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Motor Control and Learning > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the components of the balance assessment subjective history?

A

Ask questions about how many falls have occurred
Inquire about how the patient is managing in the home (and what strategies they are using)
What their perception of the risk of falls is

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2
Q

What are the 4 components of a balance assessment?

A

Subjective History
Ongoing Movement Analysis
Objective balance examination
Patient Self-Reporting Questionnaires

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3
Q

Steady State Balance Tests

A

Static timed tests

Single leg balance

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4
Q

Dynamic Balance Tests

A

Any test involving movement

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5
Q

Sensory Organization Tests

A

CTSIB

BESS Test

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6
Q

Reactive Balance Tests

A

Push, Pull, or Release Tests

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7
Q

Anticipatory Balance Tests

A

Functional Reach

Star Excursion Balance

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8
Q

Functional Balance Tests

A

Include a variety of components and incorporate functional tasks (Walking While Talking)

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9
Q

Components of selecting appropriate balance tests

A

Evidence support
What you hope to learn (screening, falls risk, comparison to norms, etc.)
Clinical limitations (time, equipment, stairs/environment)

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10
Q

Romberg/Sharpened Romberg Test

A

Romberg: Feet together, eyes open and eyes closed for up to 30 seconds
Sharpened: tandem stance, arms crossed, eyes closed up to 30 seconds
+ Test: opening eyes, taking a step, or LOB

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11
Q

Romberg Benefits and Challenges

A

Benefits:
quick screen
Limited Equipment

Challenges
Not specific
Not used in isolation => need to perform other tests

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12
Q

Modified Functional Reach

A

Measurement: 1 practice, average 2 next trials in each direction
Cut Off Scores: Not established in the modified version
Stroke Norms:
Forward: 31.7; 37.6
Paretic: 13.8; 17.7
Non-Paretic: 15.5; 18.1

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13
Q

Modified Functional Reach Pros and Cons

A

Pros
Easy
Limited equipment
Patients who can’t stand

Cons
Cognition may limit ability to follow instructions
Need to sit without much assistance

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14
Q

TUG Dual Task

A

Community Dwelling: 15 seconds

PD: TUG manual = 4.5 different than TUG

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15
Q

TUG Pros and Cons

A

Pros
Quantify cognitive impairments
May use Assistive Device
Highly recommended for PD and MS

Cons
Need more research for meaningful changes

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16
Q

Walking While Talking Test

A

Walk 20 feet, turn around, and walk back naming letters out loud

Cut off scores:
20 seconds (simple)
33 seconds (complex)
<70 cm/s = increased risk of frailty and disability
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17
Q

Walking While Talking Pros and Cons

A

Pros
Functional testing for people with cognitive impairments
Adds cognitive component

Cons
Standardization
Limited Evidence

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18
Q

Clinical Test of Sensory Integration and Balance

A

Test balance in 6 conditions (4 on modified: no conflict dome); 3 trials in each condition with max of 30 seconds in each trial

Cut off scores
Community Dwelling: less than 260 of 540 possible seconds (summing all 6 trials) or 48%

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19
Q

CTSIB Pros and Cons

A

Pros
Identify sensory strategies
Limited equipment
Adults and Peds

Cons
Little evidence in cut offs or MDC
Not useful in tracking changes (ceiling/floor effect)
Conflict dome not always available

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20
Q

BESS Test

A

Number of errors during 20 second time frame for 6 conditions on firm and foam surface
Feet together
Single leg stance
Tandem stance

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21
Q

BESS Statistics

A

Max Score: 60 points
Performance worsens after 50 years old
No established cut off for increased fall risk

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22
Q

BESS Pros and Cons

A 
Pros
Recommended for concussion
Evidence for use in younger population
Easy to perform
Identify vestibular processing impairments

Cons
Less evidence across populations
Not useful in lower level or older adults

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23
Q

Dynamic Gait Index

A

Focus on activity level on ICF model

8 items testing vestibular input on 0-3 points scale

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24
Q

DGI Statistics

A 
Max Score: 24 points
MDC: 3 points (community dwelling, vestibular, and PD)
Cut offs
19: older adults, vestibular, and PD
12: MS
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25
Q

DGI Pros and Cons

A 
Pros
Short amount of time
Dynamic balance focus
Moderate level of equipment
With or without AD

Cons
Need 20 ft space
Subjective rating
Not super sensitive

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26
Q

Functional Gait Assessment

A

7 from DGI and 3 additional (Narrow BOS walking, backwards, eyes closed walk)

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27
Q

FGA Statistics

A

Max Score: 30 points
Cut offs:
22/30: older adults
15:30: PD

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28
Q

FGA Pros and Cons

A

Pros
Short test
Focus on dynamic balance with integration of systems involvement
More objective than DGI
Highly recommended for PD and Vestibular EDGE groups
With or without AD

