Exam 2 Flashcards
** Exam 2 only has 22 questions, and there will be TONS on the balance assessment lecture (FOCUS ON THE RED POINTS AND KNOW THE RED POINTS)
ok
Below are FC’s starting Exam 2 … on the lecture of “Motor Control across the lifespan” specifically focusing on postural control
1) What is postural control
- When or where do we use postural control
- Do babies need postural control
- Another term for postural control
2) Just like movement, posture brings together what 3 things:
- And what things are included within the individual portion
3) There are two main theories related to postural control. Explain each:
- Which one of these 2 theories views posture from a reactive perspective
- Which one accounts for vision, vestibular, and somatosensory aspects of balance
4) T or F: Kids develop posture caudal to cranially
- T or F: Kids develop posture proximal to distal
- T of F: Kids will develop UE control and motor skills/development before trunk control
- T or F: As posture develops, kids go from static to dynamic posture
- Kids develop MOST gross motor skills by age ____
5) READ and UNDERSTAND THIS BELOW:
- Kids will first sit, then move to reach while sitting. They will stand, then move to mobility/dynamic movements when standing. They first get posture or trunk control, then mobility/dynamic or extremity movement. It goes trunk to extremities as far as development of posture.
- T or F: Dynamic posture develops before static?
6) T or F: Kids do not develop many gross motor skills in first year of their life?
- What gross motor skills do they develop, and in what order:
7) There are 3 states with regards to posture / postural control. Explain them:
8) So from the 3 above, which one is:
- Static balance
- Preparation for tasks
- Balance corrections
9) T or F: All 3 of these categories can be assessed (and interventions applied) in both standing and sitting?
1) How we are able to control where our body is in space, as well as reacting to diff movements to maintain posture/control.
- It is used in everything: brushing teeth, sitting up, standing, transfers, gait, balance, driving, reaching, sitting, etc. etc. etc.
- Everyone, every age, needs postural control
- Balance
2) Individual, task, and environment.
- Cognition, senses, vestibular, MS, NM, etc.
3)
- Reflex / Hierarchical Theory: Posture develops as a result of reflexes. As top down development happens, reflexes develop.
- Systems Theory: Systems theory though is more than just reflexes, but from integration of many areas of body coming together to help with posture. Systems theory says not one system (MS, NM, Vision, Vestibular) does posture or is more important than another system … ALL help and are important to posture.
- Reflexive/Hierarchical theory
- Systems theory
4) False (from head to toe)
- True
- False (trunk is proximal)
- True (ie. I can hold this position still -> now I can reach or do some mobility/dynamic mvmt in sitting/static posture).
- 5
5) ok
- False
6) FALSE
- Prone on elbows, prone reach, prone prop, roll over, sit supported, sit unsupported, sit reach, quadraped, quadraped reach, crawl, pull up, cruise, stand unsupported, stand and reach, walk.
7)
- Steady state posture: Is just sitting in chair with posture, or standing in place and maintain posture.
- Reactive Postural Control: Is when an unknown perturbation comes and you have to maintain posture and REACT (like I pushed Eric from behind without him knowing when/where perturbation was coming).
- Anticipatory Postural Control: I handed Eric something and he had to reach and maintain posture to grab it. He know before what he needed to do to change his posture.
8)
- Steady state
- Anticipatory
- Reactive
9) TRUE
1) At birth, an infant can’t hold head up. Is that because it is a strength or coordination issue? **
- When a child gets to the point where they can sit up unsupported (which is at what age?) … what is their COG fluctuation compared to older adult? And why?
- Is standing or sitting more difficult for a child? Why
2) What are muscle synergies:
- So how does synergies relate to postural control
3) What is the difference between in-phase and out-of-phase posture and movements:
- Would a baby demonstrate in-phase or out-of-phase mvmts first
- An example of this might be:
4) So baby sitting up unsupported but not swaying is demonstration of which postural control state:
- A baby developing out-of-phase postural and coordination abilities when some unexpected mvmt happens is what postural control state:
- And a baby prepping themselves for an upcoming movement is demonstrating what postural control state
- Me reaching for a bar of soap but keeping my balance is:
- Me getting bumped in the hall from behind and me catching myself is:
- Me sitting in chair at school typing sitting up is
5) So as soon as a child stands up, will they be able to reach out and grab things after they just learned to stand? Why?
- Can a child do well doing anticipatory or reactive postural control if they are just learning new development skill and are still in steady state
- T or F: So at varying stages of development, kids develop from steady to reactive to anticipatory in each of those new states
- T or F: You can develop dynamic posture or reactive control before mastering steady state / static balance?
6) So if a pt is struggling with postural trunk balance, will you work on LE strengthening and functional activities?
1) It is both. Head control is an issue in infants due to lack of strength AND lack of coordination abilities.
- 6 ish months
- All over the place. Haven’t developed postural static core strength/coordination yet.
- Standing. First, it places their COG much higher (which is harder) and they have to control and coordinate many more muscle groups to maintain standing up posture … it is harder. Trunk develops before LE’s too.
2) Synergies: when different muscle groups work together and coordinate to get an action/mvmt.
