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OTA 130 - Kinesiology > Balance and Transfers > Flashcards

Balance and Transfers Flashcards

1
Q

Stats on Falls

A
  • 1 of 3 adults 65+ falls each year
  • Falls are leading cause of death for adults 65+
  • Falls are most common cause of nonfatal injury and hospital admissions for trauma
  • Major healthcare expense/capacity of ERs
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2
Q

Direct Role of OTP in Falls

A
  • Ensuring patient safety during tx, transfers

* Teaching patient to recover from fall

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3
Q

Indirect Role of OTP in Falls

A 
Make patients’ homes safer by:
• Reducing tripping hazards
• Adding grab bars around tub/shower*
• Adding grab bars next to toilet*
• Adding stair railings*
• Improving lighting*

Environmental hazard corrections can reduce falls by 1/3!

*Note: OTP does not install these, just recommends. Some insurance may cover.

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4
Q

Balance vs. Equilibrium

A

Balance: ability to control equilibrium (either static or dynamic)

Equilibrium: state of zero acceleration where there is no change in speed or direction of body; ability to move/reposition without falling

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5
Q

Static vs. Dynamic Equilibrium

A

Static: when body is at rest or COMPLETELY motionless.

Dynamic: when all applied and intertial forces acting on the moving body are in balance, resulting in movement with UNCHANGED speed and direction.

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6
Q

Stability

A

The resistance to change in body’s acceleration, or resistance to disturbance of body’s equilibrium. Can be enhanced by determining center of gravity (COG) and changing position accordingly.

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7
Q

Gravity

A

Constant downward force; Acting at the center of a body segment.

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8
Q

Center of Gravity (COG) - Definition

A

Point at which all the body’s mass (weight) is equally balanced.

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9
Q

Center of Gravity (COG) – Determining Factors

A

Location depends on:
• Proportion of body parts
• Distribution of fat/muscle mass
• Posture
• Structural deformities (Missing limbs? Limb lengths?)
• External forces (carrying a shoulder bag?)

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10
Q

Center of Gravity (COG) – Typical Location

A

In upright standing in average adult, COG is a point on the midline (belly button) just anterior to second sacral vertebra.
• In newborn: above umbilicus
• At 2 yo: at level of umbilicus
• At 5 yo: below umbilicus

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11
Q

Factors Affecting Location of COG

A

GENDER: higher in males bc of muscle distribution (larger upper body); female pelvis is wider/heavier than male.

WEIGHT: if carrying a backpack, COG moves backward as person moves into kyphosis to compensate. If carrying front weight, COG moves forward as person moves into lordosis to compensate.

SUBTRACTION OF WEIGHT: if amputation, COG moves away from amputated limb toward healthy side (ie: amputated leg moves COG up and to opposite side)

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12
Q

Line of Gravity

A

Gravity’s action line which is visualized as a vertical line projecting downwards from the COG.

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13
Q

Base of Support

A

Supporting area beneath the body. Includes points of contact with supporting surface and area between them. Points may be body parts (feet) or extensions of body parts (cane).
• Falls occur when line of gravity moves outside of base of support!

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14
Q

Factors Contributing to Stability

A
  • Object is in stable equilibrium when COG lies within base of support.
  • Upright body is only stable when line of gravity lies within foot base.
  • Carrying a weight at the side of the body means body must shift to keep COG inside base of support (postural shift to accommodate weight)
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15
Q

Factors for Achieving Balance

A
  • Person has balance when COG falls within base of support
  • Person has balance in direct proportion to size of base of support (Larger base of support = more balance)
  • Person has balance depending on mass (Greater mass = more balance)
  • Person has balance depending on height of the COG (lower COG=more balance)
  • Person has balance depending on where COG is in relation to base of support (less balance if COG near edge of base of support)
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16
Q

Vestibular System

A

Located in inner ear. Contributes to balance in most mammals, and sense of spatial orientation. Sensory system that provides leading contribution about movement and sense of balance.