Cons
20 foot space
Not appropriate for lower level (higher balance level)

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29
Q

Mini Best

A

14 items

Foam, ramp, chair w/ and w/o arms, shoe box

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30
Q

Mini Best Statistics

A 
Max Score: 28 points
MCID: 4 points (balance disorders)
Cut off scores: 
20: PD
17: Chronic stroke
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31
Q

Mini Best Pros and Cons

A 
Pros
Different systems
Functionally based
Highly recommended for PD
More time efficient than BEST

Cons
More equipment
Can take longer if patients are slower

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32
Q

HiMAT

A

13 items for 54 points

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33
Q

HiMAT Statistics

A

Max score: 54 points
Norms: 50-54 (males); 44-54 (females)
Cut offs: none established

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34
Q

HiMAT Pros and Cons

A

Pros
Good objective test for higher level balance deficits
Integrates functional tasks for younger populations
Highly recommended for TBI/concussion

Cons
Must be independent with ambulation
Consider contraindications
Limited research in other populations

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35
Q

Activity Balance Confidence Scale

A

16 item self-report measure rating patient’s confidence in various tasks
0 = no confidence
100 = very confident
Score is average of all items

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36
Q

ABC Scale Statistics

A 
Max Score: 100%
Cut offs: 
Older adults: 67%
PD: 69%
Stroke: 81% indicates multiple faller
37
Q

ABC Pros and Cons

A

Pros
Identify self-perception of balance
Objective measure of fear of falling
MS, PD, and acute vestibular

Cons
Confusing for cognitively impaired
Time intensive
Requires reading skills

38
Q

Falls Efficacy Scale

A

16 items self-reported measure rating patient’s confidence in various tasks
10 = very confident
100 = not confident
Score based on sum of all items

39
Q

Falls Efficacy Statistics

A

Cut offs:

80: increased risk of fall
70: increased fear of fall

40
Q

Falls Efficacy Pros and cons

A

Pros
Identify patient’s perception of balance
Objective measure of fear of falling

Cons
Confusing for cognitively impaired
Requires reading skills
Less researched than ABC

41
Q

Tests for identifying fall risk

A 
Berg Balance
DGI
FGA
Tinetti (POMA)
10 meter walk
ABC Scale TUG
42
Q

Tests for Dual Tasks

A

Walking While Talking
TUG Dual
DGI
FGA

43
Q

Tests for younger patients after concussion

A

HiMAT
Mini BEST
TUG

44
Q

Tests for older community dwelling adult with history of falls

A 
Mini Best
CTSIB
Berg
DGI
FGA
ABC Scale
TUG
45
Q

Tests for complaints of dizziness

A

DGI
FGA
Mini Best

46
Q

10 Meter Walk Test

A

Average 3 trials
Can use AD
Space to accelerate/decelerate

47
Q

10 Meter Walk Statistics

A

MCID: 0.05 m/s (geriatrics)

48
Q

Walking speed Table

A

0-0.6 m/s: Dependent and likely to be hospitalized
0-0.9 m/s: need intervention to reduce fall risk
0-0.1 m/s: Discharge to SNF
0.1+ m/s: discharge home more likely
1.0 m/s: independent in ADLs, less chance of hospitalization, less likely for adverse event
Household Walker: 0-0.4 m/s
Limited Community Ambulation: 0.4-0.8 m/s
Community Ambulator: 0.8-1.2 m/s
Cross street and normal walking speed: 1.2+ m/s

49
Q

Berg Balance

A

14 items testing static and dynamic activities (non-vestibular)

50
Q

Berg Balance Statistics

A 
Max Score: 56 points
MDC: 6 points (older adults)
Cut offs:
45: elderly population and stroke increased risk
40: 100% risk of falls in elderly
51
Q

Pediatric Balance Scale

A

Peds version of Berg
Scored as best of 3 trials
Ages 4-15

52
Q

Berg Pros and Cons

A

Pros
Highly recommended for incomplete SCI, MS, stroke, PD, TBI
Good evidence use for mild-moderately impaired patients

Cons
Not useful in those requiring AD
Not recommended for low level patients not anticipated to ambulate (floor effect)

53
Q

Tinetti (POMA)

A

16 items (9 balance, 7 gait)

54
Q

Tinetti Statistics

A

Max Score: 28 points

Cut offs: 19 (older adults)

55
Q

Tinetti Pros and Cons

A

Pros
Recommended for PD (not for other edge groups)
Can use AD
Strong evidence older adult population that has been hospitalized
Gait analysis component

Cons
Less generalizable for younger or healthy older adults
Can’t track changes in higher functioning (Ceiling effect)

56
Q

Postural Control

A

Controlling the body’s position in space which includes STABILITY and ORIENTATION