- In order for a child to sit up unsupported, or stand, or for an adult to do these things - large muscle groups must work together, react, anticipate, move, contract/relax, and coordinate mvmt = muscle synergies.
3) In-phase is when body parts move together (to try and maintain posture/mvmt/balance). Out-of-phase is when diff body parts move out of phase or not with each other to try and maintain posture.
- In-phase
- Alaya being pushed over at 6 months and everything topples over together (in-phase). But later she developed out of phase reactive coordination abilities to maintain posture where one arm goes back to brace and the other arm flails out to act as a counter balance (both arms out of phase).
4) Steady state
- Reactive
- Anticipatory
- Anticipatory
- Reactive
- Steady state
5) NO. They have to develop trunk control in that new gross motor state just developed before they can develop new ability of UE’s or LE’s to do movements outside their postural base (ie. reaching out or across midline).
- NO
- True
- False
6) No. Go proximal to distal. If problem is proximal, start there and work distal.
** THIS WILL BE ON THE EXAM **
1) Remember the ? on the exam about what babies develop first? Will they use or rely on muscle, vestibular, or vision first?
2) What 3 major systems play into balance, posture, movement
- Are vision and vestibular system interconnected?
- T or F: Children with abnormal vestibular systems showed a gross motor development delay?
- T or F: Throughout development, and even within different tasks, we rely on those 3 elements of balance differently (one being used more than another depending on the situation).
- T or F: Turning off one of the 3 balance systems will heighten and strengthen the other 2?
3) Remember the video we watched of the child in the room where the walls move, but the floor does not move? What was the point?
- At what age do kids move from a visual reliance/dominance to more reliance on somatosensory
- At what age will kids NOT fall over in this test, since they’ve developed other skills
4) We know that balance is primarily resultant from the 3 systems just discussed, and that posture and balance go hand and hand. But does cognition play any role in postural control?
- How?
- How could you test or prove this?
- T or F: If you challenge both systems (or 2 systems) one may deteriorate or one may be stronger and relied on more?
5) By the time we get to 10-12 yrs old, we have developed all the abilities to get postural control. So we’d assume kids should be just as stable as adults with balance and posture. Are they?
- Why
- So T or F: Kids are just as able to balance / posture effectively as adults
6) T or F: The more practice kids get with posture, balance, strength, etc. - the better or stronger they will get
- So how does this relate to motor learning
1) Babies rely on VISION FIRST as they develop. And when developing a new skill, they rely more on VISION at first to learn the new skill.
2) Vision, Vestibular, Motor (muscle and somatosensory)
- YES. VOR reflex
- True
- True
- True
3) That a child will fall because their vision is telling them the wall is moving, so they fall. But an adult won’t fall because their muscular, somatosensory, and vestibular system tells them they are NOT moving, so they override the visual system. In other words, kids rely more on VISION to maintain balance at first.
- Age 3
- Age 7
4) YES.
- If you can’t think or perceive, then it doesn’t matter how 3 systems work.
- If you did a balance test and added a cognition piece, it would be much harder. Have them balance while counting backwards by 7 from 100 (a dual balance task).
- True
5) Um … yes pretty much
- Well, kids do have larger heads, and maybe their muscles are not as strong/coordinated … but their COG is lower to ground, their vestibular systems are more in tact (hair cells haven’t died yet), and their eyes are better younger.
- True
6) True
- The more practice and learning you develop, if it becomes PERMANENT, you’ve done motor learning.
(PUT THESE NOTES IN “MY DOCS” ABOUT EDUCATING PEOPLE ON AGING. Also add these notes on aging into the doc for my kids in the future to help them change their viewpoint on aging) ****
1) Then we went from kids to geriatrics … below are some of the myths or facts about aging. Are they true or false:
- You experience incontinence with age
- Most older adults fall
- You do not get weak from getting older
2) How old is old?
- The whole point of the geriatric section was:
- What is ageism:
- Is aging Heterogeneous
3) What are the non-modifiable factors that contribute to aging, what are the non-modifiable factors to aging:
- What % of the factors that contribute to aging are NON-modifiable
4) T or F: Generally, PT’s under-dose older pt’s … and they shouldn’t
- T or F: Older pt’s should never do squats or dead lifts
5) Now, it is true that many elderly people do fall. What % of elderly people 65+ fall each year (those who are community dwellers):
- What are INTRINSIC risk factors that lead to someone falling:
- What are EXTRINSIC risk factors that lead to someone falling:
- T or F: Recent hospitalizations are a risk factor for increased risk for falls
6) Do we as PT’s have a way to predict if someone is at a risk for falls:
- What is the FRQ
- Is a questionnaire a good predictor for risk of falls
- What is “Stratify”
7) How does fear of falling relate to postural control
- What is “postural stiffening”
- What is postural sway
- Older people will often couple their head and body movements together. Explain
8) T or F: The older a person gets, the more they rely on vision (just like kids)
- But what is the caveat to this?
8A) We know if one system (of the 3 balance systems) declines, the others will get heightened … but with age, do we lose abilities in all 3 systems?
