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Neuro Management > Balance Evaluation and Treatment > Flashcards

Balance Evaluation and Treatment Flashcards

1
Q

what is postural control and how do we achieve postural control?

A

Postural control is controlling body position in space to maintain dynamic Stability (COM within BOS) and orientation (relationship between segments and between body and
environment)
We achieve these goals by:
- using and integrating sensory info
- generating forces to control the body’s position.

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2
Q

what is COM?

A

center of the total body’s mass (weighted average of each segment)

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3
Q

what is BOS?

A

area of object in contact with the supporting surface

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4
Q

what is COG?

A

vertical projection of the COM

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5
Q

What is balance?

A

ability to maintain projected COM within the limits
of BOS

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6
Q

what systems are involved in postural control?

A

musculoskeletal system
eye-head coordination
adaptive mechanisms
anticipatory mechanisms
sensory strategies
sensory systems
neuromuscular synergies

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7
Q

what is needed for balance?

A
  1. ROM - especially at the
    ankles.
  2. Tone/strength in muscles
  3. Postural tone- antigravity
    muscles
  4. Postural Alignment - allows
    the body to be in equilibrium
    with the least amount of
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8
Q

what are neuromuscular ankle strategies? when do we use them?

A

-ankle strategies mainly with smaller perturbations
- for normal stance on flat or slightly uneven surfaces
-Backward motion of the surface induces
forward sway and muscle response
Gastrosoleus –> Hamstrings –> Paraspinals
- Forward motion of the surface induces
backward sway and muscle response
Tib Anterior –> Quadriceps –> Abdominals

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9
Q

what are neuromuscular hip strategies?
when do we use them?

A
  • for narrow/ small/ very unstable/moving surfaces, inclines
  • for larger backward pertubations –> response: Paraspinals –> Hamstrings
  • Brings hips forward to counteract change in COG
  • Larger Induced Forward sway–> response: Abdominals–> Quadriceps
  • Brings hips backward to counteract change in COG
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10
Q

what are other neuromuscular strategies besides ankle and hip?

A
  • Stepping Strategy occurs when the COM moves outside the BOS with very strong perturbation
  • Mediolateral control occurs in the hip and in the trunk primarily (adduction of one leg and abduction of the other). Main muscles include gluteus Med and TFL.
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11
Q

what are adaptive mechanisms with regard to balance strategies?

A
  • The boundaries of the strategies
    are dynamic; boundaries can shrink following
    habituation.
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12
Q

what is nystagmus

A

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

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13
Q

what is an abnormal saccade

A

inability of the eyes to maintain focus
with the head moving

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14
Q

what is diplopia

A

Double vision

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15
Q

what is the visual sensory system?

A

Info about position of the head and motion,
verticality.
Problems arise when an individual can not distinguish between self-motion and environment motion

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16
Q

what is the somatosensory system?

A

Info about the body position /movement in space with reference to the supporting surface.
Includes spindles, golgi tendon organs, joint
receptors, cutaneous receptors

17
Q

what is the vestibular system?

A

Provides the CNS with information about the position and movement of the head with
respect to gravity.

18
Q

describe anticipatory control

A
  • The patient’s ability to prepare for anticipated
    displacements based on prior experience, anticipation, practice, and knowledge of physical constraints.
  • Postural “preparation ” @ 30 msec before actual
    movement occurs.
  • They also reoccur after the movement takes place to make adjustments.
19
Q

what should be included in a balance assessment?

A
  • A standardized functional measure of skills requiring postural control. (ex. Tinetti, Berg, Get up and Go, etc…)
  • Assessment of sensory inputs. (ex.Foam and Dome, Balance Master, Equitest)
  • Assessment of balance strategies through observation
  • Tests for underlying impairments of sensory, motor, and cognitive systems.(ex. ROM measurements, strength testing, sensory testing, cognitive testing etc…)
20
Q

what is the functional reach test?

