Balance / Assessment Flashcards by Ariyana Williams

Goals of the postural control system

-maintain a steady stance
-anticipate volitional goal directed movements
-adapt to changing requirements

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Components of the postural control

-motor
-sensory
-central processing (awareness, attention, automatic reactions)

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Postural control is achieved by continually …..

positioning the body’s center of gravity over the
base of support during both static and dynamic situations

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Balance is simply defined as

keeping the center of gravity within the base of support in a given environment

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Deficits within any single component of balance are typically not sufficient to cause postural
instability, because….

However,

compensatory mechanisms from other components prevent that from
happening

deficits across multiple components may lead to instability and falls

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The balance system consists of a complex set of control process that can be divided into
two distinct and interdependent systems

Gaze and postural

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the gaze stabilization system maintains

gaze direction and visual acuity during activities involving active head and body movements

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postural stabilization system function

keeps the body in balance for static and dynamic
activities

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a rapidly acting system that reflexively drives eye
movements that are equal and opposite to those of the head.

VOR (vestibule-ocular reflex)

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The 2 components of the balance system are

interdependent

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Does the VOR require visual information?
What is it influenced by?
Is it effective in slow movements?

-NO
-the individuals state of arousal
-NO

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VOR is effective for stabilizing gaze during

rapid movements

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allows the direction of gaze to smoothly follow a
visual target during active movement

smooth pursuit eye movement system

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What does the smooth pursuit eye movement system require

it is not affected by

it dominates during

the presence of a visual target

the absence or presence of vestibular info

slow movements

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When
the VOR and smooth pursuit systems fail to maintain gaze on the target

saccadic eye movement system can generate rapid catch-up eye movements

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when gaze is
first directed to a new visual target

saccadic eye movement system can generate rapid catch-up eye movements

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The saccadic eye movement system requires

it is not affected by

the presence of a visual target
and is not affected by vestibular information

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Maintaining postural stability is a more complex balance process that relies on the
interaction of three major components

vision, vestibular, propio, contact with support surface in combo
motor reactions among muscles
integration of sensory and motor info and adaptation of env

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Alignment contributes to postural stability by

allowing the body to remain in equilibrium
with the least amount of energy

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Factors that influence postural tone
include

activation of cutaneous receptors against a surface, visual, and vestibular inputs.

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During upright posture, there is background activity in the
anti-gravity muscles, which is termed

postural tone

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Muscles that tend to be tonically active during stance include

the gastrocnemius and soleus,
tibialis anterior, gluteus medius and tensor fascia lata, iliopsoas, thoracic erector spinae,
and intermittent contractions of the abdominals.

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There are five basic strategies that have been identified as responses to unexpected
postural perturbations.

2 hip is?

What is the pattern?

Who tends to use this more?

A hip strategy is the activation of muscles around the hip joint as a result of a
sudden and forceful disturbance of the base of support or a perturbation to balance
while standing on a narrow support surface

proximal to distal

older adults

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There are five basic strategies that have been identified as responses to unexpected
postural perturbations.

1 ankle strategy is?

What is required?

An ankle strategy is the activation of muscles around the ankle joint after a small
disturbance of the base of support when standing on a firm, level support surface

significant amount of ankle strength and mobility

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There are five basic strategies that have been identified as responses to unexpected postural perturbations. 3 stepping is?

The stepping strategy has been defined as taking a step rapidly in the direction of the movement of the center of gravity, which has been displaced beyond the limits of the base of support.

There are five basic strategies that have been identified as responses to unexpected postural perturbations. 4 reaching is? Has a significant role in?

The reaching strategy includes moving the arm to grasp or touch an object for support preventing falls

There are five basic strategies that have been identified as responses to unexpected postural perturbations. 5 suspensory is?

The suspensory strategy includes bending knees during standing or walking for the purpose of maintaining a stable position during a perturbation

Adaptations when unexpected postural perturbations happen are based on

Adaptations are based on what the CNS perceives to be the safest.

Visual inputs provide the CNS with information about

the position and motion of the head with respect to surrounding objects

Visual inputs are important source of information for postural control, but are they absolutely necessary? They are not always accurate for ..

