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Motor Control > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Majority of falls in neurologic pathologies are associated with…

A
  • Mobility (Gait)
  • Transfers
  • Stair Climbing
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2
Q

Sensory Weighting Hypothesis

A

When one sensory system is less reliable, the input to the CNS from that system is weighted less heavily, and inputs from other systems will be weighted more heavily.

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3
Q

Why postural control?

A

the ability to control our body’s position in space is FUNDAMENTAL to everything we do

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4
Q

Alignment

A

relationship of body segments to one another, as well as to the position of the body with reference to gravity and the base of support

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5
Q

Center of Mass (CoM)

A

point at center of the total body mass

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6
Q

Center of Gravity (CoG)

A

vertical projection of the center of mass

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7
Q

Center of pressure (CoP)

A

center of distribution of total force applied to supporting surface

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8
Q

Posture

A

biomechanical alignment of the body and the orientation of the body in the environment

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9
Q

Postural control

A

control of the body’s position in space for orientation and stability

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10
Q

Postural Tone

A

activity increases in antigravity muscle, which keeps the body from collapsing in response to the pull of gravity during quiet stance

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11
Q

Postural orientation

A

ability to maintain an appropriate relationship between body segments, and between the body and the environment for a specific task

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12
Q

Postural stability or balance

A

ability to control to center of mass in relationship to the base of support

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13
Q

Clinical definition of a Fall

A

an event that results in a person coming to rest inadvertently on the ground (unplanned or unexpected contact with a supporting surface)

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14
Q

Research definition of a Fall

A

movement of the CoM outside of the base of support (including stepping to recover stability)

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15
Q

Clinical Test of Sensory Interaction in Balance (CTSIB)

A

Helps determine which sensory system an individual relies on to maintain balance

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16
Q

Factors Contributing to Aging

A

Primary or Genetic Factors - Contribute to loss of neuronal function - LITTLE control
Secondary or Experimental Factors - Environment, nutrition, and lifestyle, affect our nervous system function - MORE control

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17
Q

Stats on Falls in the Elderly

A

One out of three elderly fall each year

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18
Q

Intrinsic Factors for Falls in Community

A

Age and gender
Physiological and psychosocial
Cognitive impairments
Impaired ADLs

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19
Q

Hip Strategy

A
  • FORWARD SWAY: to prevent falling on face, use large ANTERIOR muscles
  • BACKWARD SWAY: to prevent falling on back, use large POSTERIOR muscles
  • TIMING: from proximal to distal
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20
Q

Extrinsic Factors for Falls in Community

A

Environmental factors (stairs, rugs, slippery surfaces, poor lighting)

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21
Q

Postural Control Problems Vary According to Variabiltity of

A
  • Type of neurological injury
  • Degree of lesion
  • Location
  • Age
  • Premorbid condition
  • Extend of compensation
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22
Q

What contributes to Abnormal Postural Control

A
  • Problems in Action System
  • Problems in Sensory/Perceptual Syatem
  • Loss of Anticipatory Postural control
  • Problems in Cognitive System
  • Impaired Seated Postural control
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23
Q

Quiet Stance-Alignment

A

Abnormal alignment due to musculoskeletal impairments

Example: Children with CP

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24
Q

Multidirectional Stability

A
  • continuum of response patterns that control stability in 360 degrees of possible perturbation directions
  • muscles can belong to more than one pattern of movement or synergy
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25
Q

Dynamic Systems Model

A
  • emerges from complex interactions of many systems
    - musculoskeletal components
    - internal representations
    - adaptive mechanisms
    - anticipatory mechanisms
    - sensory strategies
    - individual sensory systems
    - neuromuscular synergies
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26
Q

Spontaneous Sway

A
  • Pt with PD have postural sway in quiet stance

- Increased sway and velocity

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27
Q

Basal ganglia in Control of Postural Set

A

the ability to quickly change muscle patterns in response to changing tasks and environmental conditions

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28
Q

Coactivation in Perturbed Stance

A

postural coordination strategy in people with neurologic conditions as well as young healthy children

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29
Q

movement strategies to maintain balance

A
  • controlling body sway
  • feedback control
  • feedforward control
  • anteriorposterior stability
  • lateral stability
  • multidirectional stability
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30
Q

Intact System for Postural Control

A
  • adaptable postural control system to meet the goals of stability and orientation in any environment
  • visual contribution to postural control
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31
Q

Visual Inputs

A
  • relationship of our body to objects in the environment
  • position and movement of the head with respect to surrounding objects
  • direction and speed of head movement
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32
Q

Somatosensory inputs

A
  • surface of support
  • position and movement about the body with reference to the BOS
  • relationship of body segments to one another
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33
Q

Vestibular inputs

A
  • gravity
  • powerful source of information for postural control
  • position and movement of the head with respect to gravity and inertial forces
  • angular and linear acceleration/deceleration of the head
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34
Q

Synergy

A

the functional coupling of groups of muscles that are constrained to ACT TOGETHER as a unit

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35
Q

Ankle Strategy

A
  • FORWARD SWAY: to prevent falling on face - use POSTERIOR muscles to restore CoM
  • BACKWARD SWAY: to prevent falling on back use ANTERIOR muscles
  • TIMING: from distal to proximal
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36
Q

