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PHTH 528 - Neuro Midterm > Balance Evaluation and Treatment - Lecture #2 > Flashcards

Balance Evaluation and Treatment - Lecture #2 Flashcards

1
Q

What allows the body to maintain in space?

A
  • Dynamic stability (COM within BOS)
  • Orientation: relationship between segments and between body and environment
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2
Q

How are we able to 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

What is COM?

A

Center of the total body’s mass
- weighted average of each segment

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4
Q

What is BOS?

A

Areas of object in contact with supporting surface

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5
Q

What is COG?

A

Vertical projection of the COM

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6
Q

What is balance?

A

Ability to maintain projected COM within the limits of BOS

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7
Q

What are the different postural control system?

A
  • eye-head coordination
  • adaptive mechanism
  • anticipatory mechanism
  • sensory strategies
  • sensory systems
  • neuromuscular synergies
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8
Q

What do we need for balance?

A
  • ROM - especially the ankles
  • Tone/strength in the muscles
  • Postural tone- antigravity muscles
  • postural alignment- allows the body to be in equilibrium with the least amount of energy
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9
Q

When is the ankle strategy used?

A

In a normal stance on flat or slightly uneven surfaces

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10
Q

How does ankle strategy use the backward motion?

A

Induces forward sway and muscle respone

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10
Q

What muscles are activated during the backward ankle strategy?

A

Gastrocsoleus
Hamstrings
Paraspinals

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11
Q

How does ankle strategy use the forward motion?

A

induces backward sway and muscle response

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12
Q

What muscles are activated during the forward ankle strategy?

A

Tib anterior
quadriceps
abdominals

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13
Q

When is the hip strategy used?

A

During narrow and small
Very unstable and moving surfaces
Inclined

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14
Q

How does the backward sway involve the hip strategy?

A

A response will induce the paraspinals to the hamstrings
- it brings the hips forward to counteract change in COG

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15
Q

How does the forward sway involve the hip strategy?

A

A response will induce the abdominals to the quadriceps
- it brings hip backward to counteract change in COG

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16
Q

What is the stepping strategy?

A

When the COM moves outside the BOS after a strong perturbation

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17
Q

What is the mediolateral control?

A

Happens in hip in trunk primarily (adduction of one leg and abduction of the other)
- using gluteus med adn TFL

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18
Q

What is adaptive mechanism based on?

A

On the environment and task demands so we can different strategies
- the boundaries of the strategies are dynamic and can change (can shrink according to habituation)

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19
Q

What is nystagmus?

A

When eyes move in a slow phase to the side with fast return to the middle with a regular beat

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20
Q

What is abnormal saccade?

A

inability of the eyes to keep focus with the head moving

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21
Q

What is diploplia?

A

Double vision

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22
Q

How does the visual input impact the sensory systems?

A

information about the position of the head and the motion along with verticality

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23
Q

What is the problem with the visual input for the sensory system?

A

Can’t distinguish between self-motion and environment motion

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24
Q

How does the somatosensory input impact the sensory system?

A

Information about the body position/movement in space with reference to the supporting surface
- includes spindles, GTG, joint receptors and cutaneous receptors

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25
Q

How does the vestibular input impact the sensory system?

A

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

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26
Q

How does attention affect balance?

A

With balance deficits, keeping an upright posture while moving stops to become automatic

27
Q

What does preliminary studies say about attention and balance?

A

Shows that verbal attention tasks have a big impact on the possible faller to keep standing balance

28
Q

What is anticipatory control (postural set)?

A

The patient’s ability to prepare for anticipated displacements based on past experience, anticipation and knowledge of physical constraints
- they also reoccur after moving takes place to make adjustments

29
Q

How long does postural mm take?

A

“prepare” @ 30 millisecond before actual movment occurs

30
Q

What should be included in a balance assessment?

A
  • standarized functional measure of skills that need postural control
  • assessment of sensory inputs
  • assessment of balance strats
  • test of underlying impairs in the sensory, motor and cognitive systems
31
Q

What are some examples of postural control test?

A
  • tinetti
  • Berg
  • Get up and go
32
Q

What are some examples of sensory inputs?

A
  • foam and dome
  • balance master
  • equitest
33
Q

Balance Assessments

What is the purpose functional reach?

A
  • quick screening tool for balance problems in older adults
  • find the area in the BOS that a persoin can for sure and safely move their COM
34
Q

Balance Assessments

How is the functional reach performed

A
  1. stand with feet shoulder width apart
  2. arms raised to 90deg flexion
  3. without moving feet, they reach forward as far as they can without losing their balance
  4. The distance middle fingertip measured with a yard stick mounted on the wall
35
Q

Functional reach

What is age 20-40 norms in men and women?

A

men - 16.73 in
women - 14.64 in

36
Q

Functional reach

What is age 41-69 norms in men and women?

A

men - 14.98 in
women - 13.81 in

37
Q

Functional reach

What is age 70-87 norms in men and women?

A

men - 13.16 in
women - 10.47 in

38
Q

Balance assessments

What is the predictive validty of the functional reach for men?