- For vestibular system, T or F: We lose about 40% of nerve and hair cells by age 70. 3% loss per decade of vestibular nucleuscells from ages 40-90
9) Older people lose more type 1 or type 2 muscle fibers
- Do older people lose more strength in UE’s or LE’s when they age?
- T or F: People will get weaker in nursing home more than in community / community dwellers (since nursing home pt’s sit more)
10) T or F: Balance reactions or postural sway corrections in steady state are proximal to distal
- Of the 3 corrective strategies, what does postural sway use:
11) So if we sway (postural sway) or lose balance or have a perturbation, what muscle will activated first (in ankle strategy):
- So if you are pushed backwards, what muscle activates first (in ankle strategy)
- So if you are pushed forwards, what muscle activates first (in ankle strategy)
- What are atypical responses to postural sway or balance perturbation (with ankle stategy)?
12) If I lightly pushed someone forward or backwards, how many steps should they take (normally)
- An abnormal response would be
- Is a history of falls an indication of an increased risk for falls
- And what is safer to hold on to, a cane / AD or a railing
1)
- False (incontinence is not normal for anyone)
- False (only about 1/3rd of adults over 65 fall)
- True
2) It is all a perception. It’s relative and different to everyone.
- That aging doesn’t have to mean we lose ROM, strength, and function. It is a perception, and a choice.
- Ageism: Discrimination of someone based on their age. Older people are portrayed as dumb, fall all the time, pee their pants, etc. That is NOT true.
- Yes. It is NOT homogeneous, meaning the same for everyone. Everyone ages differently.
3)
- Non-modifiable: Genetics, gender, race, age, dementia.
- Modifiable: Health, lifestyle, mentality / mental health, exercise, attitude, perspective, diet, social interaction, work environment (fields, coal mine), smoking/alcohol, etc.
- 20%
4) TRUE
- False. They have to do sit to stands every day, and pick stuff up off the floor, so make them do squats and dead lifts.
5) 33%
- Intrinsic: strength, cognition, vision, previous falls, fear of falling, balance deficits, arthritis, depression, age over 80
- Extrinsic: rugs, floor, curbs, ice, shoes, poor lighting, house environment
- True (If there was a hospital stay in the last 6 months, you are a higher risk of falling).
6) We have outcome measures: self assessments or questionnaires, or performance based tests like: Tinetti, Berg, TUG, 5STS, etc.
- Fall Risk Questionnaire (given to patients fearful of falling)
- Probably not. May be a helpful tool, but it is not an objective tool really.
- A questionnaire for HOSPITAL pt’s to assess their fall risk
7) If someone is fearful of falling, their posture will absolutely be changed. They’ll hunch over, bend their knees to lower COG, keep extremities near midline, etc. Their posture leads to a viscious cycle of making them more prone to falls, falling, getting more scared, resulting in worse posture, etc.
- When people are afraid of falling, they will stiffen up and bring arms in to COM and bend legs to lower COG.
- Postural sway: the slight movement we ALL do to keep our balance.
- If they turn head, they will turn body (and visa versa). They do this in fear of falling, often because vestibular or visual impairments.
8) TRUE
- The older someone gets, the more their vision deteriorates (decreased visual acuity, glaucoma, cataracts, etc.)
8A) Yes. From point above, our eyes get diseases and old, our vestibular system loses cells and becomes compromised more often, and we lose tactile and receptor fields to lose somatosensory / proprioceptive input and loss of balance.
- True
9) Type 2
- LE’s
- True
10) False/True. Depends on which strategy is used. When we correct for POSTURAL SWAY or balance deviations, we do it DISTAL to proximal
- Ankle strategy
11) The muscle being stretched
- Tibialis anterior (since it is stretched and is distal)
- Gastrocs
- Co-contraction of concentric and eccentric m’s, proximal to distal mvmt first, sequencing / timing of muscle activation issues, increased hip response, muscle synergy issues, stepping, falling.
12) One
- Many steps
- Yes
- RAILING
** KNOW THIS **
1) 3 Problems with coordination of muscle response to maintain balance:
2) The 4 PT interventions
- *** We know as people age, they lose their cognitive abilities. First, how can you work on / practice that:
- How do you KNOW if the pt understood and comprehended what you taught / instructed / educated / demonstrated to them
1)
1. Sequencing (order of activating muscles correct)
2. Timeliness
3. Adaptation to task
2)
1. What strategy is used (response strategy)
2. Sequence of muscle activation
3. Look at timing and speed
4. Adaptation to different environments / perturbations
- ** Do a cognition test/activity during an exercise or balance activity (DUAL task during balance activity).
- Have them teach explain it / teach it back to you, and they MUST demonstrate it themselves to prove understanding.
Below are the FC’s I created in preparation for Quiz 2 on Balance Systems and Intro to Balance Assessment
1) Why is postural control so important
2) T or F: Research and clinical practice influence each other
3) Define:
- Postural Control: ** SOS **
- Posture:
- Postural Orientation:
- Postural Stability:
- Center of Mass (COM):
- Center of Gravity (COG):
- Are COM and COG the same thing?
