Evidence based treatment - Ataxia (TBI) Flashcards
balance
Balance is the ability to maintain any upright posture against gravity, external and internal forces.
Control of balance requires the ability to maintain posture, the ability to control voluntary movement (to move between postures) and the ability to react to external perturbing forces (loss of balance / trips / pushes).
Balance requires multisensory information which is used to feedback postural and positional changes.
vestibular function
Vestibular, visual and proprioceptive systems provide information regarding the body’s position and motion in external space. To remain balance this sensory information needs to be available, correctly processes and integrated so that the correct motor response can be executed.
what does balance require
Balance requires a number of systems to working appropriately and to be able to coordinate activity for the individual to remain balanced.
link between visual sysytem and balance
The visual, somatosensory and vestibular system can all contribute to impaired balanced. Vestibular disorders can be either central (CNS involvement) or peripheral (involving the inner ear).
what happens if proprioception is insufficient
treatments that challenge this particular system can be used (foam mats).
the visual system provides compensation for the proprioceptive system
can be used during treatment. During initial treatment the focus should be on recovery rather than learning compensatory methods.
how should Balance exercises be graded
by progressively decreasing the area of the base of support, increasing the height of the centre of gravity from the supporting surface or by manipulation of the environment by the removal / alteration of visual and somatosensory cues
what happens to the complexity of balance tasks
they are progressively increased overtime as the patient improves. Care should be taken to avoid falls.
what should balance training include
include exercises that are aimed at maintaining, achieving and restoring balance during any posture and any change in posture, for example transfers.
Activities should also incorporate levels of distractions whilst performing tasks; dual tasks are more challenging for the patients
how often should balance training be performed
for 15 -60minutes per session, 2-7 days per week for 4 – 6 weeks
how does ataxia occur and whay does it cause
an inherited condition or a cerebellar lesion multidirectional instability postural tremors and upscaling of automatic postural corrections observed in quiet standing.
what happens during movement when a patient has ataxia
dysregular trunk alignment in standing followed by slow underfoot balance perturbation, responses to changes in balance are magnified and last longer due to overshooting. There is the loss of accuracy of the protective step mechanism, an increase in the hip and knee compensatory strategy with reciprocal activation of tibialis anterior and quadriceps with triceps surae and hamstring muscle groups
what is the rehabilitation approach with ataxia
restorative or compensatory
compenattory approach
The compensatory approach uses orthotics and devices, movement retraining. and reduces the degrees of freedom and optimises the environment
restorative approach
Whilst the restorative approach aims to improve function by improving the underlying impairment