57
Q

Environment factor of balance

A

Layout of home

58
Q

Task factor of balance

A

Tasks performed (walking: dynamic; standing: static)

59
Q

Individual factor of balance

A

PMH

60
Q

Center of Mass

A

Center of total body mass (point)

Assumed

61
Q

Center of Gravity

A

VERTICAL projection of the COM

62
Q

Base of Support

A

Area of the body in contact with the support surface

63
Q

Postural Orientation

A

Maintain an appropriate relationship between body segments and between the body and the environment

64
Q

Postural Stability

A

Ability to control the COM within the BOS

65
Q

Posture vs Postural Systems

A

Posture: Task, individual, and environment

Postural Systems: Musculoskeletal, cognition, muscle synergies, sensory systems, sensory organization

66
Q

Task Constraints of postural control

A

Balance control: steady-state, reactive, proactive balance
Feedback control: occurs in response to sensory feedback from external perturbation
Feedforward control: anticipatory postural adjustments made in anticipation of voluntary movement

67
Q

Environmental Constraints of postural control

A

Changes in support surfaces
Differences in visual and surface conditions
Multiple tasks

68
Q

Steady-State Balance

A

Body Alignment can minimize effect of gravitational forces
Muscle tone keeps body from collapsing in response to the pull of gravity (intrinsic stiffness, background muscle tone, postural tone)

69
Q

Stability Limits

A

Point at which a person will change configuration of his/her BOS to achieve stability
Change based on task, individual’s biomechanics, and environment

70
Q

Not fixed boundaries

A

Not set

Depend on the tasks you are performing

71
Q

Factors affecting Movement Strategy

A

Stability limit

Perceptual and cognitive factors

72
Q

Reactive Balance Control

A

Motor Patterns: ankle, hip, step, reach-to-grasp
Fixed-support vs. change-in-support
Synergy: functional coupling of muscle groups to act as a unit

73
Q

Fixed-support vs Change-in-support

A

Ankle: slowed perturbation
Hip: Faster perturbation or narrow BOS
Stepping: Fastest perturbation or very narrow BOS
Reach-and-Grasp: reach and grasp while stepping after perturbation

74
Q

Ankle Strategy

A

Distal to proximal activation

Useful with small balance disturbances, on a firm surface, intact ankle ROM and strength

75
Q

Hip Strategy

A

Proximal to Distal activation
Longer length of time to regain balance
Useful with larger and faster disturbances, small support surface, and compliant support surface

76
Q

Refining and Tuning Muscle Synergies

A

Postural synergies are not fixed, stereotypical reactions
Synergies are refined and tuned in response to changing demands in task and environment
Adaptation: movements in response to demands

77
Q

Proactive Postural Control

A

Preselect muscles required to complete the task prior to the movement
Based on previous experiences
Benefits: prevent disturbances to the system

78
Q

Sensory Inputs for steady-state balance

A

Visual inputs
Somatosensory Contributions
Vestibular Contributions

79
Q

Components of visual inputs

A

Position and motion of head with respect to surrounding objects
Reference for verticality

80
Q

Somatosensory contributions

A

Provides CNS with position and motion information about body with reference to supporting surfaces
Report information about relationship of body segments to one another

81
Q

Vestibular Contributions

A

Provides CNS info about position and movement of head with respect to gravity and inertial forces

82
Q

Sensory integration of balance

A

Tend to rely on visual input when learning a new task
Transition to reliance on somatosensory system once in associative phases of learning
Increased tactile feedback changes postural muscle activation
Utilize sensory info to prevent loss of balance in different ways
Moving room example

83
Q

Neurocom Results

A 
Nothing: Vestibular, Vision, and Somato
Blindfold: Vestibular and Somato
Head Box: Vestibular and Somato
Foam Surface: Vestibular and Vision
Blindfold and Foam: Vestibular
Foam and Head Box: vestibular
84
Q

CTSIB Results

A

Vision: 2, 3, 5, and 6
Somatosensory: 4-6
Vestibular: 5-6
Sensory Selection: 3-6

85
Q

Strategies for Steady State Stability

A

Passive skeletal alignment and muscle tone
Postural tone
Hip and Ankle strategies

86
Q

Strategies for Perturbation Stability

A

Ankle, hip, and stepping strategies

87
Q

Attentional Resources

A

Info processing resources required to complete a task

88
Q

Dual-Task Interference

A

Two tasks performed simultaneously

Attentional resources may decrease in performance on one or more tasks (motor and cognitive)

89
Q

Cognitive Systems in Postural Control

A

Attentional demands vary as function of sensory context
Performance of secondary task not always detrimental effect on postural control
Important to assess balance under single and dual-task conditions

Motor Control and Learning (2 decks)

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