- Base of Support (BOS):
- Does it include the area between legs?
- Center of Pressure (COP):
- Does the COP move around the COM or the COM move around the COP
- How might someone’s COP look if they had some neurological disorder
4) The term “postural control” is used interchangeably with the term:
- To ensure stability, the ___________ generates forces to control motion of the COM
5) All tasks require postural control (or balance). And, every task requires 2 components of postural control:
- T or F: Orientation and stability are the same, regardless of the task or environment
- T or F: Some tasks place importance on maintaining an appropriate orientation at the expense of stability
- An example from the point above would be:
- An example of someone who sacrifices orientation for increased stability
- T or F: The task and environment influence the orientation and stability demands of a task
6) So the example of a person on a bench reading a book, then stands up to read the book. What changes with orientation and stability in that transition
7) Balance (postural control) arises from what 3 things interacting:
- What is the “postural control system” or postural systems
- What 3 things factor into the INDIVIDUAL part of balance
8) Explain these aspects of balance / posture for the TASK portion:
- Steady state postural control:
- Reactive “:
- Anticipatory “:
9) Would reactive rely on feedback or feedforward
- Which one would rely on feedforward
10) If someone’s reactive balance is impaired, what might be the reason why they have impairment
ok
1) Critical to independence in functional tasks like sitting, standing, transfers, reaching, walking, etc. So if postural control is impaired, you lose function (or independent function) to do ADL’s, have an increased risk of falling, and even increased risk of mortality and morbidity.
2) True. Research impacts clinical practice, and visa versa
3)
- Postural Control: controlling the body’s position in space for the dual purposes of STABILITY and ORIENTATION.
- Posture: Term to describe both the biomechanical
alignment of the body and the orientation of the body
and the enviornment.
- Posture: Term to describe both the biomechanical
- Postural Orientation: Ability to maintain an appropriate relationship between the body segments and between the body and the environment.
- Postural Stability: Ability to control the center of mass (COM) in relationship to the bass of support (BOS). ** It really is the controlling of the COM (or COG) to the BOS.
- Center of Mass (COM): The point that is at the center of the total body mass (average of COM of each body segment).
- Center of Gravity (COG): VERTICAL projection of the COM
- NO. COM is a point on body, COG is vertical projection from COM
- Base of Support (BOS): Area of the body that is in contact with the support surface.
- Yes
- COP: Center of distribution of the total force applied to the supporting surface (where forces meet the ground).
- COP moves around the COM to keep the COM within
the support base
- COP moves around the COM to keep the COM within
- Much more out of control
4) BALANCE (or equilibrium)
- Nervous system
5) Orientation, and stability
- False. Stability and orientation demands change with each task.
- True
- Soccer goalie (fall to the ground to block a goal)
- Tightrope walker
- True
6) Orientation doesn’t change (if person stays afixed to reading), but stability changes a lot (from bench to standing for BOS).
7) Individual, Task, Environment
- Connection between musculoskeletal (including muscle synergies), neuromuscular (nervous system), senses (vision, vestibular), and cognitive systems all interacting to maintain posture.
- Motor, Sensory, Cognitive
8)
- Steady state postural control: To maintain normal posture (in sitting, standing, etc.). Ability to control COM relative to BOS in non-changable conditions.
- Reactive “: Recovering or modifying posture after an unexpected pertebation. (ie. walking and tripping over obstacle and you have to correct COM and BOS).
- Anticipatory “: Prepare sensory and motor systems for the postural demands of an upcoming task (preparing).
9) Feedback
- Anticipatory
10)
- Muscle Sequencing problems
- Problems with timely activation of postural responses
- Problems adapting postural activity to changing task and environmental demands
1) What is “static balance”
- What is postural sway
- Does postural sway happen in static balance
- So is there really such thing as static balance
2) So in order to achieve as much ideal static balance as possible, what needs to happen
- For bony alignment, LOG (line of gravity) should go through what:
- What is muscle tone
- What is postural tone
3) So if there really is not a static balance, and postural sway happens all the time, do we need movement strategies to create postural tone and maintain balance and BOS despite postural sway
- When standing, what are the movement strategies for postural sway (or pertebations)
- If sitting and we get a pertebation, our postural sway movement pattern happens at the ____
4) When standing in steady state “static balance” and a pertebation comes, is the ANKLE or the HIP strategy used first.
- What is the progression of movement strategies with a pertebation (or reactive balance control):
- Fixed support options (from point above) are:
5) What are muscle synergies
6) With ankle strategy, do muscle synergies respond proximal to distal or distal to proximal
- With hip strategy, do muscle synergies respond proximal to distal or distal to proximal
- What m’s activate and in what order (if using ankle strategy) to correct for a FORWARD pertebation/sway (and in what order)
- With BACKWARD instability/sway (using ankle strategy), what m’s activate and in what order
7) With HIP strategy, if going forward, what m’s activate and in what order
- With HIP strategy, if going backward, what m’s activate and in what order
- T or F: Hip strategy is distal to proximal muscle activation?
