balance PP Flashcards
defined as the ability to maintain the body’s center of mass over its base of support (BOS)
Balance
The area contained within the parts of the body making physical contact with the external enviornment
Base of support
3 system linked to balance control
3 legged stool
- Vestibular
- Visual
- Somatosensory
- Musculskeletal and neuromuscular compnents
KC adds to the
3 systems. what do they add?
sensory organization for balance control
Knowing where your body is in space
Input from body regarding its position and movement
Proprioception
Responsible for processing information about movement with respect to gravity
- Rotation, acceleration/deceleration and head stabilization
- Postural control and coordination of eye and head movements
- What are you working on ?
Vestibular system
Allows the information provided by the other systems to be integrated into a whole picture
- Reduced response time, fear and exaggerated responses
Cognitive or Sensory Organization
K & C, pg 263
React to maintain balance in response to the unexpected
Pertubations
HIP STRATEGY
- Occurs with larger LOBs or when unable to use ankle strategy
- Proximal to distal manner
- uses hiop flex or ext to moe the center of mass within the BOS
what muscles kicking in?
- LOB- in anterio direction ?
- LoB in posterio direction?
- ant- lowr back then hamstrng muscles
- Post-lower abs then quads
when LOB is too great and COG is too far off BOS and need to increase area of BOS
Person will step in direction of LOB
Stepping Strategy
Factors that will influence balance strategies
KC 264 box 8.1
speed and intensity of displacing forecs
characteristics of the support surface
manitude of the dipacement of the COM
subjects
FINISH
Internal Risk Factors
- Age
- Decreased flexibility and reflexes
- Fear and Hx of falls
- Visual deficits
- Vertigo, orthostatic hypotension
- Weakness
- Cognition
- Infections
- Diabetes/other neuro issues
- CVA/Cardiac/Parkinson’s/Co-morbidities
Environmental Factors
external factors
- Tripping hazards
- Medicines
- Poor lighting
- Unsteady surfaces and changes in surfaces
NO THROW RUGS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Most Common Risk Factors for Falls Among the Elderly
Box 8.2, K & C, pg 269
put in
what are some Age-related changes in balance that are the result of changes in every system in our bodies
- Neurologic changes
- Orthopedic changes
- Psychomotor changes
- Sensory changes
- Reduction in the function of the vestibular system
Safety During Balance Exercises
K & C, Box 8.3 pg 273
USE GAIT BELT
- STAND slightly behind and to the side of the pt with one arm hold the belt and the other arm on or near the top of shoulder
- Perform exercises in // bars or with AD to help pt maintain balance
- Be aware of environment
- Avoid sharp objects
- Check equipment to ensure that it is operating correctly
GUARD pt when getting on and off equipment
Ensure environment free of debris
Evidence Based Practice
Exercises for Elderly with Low Physical Functioning
Box 8.4, pg 265 K & C
put in
Evidence Based Practice
Exercise Program for Elderly with Balance Deficits One Year Following Stroke
Box 8.5, pg 266 K & C
put in
Evidence Based Practice
Balance Ex Program Incorporating Strengthening, Walking and Functional Activities
Box 8.6, pg 267 K & C
put in
Evidence Based Practice
Circuit Training Program to Address Balance Impairments and Function
Table 8.3, pg 268
put in
Evidence Based Practice
Progressive Balancing Exercises
Box 6-2 Shankman, pg 98
put in
How can we help?
Individualize a therapeutic exercise program to improve your patient’s function.
Definition of therapeutic ex pg 2 K & C
put in
Balance Testing- name some tests
Unilateral Stance/SLS Test-single leg test
Functional Reach- how far can they reach and keep bal
Timed Get Up and Go-sit to stand
Tinetti Test-
Berg Balance Test
what are you Reviewing in the pts chart to assess CLOF
Meds
Vitals as needed
What can you do? what can we recommend?
Environmental recommendations
Grab bars/shower bench
NO THROW RUGS!!!!!!!!!!!!!!!
Try to address cause
Focus on impairments (Nagi Model) to improve function
Ex: If pain is limiting, address pain
Ex: Decreased ROM, address ROM
Ex: Weakness, perform strengthening exs
Ex: Gait deficits, perform gait training
Assistive devices may be needed
WHEN?
Sitting Balance
Static Balance
Dynamic Balance
Proprioception Deficits
Vestibular Deficits
Continuing Ed Classes
Fear
What can you do if there is Fear of Falls
Assistive Devices
LRAD
Start in pool if possible
Contact Guard Assist (CGA)
Document!!!
LOTS of practice and feedback as needed
Vary environments to keep pt challenged
DON’T FORGET GAIT BELT TO ENSURE SAFETY!!!!!!!
Relaxation techniques
kc 262-263 vestibular
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