Hip Strategy

A
  • FORWARD SWAY: to prevent falling on face, use large ANTERIOR muscles
  • BACKWARD SWAY: to prevent falling on back, use large POSTERIOR muscles
  • TIMING: from proximal to distal
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37
Q

Neuromuscular System

A

Older adults demonstrate:
Slower response onset in key muscles
Increased co-activation to stiffen the joint

38
Q

Perturbation size and velocity increase

A

Stable older adults show increased amplitude of response as compared to younger adults
Unstable older adults exhibited much more increased amplitude of response

39
Q

Stepping Reaction

A

Forward or backward stepping with one of more lateral

40
Q

What the effect of a loss of sensory input? Depends on

A

1-availability of other senses
2-availability of accurate orientation cues
3-ability to accurately interpret and select sensory info for orientation

41
Q

Somatosensory changes with age

A

Vibratory sensation threshold increases with age and tactile sensitivity increases

42
Q

Visual changes with age

A

Visual threshold increases with age and visual acuity decreases

43
Q

Problems in cognitive Systems

A
  • Impaired postural stability under dual-task conditions

- Postural control in demential

44
Q

Anticipatory Postural Ability in Elderly

A

Elderly have difficult maneuvererring around because of REDUCED ability to INTERGRATE balance adjustments into ongoing voluntary movements

45
Q

Cognitive Issues and Postural Control in Elderly

A

Older adults show increased time of pressing a button when hearing a sound

46
Q

Dual-Task Intervention

A

Concentrate on limiting any calculation errors while walking

47
Q

Stepping Strategy

A

when the ankle and hip strategies are not enough to maintain the balance, a step will restore the CoM

48
Q

Combined strategies

A

ankle and hip strategies are combined in a continuous way

49
Q

Lateral Stability

A
  • alternative strategy is used to recover stability in mediolateral direction
  • mainly muscles at hip and trunk
  • muscle patterns organized proximal to distal
50
Q

Multidirectional Stability

A
  • continuum of response patterns that control stability in 360 degrees of possible perturbation directions
  • muscles can belong to more than one pattern of movement or synergy
51
Q

Delayed Activation of Postural responses

A
  • onset latencies in paretic muscles were longer and smaller in amplitude (slow and small in amplitude)
  • Problems in timing and organization of muscle activity
52
Q

Problems Modifying Postural Strategies

A

Inability to modify postural strategies in response to changing tasks and environmental demands

53
Q

Normal posture control requires

A

1-organization from visual, somatosensory, and vestibular systems
2-coordination of sensory info with motor action

54
Q

What the effect of a loss of sensory input? Depends on

A

1-availability of other senses
2-availability of accurate orientation cues
3-ability to accurately interpret and select sensory info for orientation

55
Q

Dynamic Systems Model

A
  • emerges from complex interactions of many systems
    - musculoskeletal components
    - internal representations
    - adaptive mechanisms
    - anticipatory mechanisms
    - sensory strategies
    - individual sensory systems
    - neuromuscular synergies
56
Q

Sensory Selection Problem

A

Inability to appropriately select sense for postural control in environments in which one or more Orientation cues inaccurately report body’s position in space

57
Q

Loss of Anticipatory Postural control

A

Inability to adapt to changing tasks and environmental demands
-Highly dependent on PRIOR experiences and learning

58
Q

Problems in cognitive Systems

A
  • Impaired postural stability under dual-task conditions

- Postural control in demential

59
Q

Impaired Seated Postural control

A
  • Sitting Balance is critical part of functional independence in ADLS
  • Seated Postural control is impaired in neurologic pts
  • Sitting balance is good prognostic indicator
  • Trunk muscle helps maintain sitting balance
60
Q

Cerebellum in Control of Adaptation

A

the ability to modify postural amplitude in response to changing tasks and environmental conditions

61
Q

Basal ganglia in Control of Postural Set

A

the ability to quickly change muscle patterns in response to changing tasks and environmental conditions

62
Q

Spinal Preparation for Postural Control

A
  • GRF for orientation present though diminished
  • tonically active extensor muscle for antigravity support for postural orientation
  • no lateral stability
  • somatosensory contributions to postural control
63
Q

Brainstem Level for Postural Control

A
  • controls level of postural tone in combination with cerebellum
  • circuits for automatic postural synergies
  • vestibular contributions to postural control
64
Q

Intact System for Postural Control

A
  • adaptable postural control system to meet the goals of stability and orientation in any environment
  • visual contribution to postural control
65
Q

Visual Inputs

A
  • relationship of our body to objects in the environment
66
Q

Somatosensory inputs

A

surface of support

67
Q

Vestibular inputs

A

gravity

68
Q

Sensory Strategies

A

when one sensory system is less reliable, the input to the CNS from that system is weighted less heavily, and inputs from other systems will be weighted more heavily

69
Q

Body Functions [Structures]

A
  • 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 [related to voice and speech]
  • functions and [structures] of the cardiovascular, hematological, immunological and respiratory systems
70
Q