- T or F: Hip strategy doesn’t use ankle m’s to help correct
8) Ankle and hip strategies are fixed support strategies. What are the other types of strategies you could use
- Does BOS move in fixed or change-in-support strategies
9) You can also experience mediolateral (ML) pertebations. Would recovery strategy for ML sway come from ankle, knee, or hip
10) T or F: Everyone uses same strategies every time a certain pertebation happens
- Can we develop or refine our muscle synergy response
1) Being able to sit or stand with stability where BOS doesn’t really change
- Posture swaying. In biomechanics, balance is an ability to maintain the line of gravity (vertical line from centre of mass) of a body within the base of support with minimal postural sway. Sway is the horizontal movement of the centre of gravity even when a person is standing still.
- YES
- NOT really
2) Bony alignment to minimize gravitational forces, muscle tone to keep bony alignment in place
- Ear to shoulder to hip to knee to ant part of ankle.
- Force with which a muscle resists being stretched/lengthened … it’s stiffness
- Postural tone is the steady contraction of muscles that are necessary to hold different parts of the skeleton in proper relation to the various and constantly changing attitudes and postures of the body.
3) YES
- At the ankles, then hip, then stepping, then reaching
- Hip
4) Ankle
- Ankle, hip, stepping, and then reach and grasp (fall and reach and grasp something).
- Ankle and hip
5) Coupling muscle groups that act together as a unit to help maintain balance or react/respond to balance changes.
6) Distal to proximal
- Proximal to distal
- Gastrocs, hamstrings, paraspinals
- Tib ant, quads, abs
7) Abs, quads
- Paraspinals, hamstrings
- False
- True
8) Change-in-support strategies (step or reach-grasp strategy).
- Change-in-support strategies
9) HIP (and a little at trunk) … then it would progress to stepping as a recovery/reactive strategy.
10) False. Every person is different, every task and environment is different - some use a combination of ankle and hip, etc. It is complicated.
- Yes
1) We know the MS and NM systems, and cognition are critical to maintaining balance, but what sensory input is also critical for postural control
- Which sense is most important for postural control
- Is vision necessary for steady state postural control
2) How does the somatosensory system play into postural control
- So if you lose sensation due to neuropathy or vascular issues, will your COM sway more or less
3) If cognition is impaired, will balance or postural control be impacted
- Why
1) Vision, somatosensory, and vestibular input. *** To know when and how to apply forces at muscles, the body needs to know WHERE it is in space, and whether it is in motion or not.
- IT DEPENDS
- Yes, but not as much
2) I need to feel where I’m sitting and standing, to know where I am, what I’m seated on / standing on. The sensation of what I feel is important to know where I am to let the brain know how to respond.
- More
3) Of course
- The brain sends the signals to m’s and nerves to generate forces to maintain posture, so if cognition is off, then signals get impacted, resulting in more sway.
Below are the notes / FC’s on chapter 10 for the reading quiz prep
1) When someone has abnormal postural control, what does that really mean
- T or F: The risk for falls in pt’s with a stroke, parkinson’s, CP, or other cognitive or NM pathology is significantly higher
- T or F: Most people are fine after a fall, but depending on age and health condition, some will require medical attention and may result in a hip fracture
2) If someone has an impaired or unsteady steady state balance system, what do they often do to compensate
- Why is this bad
3) So we know what proper alignment is (which nobody technically has), but those with pathologies (stroke, parkinson’s, CP, etc.) will have alignment issues. Why is this bad?
- What about CP pt’s with hypo or hypertonia (or rigidity and spasticity)
- How might CP pt’s demonstrate ankle or hip strategies
4) What muscles will be tight / contractures in CP pt’s
5) T or F: The lower you put the support for kids with CP, the more control they’ll have
6) Kids with CP, for example, have abnormal sequencing of muscle groups / synergies. Explain
7) What is coactivation / cocontraction:
- Is this a good postural control / recovery strategy
- SO BIG point is that whether stroke victims, parkinson’s, CP, TBI, etc. - they have an impairment of the cognitive and motor functions, so they get messed up muscle synergies, cocontractions, delayed onset of posture responses, no signals to contract, muscle activations sequencing in the wrong order, etc. And all of this results in poor balance / posture.
RESULTS OF QUIZ:
8) If your COP is moving, you probably have an issue with:
- The strategy used when you rapidly move a limb to correct postural pertebations
- A dual-task test for balance is what
- If your balance decreases when your close your eyes, what issues are you having
ok
1) They lose their balance and are at risk for falling … because they have some muscle sequencing problem, timing problem, inability to adapt to the task, LE / trunk weakness, cognition issue, vision/vest issue, etc.
- True
- True
2) Use their arms for support/balance (activate somatosensory or motor systems more).
- Then arms can’t perform functional tasks (typing, eating, ADL’s, etc.)
3) Now COM will go outside BOS, resulting in postural issues.
- Now limbs are weak and can’t support, or contractures place them in a way you have to change BOS (leading to poor body alignment) and alterations, or flailing spasticity changes orientation which forces COM out of BOS.
- Hemiplegia pt’s can only do it on one side, diplegic pt’s wouldn’t be able to do it at all. High tone or spastic pt’s would have difficulty.
