Balance and FMS Flashcards
functional balance tests focus on
1: static balance
2: dynamic balance
3: balance responses to manual perturbations
4: functional mobility (gait)
static balance
maintenance of posture
examples:
- standing (double limb stance, single limb stance (SLS), tandem stance (heel to toe))
- Romberg test
dynamic balance
balance during weight shifting or voluntary movement
examples:
- sit to stand (STS)
- sit down (SIT)
- reaching movements
- turning
- step ups
gait balance tests
include timed walking, walking with commands to turn directions, turn the head,
functional balance grades
Normal
Good
Fair
Poor
normal balance grade
STATIC: patient able to maintain steady balance without handhold support
DYNAMIC: pt accepts maximal challenge and can shift weight easily within full range in all directions
Good balance grade
STATIC: pt able to maintain balance without handhold support, limited postural sway
DYNAMIC: pt accepts moderate challenge; able to maintain balance while picking object off floor
Fair balance grade
STATIC: pt able to maintain balance with handhold support; may require occasional minimal assistance
DYNAMIC: pt accepts minimal challenge; able to maintain balance while turning head/trunk
Poor balance grade
STATIC: pt requires handhold support and moderate to maximal assistance to maintain position
DYNAMIC: pt unable to accept challenge or move without loss of balance
romberg test
used to determine proprioceptive contributions to upright balance.
1: Pt instructed to stand with feet together, eyes open (EO) unaided for 20-30 seconds. If the patient falls with EO the test is over.
2: pt then stands with eyes closed (EC)
negative = minimal sway positive = pt able to stand with EO but demonstrates increased instability o falls with EC
- if unsteady with EO, this test is not appropriate
- *in the sharpened Romberg test, the feet are placed in tandem
positive Romberg test indicates..
loss of proprioception that can occur with posterior column lesions in the spinal cord (spondylosis, tumor, degenerative spinal cord disease, tabes dorsal is) and peripheral neuropathy
other balance grades
poor (P): PT needs to hold the pt up
Fair (F): independent by needs external support
Fair(F): can sit unsupported
Good (G): min resistance
Good + (G+): mod resistance
Normal (N): max resistance
functional movement screen (FMS)
7 position screen to analyze movement
graded 0-3
not a diagnostic tool; maps out someone’s functional status- catch problems before they worsen
quality vs. quantity
7 FMS steps
- a;ways do both sides!
1: squats
2: hurdle up and over
3: in line lunge
4: shoulder mobility
5: active straight leg raise
6: trunk stability push up
7: rotary stability
FMS grades
0= pain 1= can't complete 2= compensation 3= perfect movement
*anything lower than 2= risk of injury
1: squats
slide board under heels when needed?
2: hurdle up and over
**score the leg moving forward.
Tibial tuberosity= point of reference to clear
- looking for stability on stance leg, touch with heel and return
- no sidebending, lumbar flexion, IR/ER at hip, no touching with toe, stable torso, hip/knee/ankle aligned,
- hand stick should stay parallel to string
3: in line lunge
- test leg is forward
- same distance as tibial height
- looking for weakness and asymmetry
- feet on board in lung position, back heel can rise.
- Back foot is same side of shoulder overhead holding onto dowel
- points of contact for hand stick: head, sacrum, T-spine. keep vertical throughout
Compensation: not finishing
4: shoulder mobility test
- score is for flexed shoulder
- *important to remember than problem could be related to opposite arm
- take distal wrist crease to measure hand length
- patient puts hands behind back to attempt to get within that length
1=not within range
2=within 1 and 1/2 hand length
3=within hand length
5: active straight leg raise
- supine, hips neutral, feet dorsiflexed
- stick half way between knee and ASIS
3= ankle passes stick 2= malleolus between stick and middle knee 1= doesn't pass knee joint
6: trunk stability push up
- pt lies flat on ground. feet together, dorsiflexed. hands at top of forehead, shoulder width apart
- females can start with hands at chin level
- perform a push up with stomach and chest as a unit
compensation: hyperextension
3= up as a unit
2=hyperextension, lagging of lumbar spine.
-move hands down to chin level (males) or to shoulder/clavicle level (females)
7: rotary stability
tests ability to be stable around a mobile UE/LE
on all 4s
pick up same arm and leg.
if can’t: pick up opposite arm and leg
- controversial bc a lot of ppl can’t perform a 3
- *balance is key to this test
total FMS score
21 total points
average=15
