Balance, coordination, and function Flashcards
What are the parts of postural control and balance?
- stability (static postural control)
- controlled mobility (dynamic postural control; moving in and out of positions)
- anticipatory control - know something’s coming and make changes accordingly
- automatic control - maintaining balance and control when you don’t know it’s coming
What are motor strategies for balance?
- righting reactions - orient head in space and body in relation to the head and support surface
- equilibrium reactions - protective reactions (ankle, hip, and stepping strategy)
What are characteristics of cerebellar impairments?
- Hypotonia
- Dysmetria: hypometria and hypermetria
- Dysdiadochokinesia
- Intention Tremor
- Nystagmus: Cb nystagmus, vestibular nystagmus, and positional vertigo
- rebound phenomenon
Control of the position of body parts with respect to each other and gravity
postural control
Ability to keep center of mass within the base of support; all forces acting on the body are balanced
balance
When doing the Romberg test, the pt has a significant test without eyes closed. what does this indicate?
cerebellar problem
- not an appropriate test
Ability to execute smooth, accurate, controlled movements
coordination
- dependent on intact NM system from 3 inputs: visual, somatosensory, and vestibular
How do we test Anticipatory Control vs Automatic Control?
- 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?)
What are the balance grades? (4-0)
- 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
What are the main areas of the CNS involved if coordination impairments are present?
BG and Cb
general muscle weakness
Asthenia
(Cb pathology)
- application of manual resistance to determine ability to hold
Loss of ability to associate muscles together for complex movements
asynergia
Cb pathology
increased time required to initiate voluntary movement
delayed reaction time
Cb pathology
disorder of the motor component of speech articulation
dysarthria
Cb pathology
impaired ability to perform rapid alternating movements
dysdiadochokinesia
Cb pathology
inability to judge the distance or range of a movement
dysmetria
Cb pathology
movement performed in a sequence of component parts rather than as a single, smooth activity; decomposition
dyssynergia
(Cb pathology)
- finger to therapist’s finger, finger to nose, alternate heel to toe, toe to examiners finger
ataxic pattern, broad BPS; postural instability; high-guard position of UEs
Gait disorders
Cb pathology
rhythmic, quick, oscillatory, back-and-forth movement of the eyes
nystagmus
(Cb pathology)
- red flag when straight vertical; means CNS impairment (vestibular has rotational component
inability to halt forceful movements after resistive stimulus removed; pt unable to stop sudden limb motion
rebound phenomenon
Cb pathology
involuntary oscillatory movement resulting from alternate contractions of opposite muscle groups
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)
rhythmic oscillations of the head; axial involvement of the trunk
titubation
Cb pathology
inability to initiate movement; associated with fixed posture
akinesia
BG pathology
slow, involuntary, writhing, twisting, “wormlike” movements; frequently greater involvement in distal UEs
Athetosis
BG pathology
Decreased amplitude and velocity of voluntary movement
Bradykinesia
BG pathology
involuntary, rapid, irregular, jerky movements involving multiple joints; most apparent in UEs
chorea
BG pathology
movement disorder with features of both chorea and athetosis
choreoathetosis
BG pathology
large-amplitude sudden, violent, flailing motions of the arm and leg of one side of the body
hemiballismus
BG pathology
abnormally increased m activity or movement
hyperkinesis
BG pathology
decreased motor response esp to a specific stimulus
hyopkinesis
BG pathology
uniform consistant resistance as limb is moved
lead pipe rigidity
BG pathology
series of brief relaxations or catches as limb is passively moved
cogwheel
BG pathology
involuntary rhythmic oscillatory movement observed at rest
tremor (resting)
BG pathology
What are some functional assessments?
- Barthel index
- Functional independence measure (FIM) - req’d for medicare inpatient rehab
- outcome and assessment information set - req’d for home health initial eval (housekeeping, laundry, phone, locomotion)
- SF-36
What are some gait assessments
- timed walking tests
- distance tests (3, 6 qw min)
- DGI - sensitive in likelihood of falls in elderly and vestibular dysfunction
- walkie talkie test - determines attentional demands; pt slows down/ staggers/ loses balance/ has to stop = + fall risk
What are the purposes of an environmental/ home assessment?
- Degree of safety and level of function in physical environment
- ID barriers to performance of tasks - railings? Clutter Lighting? Lighting at Night?Carpets?
- Make recommendations about accessibility and accommodations
- Determine need for adaptive equipment or assistive technology
- Assist in preparing pt and family/support network for return home
- Often performed when significant change in status (SCI, Stroke, Significant remission w/MS)
What is the progression of balance testing/activities in standing?
- Feet shoulder width apart
- Turning head
- Moving extremities/reaching inside BOS
- Weight shifts fwd/bwd and lateral
- Feet together
- Tandem stance
- Feet shoulder width apart eyes closed
- Reaching outside BOS
- Standing on one leg
- Perturbations
- Perturbations with eyes closed
- Same progression on a dynamic surface (foam
What is the progression of balance testing/activities in sitting?
- Feet shoulder width apart on floor
- Turning head
- Moving extremities/reaching inside BOS
- Weight shifts fwd/bwd and lateral
- Raise surface - feet off floor
- Feet on floor eyes closed
- Reaching outside BOS
- Perturbations
- Perturbations with eyes closed
- Same progression on a dynamic surface (foam)