Environmental Factors to Clinical Management

A
  • natural environment
  • human-made changes to the environment
  • support and relationships
  • attitudes
  • services, systems, and policies
  • products and technology
71
Q

Balance Assessments of Functional Activities

A
  • Self Efficacy Scales (ABC, Falls Scale)
  • Timed Up & Go (TUG)
  • Functional Reach Test (FRT)
  • Performance-Oriented Mobility Assessment (POMA)
  • Berg
  • Short Physical Performance Battery (SPPB)
  • Balance Evaluation Systems Test (BESTest)
72
Q

Self Efficacy Scales

A
  • Questionnaires
  • Confidence in doing ADLs
  • Activity-specific Balance Confidence (ABC) scale
  • Falls Efficacy Scale (FES)
73
Q

Timed Up & Go (TUG)

A
  • stand up from chair, walk 3m, turn around, and return to sit back on chair
  • 10 s freely independent
  • 20 s independent in basic transfers
  • 20-29 s gray zone
  • 30s usually need help with chair or toilet transfers, help in and out of tub, assistance with stairs, unable to go out alone
  • sensitive and specific indicator of fall status in community dwelling older adults (>15s)
74
Q

Functional Reach Test (FRT)

A
  • FRT is a single-item test developed as a quick screen for balance problems and risk for falls in older adults
75
Q

Performance-Oriented Mobility Assessment

A
  • frail elderly
  • balance subscale
    9 items - 16pts
  • gait subscale
    7 items - 12pts
  • maximum score - 28 pts
    19-24: at moderate risk for falls
    24-28: at low risk for falls
76
Q

Berg Balance Scale

A
  • community dwelling older adults
  • there are 14 items, scaled 0-4
  • stability (steady state)
  • anticipatory
  • no reactive postural control
77
Q

Short Physical Performance Battery (SPPB)

A
  • used to measure LE performance such as strength, balance and mobility in older adults
78
Q

BESTest

A
  • developed by Horak et.al and used to examine multiple aspects of postural control
  • biomechanical constraints, stability limits, anticipatory transitions, postural responses, sensory organization, dynamic gait
79
Q

Examination Strategies used for Balance

A
  • postural alignment
  • movement strategies
    - steady state (sitting/standing)
    - reactive (sitting/standing)
    - anticipatory postural control
    - adaptive control
  • Sensory strategies
    - CTSIB
80
Q

Alignment

A
  • posture
  • weight bearing
  • width of base of support
  • location of the CoP
81
Q

Automatic Postural Responses

A
  • to keep the COG over the BOS in response to a stimulus or unexpected perturbation
  • rapid; not under voluntary control
  • ankle, hip and stepping strategies
  • adaptive postural responses
  • reactive postural responses
82
Q

Reactive Control

A
  • Nudge test
  • unexpected external perurbation at the level of the sternum
  • subject at maximum position with feet as close together as possible; examiner pushes lightly on subject’s sternum with palm of hand 3 times
    0: begins to fall
    1: staggers, grabs, catches self
    2: steady
83
Q

Proactive Postural Responses

A
  • responses occur before prime mover and in preparation for the perturbation
  • body’s way to prepare for a ‘predicted’ perturbation, e.g, lifting a heavy bag of groceries
84
Q

Examination at Impairment Level

A
  • Motor problems: motor coordination, muscle strength, involuntary movements
  • Sensory/Perceptual Status: somatosensory problem, visual problem, vestibular problem, impaired body image and spatial relationship
  • cognitive status: alertness, memory, orientation, attention, learning
85
Q

Task-Oriented Approach to Intervention

A
  • work on these goals in PARALLEL
  • impairment level: to optimize the components of postural control
  • Strategy Level: to develop or refine task specific sensory and motor strategies used for postural control
  • Functional Level: to learn to preserve postural control during changing tasks and environmental conditions
86
Q

Ultimate Goal for Task Oriented Balance Rehab

A
  • improve participation outcomes, reflected in ability (increased frequency, independency, and reduced falls) to participate in social roles, and ADLs
87
Q

Exercises to Improve Control of CoG - SITTING

A
  • encourage balance with progressively less surface contact
  • progress by: removing UE support, making the surface less stable, add UE activities, increase limits of stability through reaching and throwing activities
88
Q

Exercises to Improve Control of CoG - STANDING

A
  • begin with slow weight shifts on a stable platform
  • elastic band LE exercise
  • standing sway
  • sit to stand
  • Tai Chi
  • add UE activities/functional activities
89
Q

Exercises to Promote Ankle Strategy

A
  • standing sway exercise
  • slow small perturbations either self generated or external
  • computerized stability training
  • increase difficulty with UE, head or eye movements
  • functional activities
  • resistance
90
Q

Exercises to Promote Hip Strategy

A
  • standing sway using a table and a wall, pt instructed to bow to move nose towards table
  • standing on rail
  • mod. to rapid perturbations
  • tandem standing
  • single limb support
  • large ant./post. weight shifts on a variety of surfaces
  • functional activities
91
Q

Exercises to Promote Stepping Strategy

A
  • 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

Motor Control (2 decks)

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