4) HS’s, Adductors, PF’s
5) False. The higher the support (more proximal) the more control they will have.
6) So instead of activating gastrocs, then HSs, then paraspinals, their sequencing of activation of muscle groups is off. One might go before another, or do co-contraction, or out of sequence. This will obviously throw their balance off.
7) Simultaneous contraction of m’s on both anterior and posterior aspects of body/joint.
- NO - results in stiffness
- Ok
8) Postural sway
- Stepping strategy
- Cognitive test while doing a balance test, and one or the other is worse due to having to do 2 tasks
- Sensory (visual)
** TONS OF ?s on exam about the RED highlighted portions of the balance assessments (the balance assessment worksheet had a lot of other tests we didn’t cover in class. Just focus on the one’s we went over in class, and the RED highlighted portions.
*** Go through “MY DOCS” and know / review the balance tests.
ok
Below are FC’s on “Introduction to Balance Assessment”
1) What is the MOST important ? to ask if assessing someone’s balance
- What else could you ask:
1A) ______ or more falls in last year = increased risk of falling.
- In the ICF model, fear of falling goes under what category
- Functional balance tests would assess what on ICF model
2) T or F: You ALWAYS want to do an objective balance assessment to get an objectified measure of the pt’s balance?
3) For these below, if you did these tests, they would assess what aspect of balance:
- Static timed tests, single leg stance
- Any test involving movement
- CTSIB, BESS Test
- Pushes, Pulls or Release Tests (perturbations unexpected)
- Functional Reach, Star Excursion Balance Test
- Include a variety of components listed above and incorporate functional tasks
4) When trying to determine which test to select, what do you need to consider:
5) Regarding the EVIDENCE for certain balance tests, what do these mean:
- MDC:
- MCID:
- Normative Values:
- Cut-off scores:
- Floor effect:
- Ceiling effect:
- Clinical limitations:
6) A test with a floor effect are bad for high functioning pt’s or low functioning?
- A test with a ceiling effect are bad for high functioning pt’s or low functioning?
7) What website should you bookmark and KNOW as a PT to get evidence based data on tests and measures
ok
1) How many falls they’ve had in the last year.
- Ask about their environment (stairs, surroundings)
- Ask about what activities they have to do
- Ask about what balance strategies they do or don’t use
- Ask what they are fearful of
1A) 2
- Personal factors
- Body impairments and activity level limitations
2) TRUE ***
3)
- Steady State Balance: Static timed tests, single leg stance
- Dynamics Balance: Any test involving movement
- Sensory Organization Tests: CTSIB, BESS Test
- Reactive Balance: Push, Pull or Release Tests
- Anticipatory Balance: Functional Reach, Star Excursion Balance Test
- Functional Balance Tests: Include a variety of components listed above and incorporate functional tasks
4)
- What are the goals / impairments of the pt, and what test best addresses / tests for that
- What is the evidence about that test
- Do I have the right equipment to run the test
5)
- MDC: amount of change required to exceed the standard error of measure
- MCID: amount of change showing a significant change in the PATIENT’S condition
- Normative Values: standard scores based on age, gender, diagnosis
- Cut-off scores: What values are the cut off to determine a risk or bad prognosis
- Floor effect: No room to measure decrease in score for lower functioning patients
- Ceiling effect: No room to continue to track increase in score at the high end of scale
- Clinical limitations: space, required equipment, time
6) Low (since you can’t really determine true deficits)
- High (since you can’t determine high performers)
7) https://www.sralab.org/rehabilitation-measures
**** Every test below in this FC we need to know. I’ve only put the data we MUST know for each … so know EVERYTHING on this flashcard.
** She said majority of exam will be on this content ***
ok
1) Romberg / Sharpened Romberg Test
- Explain Test:
- A positive test is:
- Pros and cons of this test are:
2) Modified Functional Reach:
- Explain Test:
- Is it measured in inches or cm
- How many trials do they get:
- CUT OFF SCORES:
3) Timed Up and Go (TUG) Dual Task
- Explain Test:
- Can you use an AD with the TUG Dual Task?
- CUT OFF SCORES:
4) ROF =
5) Walking While Talking (WWT) Test
- Explain Test:
- CUT OFF SCORES:
6) LET’S PRACTICE:
A patient reports a fall in the home that occurred while gathering laundry and attempting to rush to answer the door. Which of the following tests is MOST appropriate to obtain a baseline assessment of the underlying impairment?
- Functional Reach Test
- TUG Dual Task
- Walking While Talking Test
- Romberg
7) Clinical Test of Sensory Integration and Balance (CTSIB)
- Explain Test:
- So what is main reason to use this test:
- Max score you can get is:
- CUT OFF SCORES:
8) Balance Error Scoring System (BESS Test)
- Explain Test:
- Are eyes closed on all 6 activities
- CUT OFF SCORES:
- At what age does performance worsen
9) Dynamic Gait Index (DGI)
- Explain Test:
- Highest score you can get
- Equipment needed:
- Can you perform with AD
- MDC:
- CUT OFF SCORES:
10) Functional Gait Assessment (FGA)
- Explain Test:
- What activities does it add:
- Total points you can get:
- Why is FGA better than DGI
- Can you perform with AD
- Would FGA be chosen for more low or high functioning pt’s
- CUT OFF SCORES:
11) Let’s Practice:
An 85 year old patient scores an 18 on the Dynamic Gait Index during an initial evaluation. Significant difficulty noted with horizontal head turn and stepping over obstacles. What is the MOST appropriate interpretation of this test?
