Balance Exam Flashcards
Why is balance critical for individuals?
It is critical for independence and safety and provides efficiency in performing tasks.
What components are included in a balance examination?
- History
- Behavioral factors
- Neuro exam
- Tests and measures
- Movement analysis
What safety measures should be taken during a balance examination?
Appropriate guarding, gait belt, harness, working in parallel bars, manual guarding, use of walls or corners.
How are falls defined?
Falls: Unintentionally coming to rest on the ground or a lower surface.
What is the incidence of falls among older adults?
36 million falls per year, with more than 40,000 deaths.
What are some risk factors for falls?
- Orthostatic hypotension
- Medications
- Polypharmacy (4+ meds)
- Vision and hearing changes
- Urinary frequency/urgency
- Footwear and foot problems
- Home environment
- Cognitive/behavioral factors
What self-report measures assess balance confidence and fear of falling?
- Activities-specific Balance Confidence Scale (ABC)
- Falls Efficacy Scale
- Fear of Falling Avoidance of Behavior Questionnaire.
What sensory systems are examined for balance?
- Vision
- Vestibular
- Somatosensory
What does the vision system provide for balance, and how is it tested?
Information about movement and position of objects in space, orientation, and movement of our bodies.
Test:
- Visual acuity (Snellen chart)
- Smooth pursuits
- Convergence and accommodation
- Visual fields
What does the vestibular system provide for balance, and how is it tested?
Information about head movements and position with reference to gravity.
What issues can arise from vestibular problems?
Dynamic vision deficits, postural control problems, dizziness/vertigo, falls.
What does the somatosensory system provide for balance, and how is tested?
Information about the relative orientation and movement of the body in relation to the support surface.
What aspects are examined in the motor systems for balance?
- ROM
- Flexibility
- Muscle strength
- Endurance
- Tone
- Alignment
What is assessed in sitting posture?
Head and trunk verticality, natural spinal curves, pelvis neutrality, equal weight distribution.
What is assessed in standing posture?
Symmetry right and left, weight equally distributed, vertical line of gravity alignment.
What factors are considered when choosing balance tests and measures?
- Purpose of the test
- Length of time
- Patient setting
- Unique impairments
- Comfort level with the test
- Cognitive ability
- Sensitivity
- Validity
- Reliability
What is assessed during quiet and perturbed sit/stand?
- Degree and direction of sway
- Available movement strategies
What are the two methods for testing perturbations?
- Displacement (nudge) technique
- Lean and release technique
What are some common balance tests?
Romberg, Sharpened Romberg, Single Leg Stance, SOT, CTSIB, mCTSIB, Functional Reach Test, Tinetti, DGI, Mini BESTest, 4 Square Step Test, TUG.
What do the Romberg and Sharpened Romberg tests assess?
Static balance and use of sensory input for balance.
What does the Single Leg Stance test assess?
Static postural and balance control.
What does the Sensory Organization Test (SOT) examine?
Standing balance through postural sway using six different sensory conditions.
- What is the CTSIB and how is it modified for clinical use?
- What conditions are tested in the mCTSIB?
- A low-tech version of the SOT using foam pads and visual conflict domes.
- Eyes open firm surface, eyes closed firm surface, eyes open foam surface, eyes closed foam surface.
What does the Functional Reach Test measure?
The maximal distance one can reach forward beyond arm’s length while maintaining a fixed BOS in standing.
What does the Modified Functional Reach Test measure?
The maximal distance one can reach forward while sitting.
What does the Tinetti POMA assess?
Both static and dynamic balance.
What does the DGI assess?
Gait balance and fall risk.
What do the BESTest and Mini-BESTest assess?
Dynamic balance in various categories such as anticipatory adjustments, reactive postural control, sensory orientation, and dynamic gait.
What does the 4 Square Step Test examine?
Dynamic standing balance and coordination in a functional setting.
Why is dual task assessment important?
It helps predict fall risk and examines subtle deficits in motor or cognitive performance.
What does the WWT Test assess?
Gait with dual task, comparing normal walking speed to walking while reciting alphabet.
What does task/movement analysis involve?
Observing what the patient can do, how they do it, and why they did it that way.
What are common deficits noted in steady state, reactive, and anticipatory control?
Inability to maintain position, excessive sway, hesitancy to lean, and impaired timing.
What are the benefits of balance/movement system diagnoses?
Provides a standardized approach, pattern recognition, targeted interventions, and improved outcomes.