A

15.2-25.4cm are 2x more likely to fall
< 15.2 are 4x more likely to fall
If can’t reach at all: 8x more likely to fall

  • FR scores do not differentiate between healthy vs vestibular hypofunction
  • FR scores are also not related to antero-lateral postural measures
39
Q

Balance assessments

What is the purpose of the performance-oriented mobility assessment POMA (Tinetti)?

A

screening for balance and mobility skills that is used in normal ADLs in older adults
- used to determine the likelihood of falls

40
Q

Balance assessments

How is the tinetti performed?

A

Two-part test with:
- nine balance items (rated at normal, adaptive or abnormal)
- seven gait items (graded as normal or abnormal / numerical of 0-2 score)
- assistive devices are okay (but graded down for the use)

41
Q

Balance assessments - Tinetti

What is the predictive validity depending on the score?

A

A max score on both sides = 28 points
- moderate fall risk = 19-24 total
- high fall risk < 19 of total
or
- < 14 on balance scale tells that the patient would benefit from PT for balance

42
Q

Balance assessments

What is the purpose of the berg balance scale?

A

Be able to screen individuals who would benefit from PT referral and to be able to predict multiple falls

43
Q

Balance assessment

What are the tasks of the BERG?

A

14 items assessing ability to maintain position during decreasing base of support, transitional movement and COM transference (rated 0-4, from worse to best)
- **no assistive device **

44
Q

Balance assessment

What is the predictive validity of the BERG?

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

Balance assessment

What is the correlation between the BERG and functional reach?

A

= 0.78

46
Q

Balance assessment - BERG and Functional Reach correlation

What is the indication between ranges 54-56?

A

1 pt drop associated with 3-4% increased risk of fall

47
Q

Balance assessment - BERG and Functional Reach correlation

What is the indication between ranges 46-54?

A

1 pt drop associated with 6-8% increased risk

48
Q

Balance assessment

What is the significance of the Berg balance?

A

The best predictor of falls in community dwelling elderly

49
Q

Balance assessment

What is the significance of the Berg with parkinson’s disease?

A

Has been shown to be valid for Parkinson’s
- stages of disease
- parkinson’s scale
- ADL capacity

50
Q

Balance assessment

What is the significance of the Berg with acute stroke?

A

Higher Berg score is related to lower length of stay

51
Q

Balance assessment

What is the significance of the Berg with chronic stroke?

A

Berg is not able to differentiate between fallers and non-fallers (possibly due to insufficient power)

52
Q

Balance assessment

What is the purpose of the TUG?

A

Quick performance based screening tool so we can measure functional mobility in the community dwelling older adults
- assistive devices are okay
- helps measure of dual task conditions
- currently no norms
- no further sensitivity to falls in community elderly

53
Q

Balance assessment

What are the taks of the TUG?

A
  • person rises from the chair
  • walk 3 meters
  • turn 180deg
  • walk back and sit down

3 trials:
- 1 practice
- 2 timed trials w/ time averaged between the 2

54
Q

Balance assessments

How is the scoring of the TUG?

A

Originally rated from a scale of 1-5 (normal to severely abnormal) and timed
- greater validity was found with timing the task vs the orignal scoring method

55
Q

Balance assessments

How is the TUG when it comes to reliability?

A

High intra-rater and inter-rater reliability
- has a high correlation with Berg (-.81)

56
Q

Balance assessments

What is the predicitve validity of the TUG?

A
  • < or equal to 10-12 seconds = normal
  • > 14 seconds = indicates a faller
  • > or equal to 20 sec = indicate frail or functional independece
  • 30 = dependence
57
Q

Balance assessments

How do we form a TUG manual function?

A

Have patient carry a cup of water

58
Q

Balance assessments

How do we form a TUG with cognitive function?

A

Count backwards by 3s

59
Q

Balance assessment

What is the TUG not correlated with?

A

Not highly correlated to the Parkinsonian scale as the Berg is

60
Q

Balance assessment

How is the Tinetti and TUG help with the elderly?

A

The Tinetti balance subtest and TUG is able to predict ADL decline and falls

61
Q

Balance assessment

What is the purpose of the clinical test for sensory integration and balance (CTSIB)

A

To test effect of sensory interactions on postural stability

62
Q

Balance assessment

What are the tasks of the CTSIB?

A

six static standing positions with changing visuals, vestibular and somatosensory conditions

63
Q

Balance assessment

What is the reliability/validity of the CTSIB?

A

Subjects should be able to keep all conditions for 30sec for 3 times

64
Q

What are the indications for balance training?

A
  • vestibular inner ear disorders
  • neurological problems
  • orthopeedic injuries and procedures
  • decreased strength and flexibility
  • medications
  • self-confidence
65
Q

How do we treat patients with balance issues?

A
  • focus on tasks that needs higher degrees of freedom or decreasing BOS
  • training alignment (biofeedback systems)
  • train movement strats
  • facilitate activity of muscles - icing, vibration, FES, biofeedback
  • Improve sensory strats = decreasing visual dependence, decreasing somatosensory dependence, strengthen vestibular system

PHTH 528 - Neuro Midterm (8 decks)

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