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Neuromotor > Balance, coordination, and function > Flashcards

Balance, coordination, and function Flashcards

1
Q

What are the parts of postural control and balance?

A
  1. stability (static postural control)
  2. controlled mobility (dynamic postural control; moving in and out of positions)
  3. anticipatory control - know something’s coming and make changes accordingly
  4. automatic control - maintaining balance and control when you don’t know it’s coming
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2
Q

What are motor strategies for balance?

A
  1. righting reactions - orient head in space and body in relation to the head and support surface
  2. equilibrium reactions - protective reactions (ankle, hip, and stepping strategy)
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3
Q

What are characteristics of cerebellar impairments?

A
  1. Hypotonia
  2. Dysmetria: hypometria and hypermetria
  3. Dysdiadochokinesia
  4. Intention Tremor
  5. Nystagmus: Cb nystagmus, vestibular nystagmus, and positional vertigo
  6. rebound phenomenon
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4
Q

Control of the position of body parts with respect to each other and gravity

A

postural control

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5
Q

Ability to keep center of mass within the base of support; all forces acting on the body are balanced

A

balance

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6
Q

When doing the Romberg test, the pt has a significant test without eyes closed. what does this indicate?

A

cerebellar problem

- not an appropriate test

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7
Q

Ability to execute smooth, accurate, controlled movements

A

coordination

- dependent on intact NM system from 3 inputs: visual, somatosensory, and vestibular

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8
Q

How do we test Anticipatory Control vs Automatic Control?

A
  • Anticipatory Control – pt has eyes open; “I’m going to push in different directions I want you to hold you position”
  • Automatic Control - pt has eyes closed; taking vision out, must rely more on proprioception and vestibular systems; Still tell them what you’re going to be doing; Consider safety, if testing this is appropriate even (fall risk?)
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9
Q

What are the balance grades? (4-0)

A
  • 4 - Normal - Static: maintains steady balance wo/HHS; Dynamic: weight shifts easily, w/in full range, in all directions when maximally challenged
  • 3 – Good - Static: HHS not req’d; min-postural sway present; Dynamic: accepts mod-challenge; can pick object up off floor
  • 2 – Fair - Static: HHS req’d, and occasional min-assist req’d; Dynamic: accepts min-challenge; can turn head
  • 1 – Poor: Static: HHS and mod-to-max-assistance req’d; Dynamic: LOB when challenged or attempts movement
    0 - Absent: Unable to maintain static or dynamic balance
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10
Q

What are the main areas of the CNS involved if coordination impairments are present?

A

BG and Cb

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11
Q

general muscle weakness

A

Asthenia
(Cb pathology)
- application of manual resistance to determine ability to hold

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12
Q

Loss of ability to associate muscles together for complex movements

A

asynergia

Cb pathology

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13
Q

increased time required to initiate voluntary movement

A

delayed reaction time

Cb pathology

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14
Q

disorder of the motor component of speech articulation

A

dysarthria

Cb pathology

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15
Q

impaired ability to perform rapid alternating movements

A

dysdiadochokinesia

Cb pathology

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16
Q

inability to judge the distance or range of a movement

A

dysmetria

Cb pathology

17
Q

movement performed in a sequence of component parts rather than as a single, smooth activity; decomposition

A

dyssynergia
(Cb pathology)
- finger to therapist’s finger, finger to nose, alternate heel to toe, toe to examiners finger

18
Q

ataxic pattern, broad BPS; postural instability; high-guard position of UEs

A

Gait disorders

Cb pathology

19
Q

rhythmic, quick, oscillatory, back-and-forth movement of the eyes

A

nystagmus
(Cb pathology)
- red flag when straight vertical; means CNS impairment (vestibular has rotational component

20
Q

inability to halt forceful movements after resistive stimulus removed; pt unable to stop sudden limb motion

A

rebound phenomenon

Cb pathology

21
Q

involuntary oscillatory movement resulting from alternate contractions of opposite muscle groups

A

tremor
- intentional = during voluntary movement; increases as limb reaches target
- postural = movement of body in standing posture or of a limb (?) against gravity
(Cb pathology)

22
Q

rhythmic oscillations of the head; axial involvement of the trunk

A

titubation

Cb pathology

23
Q

inability to initiate movement; associated with fixed posture

A

akinesia

BG pathology

24
Q

slow, involuntary, writhing, twisting, “wormlike” movements; frequently greater involvement in distal UEs

A

Athetosis

BG pathology

25
Q

Decreased amplitude and velocity of voluntary movement

A

Bradykinesia

BG pathology

26
Q

involuntary, rapid, irregular, jerky movements involving multiple joints; most apparent in UEs

A

chorea

BG pathology

27
Q

movement disorder with features of both chorea and athetosis

A

choreoathetosis

BG pathology

28
Q

large-amplitude sudden, violent, flailing motions of the arm and leg of one side of the body

A

hemiballismus

BG pathology

29
Q

abnormally increased m activity or movement

A

hyperkinesis

BG pathology

30
Q

decreased motor response esp to a specific stimulus

A

hyopkinesis

BG pathology

31
Q

uniform consistant resistance as limb is moved

A

lead pipe rigidity

BG pathology

32
Q

series of brief relaxations or catches as limb is passively moved

A

cogwheel

BG pathology

33
Q

involuntary rhythmic oscillatory movement observed at rest

A

tremor (resting)

BG pathology

34
Q

What are some functional assessments?

A
  1. Barthel index
  2. Functional independence measure (FIM) - req’d for medicare inpatient rehab
  3. outcome and assessment information set - req’d for home health initial eval (housekeeping, laundry, phone, locomotion)
  4. SF-36
35
Q

What are some gait assessments

A
  1. timed walking tests
  2. distance tests (3, 6 qw min)
  3. DGI - sensitive in likelihood of falls in elderly and vestibular dysfunction
  4. walkie talkie test - determines attentional demands; pt slows down/ staggers/ loses balance/ has to stop = + fall risk
36
Q

What are the purposes of an environmental/ home assessment?

A
  1. Degree of safety and level of function in physical environment
  2. ID barriers to performance of tasks - railings? Clutter Lighting? Lighting at Night?Carpets?
  3. Make recommendations about accessibility and accommodations
  4. Determine need for adaptive equipment or assistive technology
  5. Assist in preparing pt and family/support network for return home
    - Often performed when significant change in status (SCI, Stroke, Significant remission w/MS)
37
Q

What is the progression of balance testing/activities in standing?

A
  1. Feet shoulder width apart
  2. Turning head
  3. Moving extremities/reaching inside BOS
  4. Weight shifts fwd/bwd and lateral
  5. Feet together
  6. Tandem stance
  7. Feet shoulder width apart eyes closed
  8. Reaching outside BOS
  9. Standing on one leg
  10. Perturbations
  11. Perturbations with eyes closed
    - Same progression on a dynamic surface (foam
38
Q

What is the progression of balance testing/activities in sitting?

A
  1. Feet shoulder width apart on floor
  2. Turning head
  3. Moving extremities/reaching inside BOS
  4. Weight shifts fwd/bwd and lateral
  5. Raise surface - feet off floor
  6. Feet on floor eyes closed
  7. Reaching outside BOS
  8. Perturbations
  9. Perturbations with eyes closed
    - Same progression on a dynamic surface (foam)

Neuromotor (17 decks)

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