Chapters 10 & 11 Flashcards
What are the majority of falls in neurological pathologies associate with?
MOBILITY (during the walking), TRANSFERS, and STAIR CLIMBING
Example of abnormal alignment in PD?
stooped (flexed posture)
rigidity
decreased spinal flexibility
Abnormal postural sway in PD displays:
increase sway area
increased velocity
Adults with DS have:
higher sway velocity
What can increased stiffness be?
compensatory strategy to improve stability
What does a pathology in the cerebellum do?
increase postural sway
Lesion in spinocerebellar (upper vermis and intermediate) part of anterior lobe:
AP sway
Lesion in lower vestibulocerebellar vermis:
increased omnidirectional sway
Lesion in spinocerebellar afferents:
low frequency and large amplitude lateral sway
Coactivation:
characterized by simultaneous contraction of muscles on both anterior and posterior aspects of the body
Coactivation in PD:
activates muscles on both aspects of the body= increasing stiffness of body= ineffective strategy for balance recovery
What are onset latencies in paretic muscles versus nonparetic side?
longer and smaller
Postural adaptation:
ability to modify postural activity with practice
Shifting central set:
ability to change pattern of postural muscle activity quickly in response to changing task conditions
Hypermetric postural responses are associated with which of the following pathologic disorders?
cerebellar conditions
unilateral cerebellar pathology affecting anterior lobe
What does normal postural control require?
organization of sensory information from visual, somatosensory, and vestibular systems
sensorimotor integration
CTSIB condition 1
normal
flat floor
eyes open
CTSIB condition 2
flat floor
blindfolf
CTSIB condition 3
flat floor
dome
CTSIB condition 4
foam
eyes open
CTSIB condition 5
foam
blindfolded
CTSIB condition 6
foam
dome
Visually dependent
abnormal in conditions 2,3,5, and 6
Surface-dependent
abnormal in 4,5, and 6
Vestibular loss
abnormal in conditions 5 and 6
Sensory selection problems
abnormal in conditions 3-6
Sensory selection problem
Refers to inability to appropriately select a sense for postural control in environments in which one or more ORIENTATION cues inaccurately report body’s position in space (there is incongruence among senses).
Anticipatory Postural Control
Highly dependent on PRIOR experience and learning
Timed Up & Go (TUG)
Sensitive and specific indicator of fall status in community dwelling older adults (>15 s)
Timed Up & Go (TUG) 10 s
freely independent
Timed Up & Go (TUG) 20 s
independent in basic transfers
Timed Up & Go (TUG) 20-29 s
gray zone
Timed Up & Go (TUG) 30 s
usually need help with chair or toilet transfers, help in and out of tub, assistance with stairs, unable to go out alone
Functional Reach Test (FRT)
a single-item test developed as a quick screen for balance problems and risk for falls in older adults.
Performance-Oriented Mobility Assessment
Frail elderly
balance: 16 points (9 items)
gait: 12 points (7 items)
Maximum score Performance-Oriented Mobility Assessment :
28 points
Performance-Oriented Mobility Assessment less than 19
at high risk for falls
Performance-Oriented Mobility Assessment 19-24
at moderate risk for falls
Performance-Oriented Mobility Assessment 24-28
at low risk for falls
Berg Balance Scale
Community dwelling older adults
Stability (steady state)
Anticipatory
No reactive postural control
Short Physical Performance Battery (SPPB)
Used to measure lower extremity performance such as strength, balance and mobility in older adults.
Balance Evaluation Systems Test (BESTest)
used to examine multiple aspects of postural control
Six systems of BESTest
biomechanical constraints stability limits anticipatory transitions postural responses sensory organization dynamic gait
BBS stability state:
Standing unsupported
Sitting unsupported
Proactive Postural Responses
Responses occur before prime mover and in preparation for the perturbation
Adaptive Control
changing task demands resulting from changes in the BOS
IMPAIRMENT level
to optimize the components of postural control (e.g., exercise to improve ROM, strength)
STRATEGY level
to develop or refine task specific sensory, motor, and cognitive strategies used for postural control
FUNCTIONAL level
to learn to preserve postural control during changing tasks and environmental conditions
