maintain balance?

Answer 8

automatic postural responses

Question 9

what are the automatic postural responses?

Answer 9

1. Ankle Strategy: small movement
2. Hip Strategy: maintains or restores equilibrium
3. Stepping Strategy: increases BOS in C M movement

Question 10

what is the ankle strategy?

Answer 10

• “Quiet Standing”
• Control small, slow, swaying
  motions
• Effective when surface area is firm
  and long in relation to foot lengt

Question 11

what is the hip strategy?

Answer 11

• Maintains or restores standing
  balance
• Most effective when support
  surface is “soft” and/or short in
  relation to foot length
• Often used if ankle strategy is
  ineffective

Question 12

what is the stepping strategy?

Answer 12

• Taking a step
• Shift weight outside existing base
  of support, then take a step to
  bring base of support back under
  centre of mass
• “Reach and grasp” also a stepping
  strategy
• Often dictated by
  environmental factors (eg
  space constrains, availability of
  supports)

Question 13

what does an inability to maintain balance in posturally threatening situations result in?

Answer 13

maladaptive strategies

Question 14

what is balance regulated by?

Answer 14

sensory systems
motor systems

Question 15

what are the 3 steps to sensory organization?

Answer 15

vision
somatosensory
vestibular

Question 16

what is balance regulated by?

Answer 16

motor systems:

• Strength tends to decline with age
• Increases risk of falls

Question 17

what are vision dependent issues?

Answer 17

*getting up at night

*closing eyes to rinse
shampoo out of hair
*scanning grocery store
shelves

*placing grocery items on
various shelves (height,
head movement & shift
over BOS

Question 18

what are surface dependent issues?

Answer 18

*changing surfaces in the
home & communit

Question 19

what are vestibular issues?

Answer 19

Can’t typically isolate this
system (eg head flexed on
fixed trunk vs fixed head on
laterally flexed trunk)

Question 20

how can you tell if balance is impaired when looking at someone?

Answer 20

when an individual is unable to maintain a sitting or standing position without support or assistance, whether while remaining static or during dynamic movement

Question 21

what are the steps to conducting a balance screen?

Answer 21

• Interview
• Observe posture
• shoulders even or uneven
• leaning more to one side
• Observe static balance

Question 22

what is the TUG test used to asses?

Answer 22

falls risk in older adults

Question 23

what may indicate fall risk when doing thee TUG test?

Answer 23

observation of challenges and/or > 14sec

Question 24

what are some compensation strategies for balance impairments?

Answer 24

getting dressed in bed
toileting hygiene while sitting
making bed while lying in it

Question 25

what are adaptation strategies for balance impairments?

Answer 25

grab bars
stair lifts
reacher

Question 26

what is acceptable postural alignment?

Answer 26

• pelvis in neutral to anterior tilt
  with equal weight bearing on the
  ischial tuberosities
• trunk extended in a midline
  orientation
• shoulders symmetrical and
  positioned anterior to the hips
• hips and knees flexed and
  neutrally rotated
• both feet securely on floor