Balance Exam and Intervention

Question 1

Requirements for Balance & Postural Control

Answer 1

Somatosensory Sense
Visual
Vestibular
Sensory selection conflict resolution
Postural responses
Force production 
Cognition

Question 2

Semicircular canals

Answer 2

Sense angular motion

Question 3

Otolith organs

Answer 3

Sense linear movement

Question 4

Timed Up and Go (TUG) Scores

Answer 4

30 seconds= needs assistance for mobility & ADLS
>12 seconds= at risk for falls
Reliable and valid following stroke and those with PD

Question 5

Activity Specific Balance Confidence Scale (ABC) Scores

Answer 5

100% confident on all 16 items is the maximum score

50-80% = somewhat impaired
66% or less = high risk for falling

<50% = likely homebound

Question 6

Clinical Test for Sensory Interaction in Balance (CTSIB)

Answer 6

Traditional – 6 sensory conditions
Firm surface EO, EC, Dome
Foam surface EO, EC, Dome

Modified version – 4 sensory conditions
Firm surface EO, EC
Foam surface EO, EC

Question 7

Berg Balance Scale Scores

Answer 7

41-56= low fall risk 
21-40= medium fall risk
0-20= high fall risk 

40-44 predicts 2x more likely to fall
Less than 40 predicts 5 x more likely to fall

A change of 8 points is required to reveal a genuine change in function between 2 assessments

Relationship non-linear
56-54
Each 1 point drop associated with 3-4% increase in fall risk

54-46 range
1 point change associated with 6% to 8% increase in fall risk

Question 8

Fall Definitions

Answer 8

Clinic: unplanned, unexpected contact with a supporting surface - Floor, Chair, Wall

Research: movement of the center of mass outside the limits of the base of support - Can also include a step in response to threat of loss of balance

Question 9

Risk Factors for Falls

Answer 9

Reduced physical activity
Reduced proximal/distal muscle strength
Reduced stability in standing
Arthritis: knees
CVA
Gait impairment
Hypotension
Psychotropic drugs

Question 10

Risk Factors for Falls After Stroke

Answer 10

Predictors after acute stroke
<30 on Berg; Lower FIM
Apraxia; Cognitive deficit

Predictors with chronic stroke
Self reported persistent balance problems
Use of mobility aids

Question 11

Fall Prevention

Answer 11

Aerobic conditioning
Improves HR, VO2 max
Unclear whether improves balance
Specificity of training

Gait activity
Increased speed and distance
Improve gait

Standing Balance
Does not improve

T’ai Chi
Decreased risk for falls

Balance master, force plate technology
Improved SLS
Functional base of support
Sensory Organization Test (SOT) of balance
Use of ankle strategy