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PHTH 528 > Balance Evaluation and Treatment > Flashcards

Balance Evaluation and Treatment Flashcards

1
Q

postural control

A
  • controlling body position in space to maintain dynamic stability (COM within BOS) and orientation (relationship between segments and between body and environment)
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2
Q

how do we achieve postural control?

A
  • by using and integrating sensory info
  • by generating forces to control the body’s position
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3
Q

COM

A
  • center of the total body’s mass (weighted average of each segment)
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4
Q

BOS

A

area of object in contact with the supporting surface

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5
Q

COG

A
  • vertical projection of the COM
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6
Q

balance

A

ability to maintain projected COM within the limits of BOS

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7
Q

systems model of postural control

A
  • sensory strategies
  • sensory systems
  • neuromuscular synergies
  • musculoskeletal system
  • eye-hear coordination
  • adaptive mechanisms
  • anticipatory mechanisms
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8
Q

what do we need for balance?

A

1) ROM - especially at the ankles
2) tone/strength in the muscles
3) postural tone - antigravity muscles
4) postural alignment - allows the body to be in equilibrium with the least amount of energy

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9
Q

neuromuscular synergies - ankle strategy

A
  • used in normal stance on flat or slightly uneven surfaces
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10
Q

how is ankle strategy used in backward movement of a surface?

A
  • forward sway and muscle response
  • gastroc-soleus –> hamstrings –> paraspinals
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11
Q

how is ankle strategy used in forward movement of a surface?

A
  • induces backward sway and muscle response
  • anterior tibialis –> quadriceps –> abdominals
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12
Q

neuromuscular synergies - hip strategy

A
  • used in narrow, small, very unstable moving surfaces and inclines
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13
Q

what happens during larger induced backward sway hip strategy?

A
  • response: paraspinals –> hamstrings
  • brings hips forward to counteract change in COG
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14
Q

what happens during larger induced forward sway hip strategy?

A
  • response: abdominals –> quadriceps
  • brings hips backward to counteract change in COG
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15
Q

stepping strategy

A

when COM moves outside the BOS with very strong perturbation

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16
Q

mediolateral control

A

occurs in hip and trunk primarily (adduction of the leg and abduction of the other)
- muscles: glute med and TFL

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17
Q

adaptive mechanisms

A
  • based on the environment and task demands, we can employ varying strategies
  • the boundaries of the strategies are dynamic
  • the boundaries can shrink following habituation
18
Q

nystagmus

A

eyes move in a slow phase to the side with a rapid return to midline with a regular beat

19
Q

abnormal saccades

A

inability of the eyes to maintain focus with the head moving

20
Q

diploplia

A

double vision

21
Q

what are the sensory systems involved with balance?

A

1) visual input
2) somatosensory input
3) vestibular input

22
Q

visual input

A
  • info about position of head and motion, verticality
  • problem: can’t distinguish between self-motion and environmental motion
23
Q

somatosensory input

A
  • info about the body position/movement in space with reference to the supporting surface
  • includes spindles, golgi tendon organs, joint receptors, cutaneous receptors
24
Q

vestibular input

A
  • provides the CNS with information about the position and movement of the bead with respect to gravity
25
Q

anticipatory control (postural set)

A
  • the patient’s ability to prepare for anticipated displacements based on prior experience, anticipation, practice, and knowledge of physical constraints
  • postural muscles “prepare” @ 30 msecs before actual movement occurs
  • they also reoccur after the movement takes place to make adjustments
26
Q

functional reach purpose

A
  • in older adults
  • quick screening tool for balance problems
  • area within the BOS that a person can confidently and safely move his/her COM
27
Q

functional reach task

A
  • stand with feet shoulder width apart
  • arms raised to 90 degrees flexion
  • without moving feet, subject reaches forward as far as they can without losing balance
  • distance of the middle fingertip measured with a yard stick mounted on the wall
28
Q

performance-oriented mobility assessment poma (tinetti) purpose

A
  • screen for balance and mobility skills used in normal daily activities in older adults
  • used to determine likelihood of falls
29
Q

tinetti task

A
  • two-part test with nine balance items (rated at normal, adaptive, or abnormal) and seven gait items (graded as normal or abnormal) or (numerical score 0-2) depending on version
  • assistive device ok (but graded down for)
30
Q

scoring for tinetti

A
  • max score on both tests = 28 points
  • moderate fall risk = 19-24 of total
  • high fall risk < 19 of total or < 14 on balance scale
  • sensitivity better than TUG and Functional Reach Test
31
Q

berg balance scale purpose

A
  • screen individuals who would benefit from PT referral and to predict multiple falls
32
Q

berg balance scale task

A
  • fourteen items assessing ability to maintain position during decreasing base of support, transitional movement and center of mass transference (rated 0-4)
  • do no use assistive device
33
Q

berg balance scoring

A

< 48 –> benefit from PT referral
< 45 –> risk of recurrent falls and predictive of a future fall
< 36 –> 100% risk for falls

34
Q

TUG purpose

A

quick performance based screening tool to measure functional mobility in community dwelling older adults

35
Q

TUG task

A
  • ability of an individual to rise of a chair, ambulate 3 meters (10 ft), turn 180 degrees and ambulate back to the chair then return to sitting
  • assistive devices ok
  • 3 trials: 1 practice and 2 timed trials with time averaged between the 2
36
Q

TUG scoring

A

< (or equal to) 10-12 secs = normal
> 14 secs = indicative of faller
> (or equal to) 20 secs = indicative of frail or functional independence
> 30 secs = dependent

37
Q

TUG manual

A
  • carry a cup of water
  • measure of dual task conditions
38
Q

TUG cognitive

A
  • count backwards by 3’s
  • measure of dual task conditions
39
Q

CTSIB purpose

A
  • to test effect of sensory interactions on postural stability
40
Q

CTSIB task

A
  • six static standing positions with altered visual, vestibular, and somatosensory conditions
41
Q

indications for balance training

A
  • vestibular inner ear disorders
  • neurological problems
  • orthopedic injuries and procedures
  • decreased strength and flexibility
  • medications
  • self-confidence
42
Q

treatment

A
  • ## treat impairments and improve strategies

PHTH 528 (2 decks)

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