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17
Q

Anatomy of the Vestibular System

A

SEMICIRCULAR CANAL SYSTEM: indicates rotational movements.

OTOLITHS: (in saccule) indicate linear accelerations.

NEURAL: Vestibular system sends signals primarily to neural structures that control eye movements, and to muscles that keep us upright.

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18
Q

Vertigo

A

Diseases affecting the vestibular system commonly cause vertigo and nausea.

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19
Q

Vestibular Disorders Affecting Balance

A
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Meniere’s Disease
  • Secondary Endolymphatic Hydrops
  • Labrynthitis and Vestibular Neuritis
  • Perilymph Fistula
  • Acoustic Neuroma
  • Ototoxicity
  • Superior Canal Dehiscence
  • Vestibular Migraine
  • Mal de Debarquement (“Sea Legs”)
  • Cervicogenic Dizziness
  • Otosclerosis
  • Cholesteatoma
  • Enlarged Vestibular Aqueduct Syndrome
  • Vestibular Hyperacusis
  • Autoimmune Inner Ear Disease
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20
Q

Non-Vestibular Risk Factors for Falls in the Elderly

A
  • Osteoporosis
  • Lack of physical activity (not moving makes body not ready to move!)
  • Taking very small steps
  • Impaired vision
  • Medications
  • Environmental Hazards
21
Q

Clinical Applications for Fall Prevention

A
  • Walking aids (canes, crutches) increase size of base of support and allow more swaying of body without falling
  • CANES are generally used to increase balance, NOT for support
  • When assisting a patient, therapist should stand with feet apart (larger base of support) and knees bent to be in stable position to resist added weight of pt.
22
Q

Common Assessments for Balance

A

1) Berg Balance Test (most popular, used in hospitals)
2) Clinical Test of Sensory Interaction and Balance (CTSIB) Test
3) Tinetti Assessment Tool

23
Q

Berg Balance Test

A 
Tests several conditions:
• Sit to stand
• Stand unsupported
• Sitting unsupported
• Stand to sit
• Transfer
• Standing with eyes closed
• Retrieving object off floor
• Standing on one foot

Score 0-4 for each item; 0=needs help, 4=independent

Score of <42 is predictive of fall risk.

24
Q

Clinical Test of Sensory Interaction and Balance (CTSIB)

A
  • Also known as “Sensory Organization Test”.
  • More used in PT
  • Assesses static balance under 6 combinations of sensory conditions:
  • Stand on firm surface, eyes open/closed/in visual conflict dome (bag over head)
  • Stand on foam surface, eyes open/closed/in visual conflict dome (bag over head)
  • Patients dependent on vision become unstable without eyes
  • Patients dependent on surface/somatosensory input become unstable on foam surface
  • Patients with vestibular loss become unstable on foam without vision
  • Patients with sensory selection problems become unstable in all but #1-2.
25
Q

Tinetti Assessment Tool

A
  • Simple, easily administered test that measures resident’s gait and balance. (We did this with Katie’s family videos.)
  • Scored on resident’s ability to perform specific tasks.
  • Has 16 conditions that assess seated balance, standing balance, and balance during gait.
  • Max score is 28; residents scoring <19 are at HIGH risk of falls. 19-24 = risk of falls.
26
Q

Basic Mobility Skills

A

1) Rolling side to side in bed
2) Transition from supine to seated
3) Transferring from one surface to another
4) Ambulation

27
Q

Functional Mobility Skills

A
  • Enables people to participate in activities such as self care, leisure, work or education
  • Begins with understanding of typical movements (everything we’ve covered in kinesiology!)
28
Q

Body Mechanics

A 
Whenever we move people—ourselves or others—assisted or unassisted, we MUST start with good body mechanics! Consider:
• Postural control
• Spinal alignment (twisting? Curves?)
• Ergonomics
• Joint angles
• Base of support
• Core strength
29
Q

