Balance Testing - Class 8 Flashcards
almost all neurological issues will have
balance affected
we should complete a balance assessment on
a pt with a neuro dz/disorder
history of falls
complaints of dizziness or vertigo
definitions of balance
ability to receive afferent sensory input and organize it in an appropriate manner to maintain
upright posture and COG over to BOS
** must have appropriate strength as well**
what systems play a role in balance
somatosensory
vision
vestibular
somatosensory
proprioception and kinesthesia
vision
we rely heavily on vision
big problems in 6th generation +
vestibular
awareness of head into space
testing somatosensory
superficial and deep sensory assessment
vision testing
CN testing of 2,3,4,6
strategies for balance
automatic postural responses
3 automatic postural responses
automatic postural responses
to keep COG over BOS
occurs rapidly, not under volitational control
3 automatic postural responses
ankle strategy
hip strategy
stepping strategy
ankle strategy
distal to proximal muscle response
when is ankle strategy used
when the sway is small, slow and near midline
ankle strategy example
anterior to posterior push will cause DF
vice versa
hip strategy
head and hips move in opposite direction
muscle contraction are from proximal to distal
when is hip strategy used
when sway is large, fast and nearing the limit of stability
example of hip strategy
anterior to posterior push will cause hip/trunk flexion
stepping strategy
LE attempts to re-establish a new BOS w/ the active limb by taking a step
when is stepping strategy done
done when the COG exceeds BOS
vestibular system role in balance
stabilize visual images on the fovea of the retina during head movement to allow clear vision
maintain postural stability, esp during movement of the head
provide info used for spatial orientation
standing tests
standing progression tests
standing progression tests are done with
arms crossed
must be held for 20-30 s
positive standing progression test
pt is unable to maintain position or excessive sway is noted
examples of standing progression tests
feet together (romberg test)
tandem (sharpened/tandem romberg)
single leg stance
clinical test for sensory interaction on balance (CTSIB) is used to
differentiate which afferent system is not contributing to balance
often called foam and dome testing
CTSIB attempts to
take away either 1 or 2 of the 3 sensory components of balance
see how the remaining structures compensate
how many components of CTSIB
6
how do we progress CTSIB
standing feet together –> stance –> tandem –> SLS
goal of CTSIB
not lose their balance for 30 s
for each portion of the test
interpreting the results
if a pt fails a test remaining systems are unable to compensate
CTSIB results –> eyes are closed
vestibular and SS are working
CTSIB results –> isolating
isolate the vestib and the SS on its own or see how the vestib works with vision or how SS w/ vision
CTSIB results –> what if vestib fails on its own with conjunction w/ vision
vestib is at fault
how do we eliminate vision
close their eyes
how do we eliminate SS
stand on unstable surface
how do we eliminate vestibular
suppose to put a lantern (foam) over their head or move the walls (via a machine)
clinically have the pt turn thier head side to side
fxnal scales
fxnal reach test
berg
tinetti
DGI (dynamic gait index)
