Chapter 11 Flashcards
What are some examples of body functions and their structures?
Mental functions [structures of the nervous system]
Sensory functions and pain [eye, ear and related structures]
Neuromusculoskeletal and movement-related functions [structures related to movement]
Voice and speech functions [structures related to voice and speech]
Functions and [structures] of the cardiovascular, haematological, immunological and respiratory systems
What are some examples of different activities and participation?
Learning and applying knowledge General tasks and demands Communication Movement Self care Domestic life areas Major life areas Interpersonal interactions Community, social and civic life
What are some examples of various environmental factors?
Natural environment Human-made changes to the environment Support and relationships Attitudes Services, systems and policies Products and technology
T/F Balance can be examined by one test.
False
What are self efficacy scales?
Questionnaires on confidence in doing certain ADLs
What are two self efficacy scales often used in clinics?
Activity-specific Balance Confidence Scale (ABC)
Falls Efficacy Scale (FES)
What are the instructions for the TUG?
Stand up, walk 3 m (10 ft), turn around, return and sit in chair
What do the TUG results indicate?
10 = freely independent 20 = independent in basic transfers 20-29 = gray zone >30 = need help with chair/toilet transfers, in/out tub, assistance with stairs, unable to go out alone
Who is the TUG indicated for?
Sensitive and specific indicator for falls in community dwelling older adults (>15)
What is the functional reach test (FRT) used for?
Quick screen for balance problems and risk for falls in older adults
What is the Performance Oriented Mobility Assessment used for? What are the subscales/point totals?
Used for frail elderly
Balance subscale = 9 items, 16 points
Gait subscale = 7 items, 12 points
MAX TOAL = 28 points
What do POMA scores indicate?
<19 = high risk 19-24 = moderate risk 24-28 = low risk
Who is the Berg Balance Test indicated for?
Community dwelling older adults
How many items are on the Berg Balance Test? What do the scores mean?
14 items, each on a (0-4) scale
> 32 = 100% risk of falls
decreases from there, at 10% with 56 points
What is the Short Physical Performance Battery used for?
Measures LE performance (strength, balance, mobility) in older adults
Who developed the BESTest and what does it look at?
Balance Evaluation Systems Test
By Horak in 2009, examines multiple aspects of postural control, 36 items in 6 systems
What are the 6 systems of the BESTest?
1 = biomechanical constraints 2 = stability limits 3 = anticipatory-transitions 4 = postural responses 5 = sensory organization 6 = dynamic gait
What postural alignment strategies are used to maintain balance?
posture, weight bearing, width of BOS, location of COP
What are automatic postural responses?
Keep the COG over the BOS in response to a stimulus or unexpected perturbation. They are rapid and involuntary
What are some examples of automatic postural responses?
Ankle, hip, stepping strategies
Adaptive postural responses
Reactive postural responses
How do you test reactive control?
Nudge Test (POMA #6) = unexpected external perturbation at sternum, pt has feet as close together as possible, PT pushes lightly 3 times
What are the scores for the Nudge Test?
0 = begins to fall 1 = staggers, grabs, catches self 2 = steady
How can you examine proactive postural responses?
Have pt lift a heavy grocery bag
What motor problems are examined?
Motor coordination
Muscle strength, power
Involuntary movements
What cognitive status aspects are examined?
Alertness Memory Orientation Attention Learning
What sensory/perceptual status aspects are examined?
Somatosensory problem
Visual problem
Vestibular problem
Impaired body image and spatial relationship
What is the ultimate goal of task-oriented balance rehab?
To improve participation outcomes, reflected in ability to participate in social roles, tasks and activities important in ADLs
How can you progress sitting balance?
Progressively less surface contact
- Remove UE support
- Make surface less stable
- Add UE activities
- Increase limits of stability through reaching and throwing activities
What are some ways to improve control of COG in standing?
Slow weight shifts Elastic band LE exercise Standing sway Sit to stand Tai Chi Add UE activities
What are some exercises to promote ankle strategy?
Standing sway exercise
Slow small perturbations either self generated or external
Computerized limits of stability training
Increase difficulty with UE, head or eye movements
Functional activities
Increase difficulty with resistance
What are some exercises to promote hip strategy?
Standing sway using a table and a wall, patient instructed to bow to move nose towards the table
Standing on a rail, add UE activities as able
Use moderate rapid perturbations either self generated or external
Tandem standing (sharpened Romberg) or walking
Single limb support
Large anterior/posterior weight shifts on a variety of surfaces
Functional activities (reaching into trunk of a car, laundry dryer)
What are some exercises to promote stepping strategy?
Standing sway with large sways, consciously taking step forward and backward
Ambulate in tandem, promote balance steps
Stepping over obstacle
Walking on uneven surfaces
Large rapid perturbations such that the hip strategy would be inadequate and stepping or reaching is required; progress from predictable to unpredictable disturbances
What are the benefits of combined exercise programs?
Improve balance
Improve mobility
Reduce risk for falls