Basic Principles for Lifting Heavy Things

A
  • Lift with straight back and bent knees
  • Rotate hips and legs, NOT the trunk
  • Both the above shifts weight from tiny back muscles to strong butt muscles
  • Use “AP Stance”: anterior-posterior; have one foot slightly behind, one slightly in front.
30
Q

3 Types of Lifting Methods

A

1) Diagonal Lift: bending knees with feet in AP Stance, lifting item close to body while straightening legs
2) Tripod Lift: Kneel down, with one knee up, prop heavy/unstable item onto that knee (such as a tire, or bag of dogfood), then lift close to body.
3) Golfer’s Lift: Bend trunk forward on one leg to lift item while simultaneously extending other leg out behind you to compensate for weight.

31
Q

Bed Mobility Positions

A

BRIDGING: Like bridge in yoga; lifting butt up with shoulders and feet on bed (knees bent). Useful for dressing, changing bedpan, repositioning for pressure.

ROLLING: Provides pressure relief; gets patient to EOB.

32
Q

Steps to Safely Roll Patient to Side

A
  • Lower the bed flat
  • Raise the knees
  • Turn head in direction of roll
  • Roll to side with safety rail up (so they don’t roll off bed!)
  • Keep eye on affected arm
33
Q

Types of Patient Transfers

A
  • Stand Pivot
  • Squat (Bend) Pivot
  • One-Person
  • Two-Person
  • Sliding Board
34
Q

Things to Consider Before Transferring Pt.

A
  • State of Patient (cognition, strength, behavioral, etc.)
  • Medical Precautions (weight bearing; IVs/cords; contraindications)
  • Clothing (nonslip footwear? Closed gown?)
  • State of Therapist (limitations, communication skills, body mechanics)
  • Environmental Considerations (equipment in order/locked; bed-w/c heights; clear pathway; etc.)
35
Q

Body Mechanics when Transferring Pt.

A
  • Get CLOSE to pt, or move them close to you
  • Position body to face pt
  • Bend knees and use legs, NOT back
  • Keep wide base of support (AP Stance)
  • Utilize elevated surfaces when possible
  • Don’t combine movements (avoid twisting/bending)
  • Keep heels down/feet flat
  • Ask for help when you need it!
36
Q

Independent vs. Dependent Transfers

A

INDEPENDENT: Pt performs all of transfer without assistance.

DEPENDENT: Pt unable to participate at all; therapist performs entire transfer.

**OTPs do both!

37
Q

Principles of Positioning Patient for Transfer

A

WEIGHT SHIFTING: from pt’s butt to feet. Leaning pt with “nose over toes” facilitates forward COG.

LOWER EXTREMITY: feet must be flat on floor; ankles stabilized; knees at 90˚; non-skid footwear at all times.

UPPER EXTREMITY: arms are assisting with transfer, or out of the way of harm; pt can push up from initial surface or reach toward new surface; NEVER pull on walker!

38
Q

Positioning a Chair/Wheelchair for Transfer

A
  • Chair/wheelchair/commode you are transferring to MUST be in place before you begin transfer!
  • Remove w/c armrest closer to bed
  • Remove seatbelt if applicable
  • Place w/c next to bed/chair
  • Lock wheels on w/c and bed
  • Move footrests out of way on side toward destination
  • Patient’s feet flat on floor, hip width apart, knees flexed to 90˚
39
Q

Sit to Stand Transfer

A

Once pt is sitting EOB/surface:
• Make sure feet flat on floor (can lower bed if needed)
• Cue patient to place hands on surface behind them or arm rests (or around you)
• Cue patient to lean forward
• Lean them over their COG (nose over toes) to facilitate onto their feet
• Have patient push up while straightening knees to stand
• Cue patient to stand up completely (tuck bottom in, shoulders back)

40
Q

Stand Pivot Transfer

A

Most common transfer. Requires patient to be able to place body weight on at least one foot and come to standing.