A

The functional reach test is a quick screening tool for balance problems in older adults. It assesses the area within the BOS that a person can confidently and safely move his/her COM.
The test requires the patient to
* Stand with feet shoulder width apart, arms raised to 90° flexion, without moving feet, subject reaches forward as far as s/he can without losing balance. Distance of the middle fingertip measured with a yard stick mounted on the wall.

21
Q

what do scores on the Functional Reach test mean?

A

Predictive validity (men):
- 15.2cm-25.4cm 2x as likely to fall
- <15.2 4 x more likely to fall
- Cannot reach at all: 8x more likely to fall (Duncan et al, 1992)
FR scores do not differentiate between healthy vs. vestibular hypofunction. FR scores not related to Antero-posterior postural measures

22
Q

what is the performance- oriented mobility assessment POMA (Tinneti)? How is it performed?

A
  • Screen for balance and mobility skills used in
    normal daily activities in older adults. Used to determine likelihood of falls.
  • 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 devices ok (but graded down for)
23
Q

what is the scoring of POMA (tinneti)?

A
  • Max score on both tests= 28 points
  • Moderate fall risk 19-24 of total
  • High Falls risk < 19 of total
  • < 14 on balance scale indicates patient would benefit from PT for balance.
  • Sensitivity better than Timed Up and Go and Functional Reach test
24
Q

what is the Berg Balance Screen?

A
  • Screen individuals who would benefit from PT referral and to predict multiple falls.
  • Task: Fourteen items assessing ability to maintain position during decreasing base of support, transitional movement and center of mass transference (rated 0-4, worst to best).
  • Do not use assistive device
25
Q

what do the scores on the BBS mean?

A
  • Score of < 48= benefit from PT referral
  • Score of < 45 = risk of recurrent falls and predictive of a future fall.
  • Score of < 36 = 100% risk for falls
26
Q

what is the significance of the BBS?

A
  • Currently best single predictor of falls in the community dwelling elderly (Shumway-Cook et. al 1997)
  • Parkinson’s disease- Berg has been shown to be
    valid for Parkinson’s
  • Acute Stroke- Higher Berg score related to lower
    Length of stay
  • Chronic Stroke-Berg not able to differentiate
    between fallers and non-fallers
27
Q

what is the TUG test?

A

Quick performance based screening tool to
measure functional mobility in community dwelling older adults.
Task: Ability of an individual to rise from 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; 2 timed trials with time averaged between the 2

28
Q

what is the significance of the TUG test?

A
  • has high Intra-rater and Inter-rater reliability
  • has high Correlation with Berg Balance
  • < 10-12 seconds = normal
  • > 14 seconds indicative of faller
  • > 20 seconds indicative of frail for functional
    independence
  • > 30 indicates dependence
  • TUG is not as highly correlated to the Parkinsonian scale as the Berg
  • Tinetti Balance subtest and TUG predict ADL decline and Falls in elderly (Tinetti better than TUG)
29
Q

what are the different types of TUG test?

A
  • TUG manual: Carry a cup of water
  • TUG cognitive: Count backward by 3’s
  • Measure of dual task conditions –>Currently no norms & no further sensitivity to falls in community elderly
30
Q

what is the CTSIB?

A
  • Purpose: To test effect of sensory interactions on
    postural stability
  • Task: Six static standing positions with altered visual, vestibular and somatosensory conditions.
  • Reliability/Validity: Subjects should be able to
    maintain all conditions for 30 seconds x 3.
31
Q

what are indications for balance training?

A
  • Vestibular inner ear disorders
  • Neurological problems
  • Orthopedic injuries and procedures
  • Decreased strength and flexibility
  • Medications
  • Self-confidence
32
Q

what are possible treatments for balance issues?

A
  • Tasks involving higher degrees of freedom or
    decreasing base of support
  • Training alignment (biofeedback systems)
  • Train movement strategies
  • Facilitate activity of muscles- icing, vibration, FES,
    biofeedback
  • Improving sensory strategies- decrease visual
    dependence, decrease somatosensory dependence, strengthen vestibular system

Neuro Management (5 decks)

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