- This is consistent with age match norms and no intervention is indicated.
- The patient is at low risk for falls and balance training on various surfaces is indicated.
- The patient is at moderate risk for falls and lower extremity strengthening is indicated.
- The patient is at high risk for falls and gait with scanning the environment is indicated.
12) Mini Balance Evaluation Systems Test (Mini BeST)
- Explain Test:
- What is the biggest con with this test
- What is MCID:
- Total Score you can get:
- CUT OFF SCORES:
13) High Level Mobility Assessment Test (HiMAT)
- Explain Test:
- Is this for low or high functioning pt’s
- What condition would this most be used on?
- Max score you can get?
- Can you use an AD?
- What are NORMS for this test: **
- CUT OFF SCORES:
14) Let’s Practice:
A 23 year old female recreational soccer player is recovering from a mild traumatic brain injury. She is independent with ambulation in the home but continues to report difficulty in community and with attempts to run. What is the MOST appropriate assessment to track changes at the ACTIVITY Level on the ICF model?
- Balance Error Scoring System (BESS)
- High-level Mobility Assessment Tool (HiMAT)
- STAR Excursion Balance Test
- Functional Gait Assessment (FGA)
15) Activity Balance Confidence (ABC) Scale
- Explain Test:
- Scoring of this test is how:
- CUT OFF SCORES:
16) Falls Efficacy Scale
- Explain Test:
- Scoring of this test is how:
- CUT OFF SCORES:
17) SO which 2 are NOT objective balance/functional tests, but are SELF-REPORTED assessments the pt fills out about their abilities
- Which one is a more logical way to score a test
1)
- Explain Test: Romberg = feet together, test eyes open and eyes closed up to 30 sec. The Sharpened Romberg = tandem stance, arms crossed and eyes closed up to 30 sec.
- Opening eyes, taking a step, or LOB
- It is a fast easy test to do for low functioning pt. Doesn’t require any equipment. So good screening tool, but doesn’t help you know what the impairment is or objectify balance in any scoring way.
2)
- Explain Test: Seated and reach forward, left, and right
- in
- 1 Practice trial, and then avg of 2 trials (in all directions)
- CUT OFF SCORES: Not established in the modified version (haven’t done enough research to get cut off values). BUT … you want to get farther than 7in to NOT be at risk of falling.
3)
- Explain Test: The TUG, but with added cognitive element (count backwards by 3, or carry glass of water)
- YES ***
- CUT OFF SCORES:
- Community dwelling older adults need to get less
than 15 secs (greater than 15 = ROF)
- Parkinson’s: greater than 4.5 second difference
between TUG and TUG-manual = ROF
4) ROF = Risk of falling
5)
- Explain Test: Pt walks 20 feet, turns around and walks back (so 40 feet total). The pt names letters out loud, or alternating letters of the alphabet).
- CUT OFF SCORES: ROF are:
- >20 seconds on simple cognitive task
- >33 seconds on complex cognitive task
- <70 cm/s speed on WWT = increased risk of frailty
and disability
6)
- TUG Dual Task
7)
- Explain Test: Test in 6 positions … first 3 on firm surface, next 3 on uneven surface. You go eyes open, then eyes closed, then Chinese lantern :) You hold those positions for 30 seconds each, and any faltering or LOB you stop clock. THEN, you do this 3 times.
- It is able to assess SENSORY parts of balance … visual compared to vestibular compared to proprioceptive (integrating SENSORY aspect of balance) … so trying to determine what of the 3 systems that are part of balance, which one(s) have the deficit.
- 6 x 30 x 3 = 540 secs
- CUT OFF SCORES: Community Dwelling Older Adult: Less than 260 seconds (summing 3 trials from all 6 conditions) or 48% accuracy
8)
- Explain Test: Measure the number of errors during a 20 sec time frame for each of the 6 condition with eyes closed. First 3 activities are on firm ground, then next 3 on foam surface. You go from feet together, to single leg, to tandem. Eyes closed on ALL activities.
- Yes
- CUT OFF SCORES: NONE established
- Performance worsens after 50 years old
9)
- Explain Test: 8 items testing DYNAMIC balance (during gait), including vestibular input (head turns), and stairs.
- 24 points
- Equipment: shoe box, obstacles, stairs, 20 foot walk way
- Yes
- 3 points (with community older adults, vestibular, and parkinson’s pt’s)
- CUT OFF SCORES: ROF …
- <19 for older adults, vestibular, parkinson’s disease
- <12 for multiple sclerosis
10)
- Explain Test: FGA has 7 of the 8 items from DGI, but adds 3 additional items (10 total).