  • *When transferring stroke pt, easier to start with uninvolved side first.
    1) Have pt come to EOB/surface with feet flat and heels pointing toward point B
    2) Stand on pt’s affected side if any, with hands on pt’s scapula and waist/hips, or holding onto gait belt.
    3) Stabilize pt’s affected foot/knee with yours, if needed
    4) Cue pt to place hands on surface they are sitting on and lean nose-over-toes
    5) Count to 3 to prepare them to push up while you give just enough resistance to have them stand upright.
    6) Pt reaches for surface, then guide themselves to sit slowly
    7) Pt’s feet move toward more perpendicular angle to new surface
    8) Pt’s sit to stand generally controlled on way down (NOT a drop!)
41
Q

Squat (Bent) Pivot Transfer

A

*NOT recommended! Unsound/unstable!
• Used when pt cannot stand erect
• Allows OT to have pt bear weight on LEs (and possibly strengthen)
• Hand placement varies from waist to under buttocks
• Must take into account height/weight of pt
1) Grasp pt around waist or gait belt around hips
2) Facilitate weight shift of trunk over feet
3) Have pt reach for next surface or push up from current surface
4) Assist by guiding and pivoting toward point B

42
Q

Sliding Board Transfer

A

Used when pt cannot weight bear through either leg, or has paralysis/severe weakness.
• Most often used with pts with amputations of LEs or spinal cord injuries (C6 or below); arms are still strong enough.
1) Set up w/c as before, remove armrest closest to surface
2) Weight shift pt to place board underneath butt on side closest to surface B
3) Make sure board completely reaches under thigh and to surface A
4) Stand in front and block pt’s knees with yours
5) Pt needs to use their arms to lift/slide body weight along board. “POP SHIFT DOWN” motion, not actually sliding.
6) Assist pt as needed with verbal/physical cueing

43
Q

Dependent Transfers

A
  • Used with pts with minimal/no functional abilities
  • Can be dangerous for both pt and OT
  • Always ask for help if pt is too heavy
  • Make sure pt can follow directions/is cooperative! You do NOT want them fighting you!
44
Q

Mechanical Lifts

A

Ex: Hoyer. Vary by facility; most can handle any amount of weight; traditionally NOT a skilled OT/PT transfer but becoming more common.
• Can prevent injury to therapist
• Therapist may provide caregiver training for safety/incorporate into tx if appropriate.

45
Q

Transfers to Sofa/Chair

A
  • Chair/sofa can be less stable than a bed.
  • Have pt reach for seat of chair/sofa, not the back of it bc it can tip over
  • If height difference, add cushions to lower surface to assist when it’s time to stand again
46
Q

Toilet Transfers

A

Using WHEELCHAIR:
• Place w/c at closest angle possible
• Have pt push up from w/c arm rests
• Have pt reach for arm rests of toilet seat/grab bars in bathroom

Using WALKER:
• Have pt enter bathroom and turn away from toilet; cue them to back up to it
• Once they feel toilet on legs, they can start to manage their clothing to sit
• Have them reach back for grab bars on toilet seat and lower slowly

47
Q

Transfers to Bathtub

A
  • Can vary depending on setup
  • Walk in shower? Tub shower? Tub bench? Curtain/sliding doors?
  • Be careful while performing transfers in bathroom due to slippery surfaces
48
Q

Car Transfers

A

Consider:
• Patient’s size
• Any precautions
• Vehicle style (2/4 door? Low or high to ground?)
• Car seats often lower than standard w/c height, which makes uneven transfer hard
• May be able to use extra long slide board
• May need 2 people to safely assist transfer

Hints:
• Ask pt to back up to front passenger seat and hold onto stable part of car
• Have seat all the way back and reclined for hip/knee precautions
• Use pillows under bottom for hip precautions

OTA 130 - Kinesiology (15 decks)

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