Balance Assessments Flashcards
Balance
Maintaining postural stability in a static or dynamic position.
Dynamic = while moving
-walking, running, etc.
Static = while standing
-standing, single leg stance
Three Pillars of Balance
Strength = lower body and core
Vestibular system = inner ears and eyes
Proprioception = joint positioning of lower body and spine
All three pillars decline with age.
Guidelines for balance include…
2x/week for older adults.
Good to add into resistance training, but more frequent the better.
Making it more complex as needed as well
How to progress balance assessments/exercises…
Focus on changing those pillars of balance.
Uneven surface
Move head side to side
Close eyes
Change base of support (tandem, single leg)
Change center of gravity (reaches, pushes, carrying objects)
Add in mental stimulation (count backwards, around the world game, juggle, catch a ball).
When/Where/Who to assess balance…
Older adults
Concussions or other brain injuries.
Conditions like vertigo where balance is impacted.
Any neurological conditions such as stroke or MS.
Injuries on one side of lower limbs.
-surgeries or injuries (especially for legs)
General Protocol for Balance Assessments
Explain assessment test to client.
Ideally have client barefoot (to see how it works through proprioception).
-but if you use shoes mostly throughout the day, just be consistent with subsequent assessments.
If balance is a safety issue, set up client near equipment they can use for assistance, or have them use their walker/canes.
-clear all other equipment to avoid tripping hazards.
Time for up to 30s (or more if test requires so).
Compare to norms if available.
-typically associated with higher falls risk
Some Balance Assessments Include…
Berg balance scale
Single leg stance/stork test
tandem stance and walk test
Romberg balance
functional reach
4square step test (4SST)
Clinical test of sensory interaction and balance (CTSIB)
Modified CTSIB
Tinetti balance Assessment Tool
Romberg Balance
Static balance test that assesses proprioception and vestibular function.
-helpful to assess people with neurological issues, older adults, those with brain injuries (such as concussions).
-can help decipher if balance if from a vestibular/proprioception issue or a strength issue
-people with vestibular or proprioceptive loss may sway more or fall when their eyes are closed.
Romberg Balance Protocol
Have the client complete each of the following positions, if the eyes open position is easy and no issues after 10s then proceed to eyes closed version, give 30s max for each position.
-double leg stance (eyes open)
-Double leg stance (eyes closed)
-Tandem stance (R and L) (eyes open)
-Tandem stance (R and L) (eyes closed)
-Single leg stance (R and L) (eyes open)
-Single leg stance (R and L) (Eyes closed)
Stop timer if they open their eyes (in eyes closed position), if they have to catch themselves from swaying, or if they are swaying too much.
If someone falls out quickly (ie. 5s in) can have them retry because of the novelty of some of the positions (to get a better assessment)
If struggling to stand tandem, can also stand semi-tandem (ie. heel of one foot at the arch/middle of other foot).
Functional Reach Test
Measures the maximum distance a person can reach forward while standing, assessing dynamic balance, and fall risk.
Modified version where client reaches forward, left, and right standing or seated
Functional Reach Test Protocol
The patient stands next to a wall with a yardstick mounted at shoulder height.
The patient raises their arm to 90 degrees of shoulder flexion with a closed fist.
The initial position is marked at the 3rd metacarpal head on the yardstick.
The patient is instructed to reach as far as they can forward without taking a step.
The final position is marked, and the difference between start and end position is measured.
The test is typically performed three times, with the average of the last two trials recorded.
Functional Reach Test Scoring
< or equal to 6 inches indicates a high falls risk.
6-10 inches indicates a moderate falls risk.
> or equal to 10 inches indicates a low falls risks.
4 Square Step Test (4SST)
Assesses dynamic balance and coordination for stepping over obstacles and moving in multiple directions.
Helpful to predict falls risks
-good for older adults, stroke, parkinson’s amputees, vestibular conditions.
Increased Falls Risks Scores in 4SST
Older adults = >15s (higher falls risk
Stroke = >15s or failed attempt
Parkinson’s = >9.68s
Vestibular disorders = >12 s
Limb loss/amputation = >24s
Protocol for 4SST
Set up four sticks in a cross on the ground.
The client starts in square 1, facing square 2.
-client will always be facing the same way in order to step in multiple directions.
Sequence = 2, 3, 4, 1, 4, 3, 2, 1
-clockwise, then couterclockwise
Timing starts when the first foot contacts square 2 and ends when the last foot returns to square 1.
Both feet much touch the floor in each square.
Complete the sequence as quickly and safely as possible without touching the sticks.
Complete 2 trials and use the best time in seconds.
Clinical Test of Sensory Interaction and Balance (CTSIB)
Assesses sensory input of static balance.
-uses visual, vestibular and somatosensory input.
-populations = clients with sensory input issues such as brain injury, concussions, chronic pain, visual loss, amputation, joint replacements.
Protocol of CTSIB
Client stands barefoot or with appropriate footwear.
Hands are kept at the sides.
Each condition is times for up to 30 seconds.
The trial ends if the participant opens their eyes (in closed eye conditions), raise their arms, or loses balance.
6 conditions in CTSIB
Eyes open, standing on firm surface.
Eyes closed, standing on firm surface.
Visual conflict dome/making them move their head, standing on firm surface.
Eyes open, standing on foam surface.
Eyes closed, standing on foam surface.
Visual conflict dome, standing on foam surface.
Modified CTSIB
does not include visual conflict dome.
Only 4 conditions tested so quicker.
Balance Exercise Prescription
Balance assessments can very easily be used as exercise prescription for most people.
-if it is something that may be more dangerous to client, draw the line with them as to what they can do at home and what they can only do with you in the clinic where it is safe.
Make the balance assessment or exercise relevant to client if needed.
-if someone has issues with balance going up or down stairs then have this be the focus.
-evidence based practice.