- Walking narrow BOS, Backwards gait, Walking eyes closed
- 30
- More objective rating scales than DGI (DGI is more subjective scoring)
- Yes
- High
- CUT OFF SCORES: ROF
- <22/30 for older adults
- <15/30 for Parkinson’s Disease
11)
- The patient is at high risk for falls and gait with scanning the environment is indicated.
12)
- Explain Test: Assesses static, reactive (stepping reactions), and anticipatory balance (up on toes), as well as sensory (eyes closed), and gait. IT IS FUNCTIONAL
- This one requires a lot of equipment (foam block, incline ramp, box, etc), and it takes 20+ minutes to administer (so it takes a long time).
- MCID: 4 points (4 points = balance disorder)
- 28 points
- CUT OFF SCORES: ROF
- <20/32 for Parkinson’s Disease
- <17 with chronic stroke
13)
- Explain Test: High level test for assessing balance in high functioning pt’s. Assesses walking, running, jumping, balance, stairs, hopping, skipping, etc.
- High
- Concussions (TBI’s)
- 54 points
- Yes
- Males = 50-54 points; Females = 44-54 points
(tested on healthy individuals 18-25 years)
- CUT OFF SCORES: None developed. Needs more research
14)
- High-level Mobility Assessment Tool (HiMAT)
15)
- Explain Test: A self-reported assessment that has 16 items where the pt SELF REPORTS measures rating the patient’s confidence performing various ambulatory tasks and their fear of falling. IT IDENTIFIES PEOPLE’s PERCEPTION of BALANCE.
- 0 = no confidence; 100 = very confident
- CUT OFF SCORES:
- Older adults = less than 67%
- PD = less than 69%
- Stroke = less than 81% indicative of multiple faller
16)
- Explain Test: 16 item SELF REPORT measure rating the patient’s CONFIDENCE in performing normal ADL’s without falling.
- Scoring of this test is how: 10 = very confident; 100 = not confident
- CUT OFF SCORES:
- Older adults: >80 = increased RISK for falls
>70 = increased FEAR of falling
17) ABC (people’s perception/fear of falling), and Falls Efficacy Scale (confidence in performing tasks/ADL’s)
- ABC
** BELOW IS A VERY HELPFUL SUMMARY by topic. So if a pt needs help with xyz, then these tests are best for that.
1) What tests could you use to IDENTIFY RISK OF FALLS:
- Acronym:
2) Wanting to focus on dual tasking:
- Acronym:
3) Younger patient following concussion / TBI:
- Acronym:
4) Older community dwelling adult referred for history of falls:
- Acronym:
5) Complaints of dizziness:
- Acronym:
6) Other tests that were not listed above, but could consider:
7) ALL 15 tests we went over … just name:
8) Those that are self reported
- Which one’s scoring makes sense?
- Which one is a self report about ability or confidence to do ADL’s
9) Which one’s test SENSORY
10) Which one’s really test GAIT
11) What is the one that requires TONS of equipment and long time to administer
- How to remember this
12) How to remember scoring for HiMAT and MiniBest
12A) Is there another set of tests where scores are in half
13) Best test for those with concussions / TBI’s
14) Questions will be some case and will list the test and their score, you have to determine if they are a ROF:
- Someone did the DGI and got a 23 … are they a ROF
- Someone with Parkinson’s scored a 21 on the FGA … are they a ROF
1) 10 Meter Walk Test ABC Scale Berg Balance Scale DGI FGA POMA/Tinetti TUG
10, A, B, D, F, P, T
10, A balance deficit facilitates PT
2) TUG Dual Task WTT: Walking Talking Test DGI FGA
3)
HiMAT
Mini BEST
TUG
Had, Mini, Trauma
4) ABC Scale Berg Balance Test CTSIB/mCTSIB DGI FGA Mini BEST TUG
A, B, C, D, F, Mini, T
5)
FGA
DGI
Mini BEST
Freaking Dizzy Man
6) Romberg Modified Functional Reach BESS Test Falls Efficiency Scale
7)
- Rhomberg/Sharpened Rhomberg
- Functional reach / Modified Functional Reach
- Tug and TUG Dual
- Walking While Talking
- CTSIB
- BESS
- DGI
- FGA
- MiniBEST
- HiMAT
- ABC
- Falls Efficacy Scale
- 10m walk
- Berg
- Tinnetti (POMA)
8) ABC and Falls efficacy scale
- ABC (0 is low, 100 is high and good)
- Falls Efficacy
9) CTSIB and BESS
10) DGI, FGA
11) MiniBEST
- It’s ironic since it is MINI, but requires MOST equipment and takes long to administer
12)
- HiMAT is high function, so high score of 54
- MiniBEST is mini, so cut 54 in half = 28
12A) Berg is 56 pts, and Tinetti is 28 pts
13) HiMAT (but remember the Had, Mini, Trauma … so you can do HiMAT, MiniBEST, and TUG)
14)
- DGI: NO. Top score is 24, cut off is 19 (then 12 for multiple sclerosis)
- No. Cut off scores are 22, but they are 15 for parkinson’s