No, since most of us can keep our balance when we close our eyes or are in a dark room They are also not always an accurate source of orientation info about self motion

Somatosensory system inputs provide the CNS with information about? receptors?

with position and motion information about the body with reference to supporting surfaces and report information about the relationship of body segments to one another muscle receptors, joint receptors, and cutaneous receptors

The vestibular system provides the CNS with information about

the position and movement of the head with respect to gravity and inertial forces

There is no one single test of balance due to the

complexity of the postural control system

Romberg test positive test is positive test meaning

requires the patient to stand with feet together, arms either at side or across the chest, with eyes open and then eyes closed for 30 seconds A positive test is the inability of the patient to remain steady and control balance with the eyes closed A positive finding is indicative of proprioceptive dysfunction

The Sharpened or Tandem Romberg requires the patient to + test meaning

stand in a tandem stance with the eyes open. A positive test is the inability of the patient to maintain balance or remain steady. This test assesses cerebral and vestibular dysfunction.

Single Leg Stance test findings? if they can ____ if they cannot ____?

This is a timed test (usually up to 30 seconds). This suggests that individuals who can stand on one leg for at least 30 seconds are at low risk of falling (high sensitivity). However, being unable to stand on one leg for at least 30 seconds does not provide much information about an individual’s risk of falling

Normal individuals maintain body weight within ____ of equal on the two legs over the full range of squatting positions

an assessment technique used to quantify and help to differentiate among a wide variety of possible sensory, motor, and central adaptive impairments to balance control

CDP

CDP information is important in

the planning of treatment focused on impairment reduction

the patient stands on a movable force plate within a movable surround. The force platform is under computer control, and can move either in a horizontal plane, or rotate out of the horizontal plane

CDP testing

Used to determine how quickly the automatic motor system can recover following an unexpected external perturbation.

motor control test

In young adults with a normal SOT and abnormal motor control test, there is increased suspicion of

The adaptation test assesses

the patient’s ability to reduce sway when exposed to surface irregularities and unexpected changes in the support surface.

Individuals performing abnormally on the _____ tend to have difficulty in changes in the surface inclination

ADT (adaptation test)

ADT difficulties can arise due to the individual’s inability to suppress

inappropriate automatic reactions and/or may have weakness of the ankle muscles and restricted range of motion

Assesses an individual’s ability to reach in different directions and recover without altering the base of support

functional reach test

This test quantifies the maximum distance a person can intentionally displace his or her center of gravity without loss of balance (including stepping or reaching for assistance)

Limits of Stability

A forward reach of less than _______ has been reported as a fall risk factor for falling within the next six months

6 inches

Patients with reduced stability limits in the AP direction ..... Laterally reduced limits can ...

tend to take smaller steps during gait while laterally reduced limits can lead to broad-based gaits.

Differences in the amount of body sway in the various conditions are used to determine a subject’s ability to adapt sensory information for postural control

Sensory organization test

Conditions 1 and 2 of the sensory organization test

In condition one: all three senses are available and accurate In condition two: vision is absent, vestibular and somatosensory are present and accurate

Conditions 5 and 6 of the sensory organization test

In condition five: somatosensory is inaccurate, vision is absent, vestibular is accurate In condition six, somatosensory and vision are inaccurate, vestibular is accurate

Conditions 3 and 4 of the sensory organization test

In condition three: vision is inaccurate, vestibular and somatosensory are present and accurate In condition four: somatosensory is inaccurate, vision and vestibular are accurate

Condition 2 over condition 1 low score finding

Low score may indicate patient makes poor use of somato reference

Condition 4 over condition 1 low score findings

low score indicates patient makes poor use of visual reference

Condition 5 over condition 1 low score findings

low score indicates patient makes poor use of vestibular cues or vestibular cues are unavailable

Condition 3+6 over condition 2+5 low score findings

a low score indicates patient relies on visual cues, even when they are not accurate

Conditions of mCTSIB

The four conditions are firm surface, eyes open; firm surface, eyes closed; compliant surface, eyes open; and, compliant surface, eyes closed. Timed for 30 sec

Cut offs for fullerton advanced balance scale

those scoring 25 or fewer points are at higher risk for falls

Cut off score for five times sit to stand

15 seconds

Cut off score for four square step test

greater than 15 seconds

Cut off score for berg balance

36 or less

Cut off score for timed up and go

13.5 seconds or longer

Cut off score for timed up and go dynmaic gait index

19 or less

Cut off score for POMA

19 or less

Cut off score for functional gait analysis

22/30