Exam 3 Flashcards
what are some clinical practice guidelines for the neurological population
Transfers:
Walking speed:
Walking distance:
Static and Dynamic Sitting and Standing Balance:
Balance while walking:
Balance confidence:
what happens to net center of pressure with both feet are in contact with the ground
When both feet are in contact there are separate COPs under each foot.
what is strength with aging
Decreased # and size of muscle fibers
Decreased rapid muscle force exertion
what is quiet standing use to stay up
inverted pendulum model of balance in A/P direction
slide 15 == look at equation
what are some clinical presentation for TBI
Both impaired Cognition & Physical Motor Function
Changes in Behavior and Emotional Control
*****Agitation, Aggression, Impulsivity
how doyou manage patient with depression
- Exercise helps-resistance training, group exercise
- Referral! Worsening depression needs to be treated as soon as possible.
- Part of the team: Be aware of the treatment plans and goal.
- Help patient focus less on the depression and more on other situation.
- Motivation! – emphasizing strength, positive feedback
what are connective tissue contractures
: skin, subcutaneous fibrosis(burn), aponeurosis, tendon.
what is the mini mental state examination
The examination has been validated in a number of populations. Lopez et al, 2005
what are some bone density issue
- osteopenia
- osteoporosis
- severe osteoporosis
what are some limitations for yoga hot yoga
Pre-existing conditions, such as cardiovascular disease, back pain, asthma, low/high blood pressure, diabetes, ect. should consult a doctor prior to starting hot yoga.
Should not be done in pregnant women.
look at slide in the psychosocial aspects of aging
13
how does dementia develop
Develops over a number of years and slowly worsens
what is the hallmark of TBI
decreased response to activity
what is the theoretical limits of stability
Theoretical limits of stability (LOS)
in stance are traditionally considered to
depend on the area of BOS
Valid in static standing tasks
Insufficient in dynamic situations
what are the normative date of the Fullerton Advanced Balance Scale
Score of 0-4 for each task
Higher = Better
40 Total Points (Full Form)
16 Total Points (Short Form)
what are the other types of dementia
- vitamin B12 deficiency
- over- or under-active thyroid gland
- excessive alcohol
dynamic equilibrium motor systmes
Initiate Automatic and Voultary Movements
Select and Adjust Muscle contractile patterns
Ankle Muscles
Legs/ Thighs
Trunk Muscles
what is the take home message for yoga
Yoga will help improve balance.
If you need a modification, don’t be afraid to ask the instructor.
The best intervention will be one that is individualized.
what does it mean to be homebound
Leaving your home isn’t recommended because of your condition.
Your condition keeps you from leaving home without help (such as using a wheelchair or walker, needing special transportation, or getting help from another person).
Leaving home takes a considerable and taxing effort.
what is the order of balance strategies
-ankle strategy
-hip
step
how do we find contractures out
AROM vs. PROM
Manipulation
what are the perceived exertion scales
Borg
Borg Modified
Visual Analog
what are some optic symptoms of MS
Optic neuritis – first manifestation
Visual blurring
Diplopia
Loss of vision in one eye
Balance assessment powerpoint
slide 7 and 8
why count velocity into consideration
The projected location of COM to be situated outside of the base of support at the instant of takeoff from the chair while the horizontal momentum of the COM is directed towards the base of support.
Standing will not be maintained when a sufficiently large horizontal velocity exists, even though the horizontal COM is currently located inside the BOS
what is the sensory envrionment
The condition which exist or are perceived to exist in the real world around us that impact balance
what must be achieved to have gait
balance must be maintained to achieve gait
humans are dynamic
how odes tai chi enhance mindfulness
Decreases stress / increases relaxation
Improves overall quality of life
what is hospice
Hospice is an alternative to the traditional hospital based care for the dying. Hospice is a philosophy of care that provides palliative rather than curative care
what is the somatosensory system
surface chances, irregularities,
base of support changes
why do we have an outcome measure selection
Identify an impact of the disorder on an individual
Establish baseline measurement to monitor change
Evaluate an impact of an intervention
Evaluate the needs of the individual
what are the different types of contractures
muscular
arthrogenic contractures
ct contractures
what are some causes for cognitive changes in later life
Mental processing speed decline (time to process sensory input and motor output)
Sensory-perceptual changes (ex. Sensitivity to visual contrast, sound)
what is hypokinesis with aging
sedentary – sitting in flexed posture in recliner
what is Transfer of outcome measures
Transfers: Five Time Sit to Stand (5TSTS)
how do medication affect falls
4+ prescription drugs
increase risk for falls compared to fewer
what is the SN and Sp of the Functional Reach
Specificity: 0.67 (R/I)
Sensitivity: 0.75 - 0.97 (R/O)
what are some essential exercises for osteoporosis
- posture alignment
- therapeutic exercises for straighten
- the stronger the muscle the stronger the bone
- exercises involving weight bearing retain more bone mineral than non weightbearing
what are some predictor and risk for institutionalization
Physical function Restricted mobility: mobility outside of the home Social resources and support Health perception Socioeconomic status Health-care system
what is the scoring for the DGI
3: no gait dysfunction
2: minimal impairment
1: moderate impairment
0: severe impairment
what is are the goal of Fullerton Advanced Balance Scale
Produce a functional assessment tool to identify balance issues in functionally independent older adults
what protects against further loss
walking
what is the secondary injury
Secondary Injury: changes compromising brain function relative to the trauma (increased ICP pressure, infection, seizures)
what are some characteristics for delirium
Confusion, changes level of consciousness, difficult concentrating,
sun downing
Difficulty with immediate recall, short term memory, maintaining attention.
what is cerebellum
coordinates and regulates posture, movement and balance
what is hormone replacement
(Estrogen) – can cause some side effects in some women/increase the risk of breast or uterine cancer
what is the protocol of the dual task
Cued walking Cognitive tasks paired with gait Balance Strength training Virtual reality
what are the steps for gait initiation
- standing goal
- gait initiation
- gait acceleration
- gait goal
Functional balance grades
slide 29
dynamic equilibrium- sensory systems section
Determine our body position
Compare, Select and Combine Senses
with response to environmental interactions
Visual System
Vestibular System
Somatosensation System
what is the berg balance scale
Objective measure that assesses static balance and fall risk in adults
History: Developed in 1989 by Berg et al
Key descriptions
=Static and dynamic activities of varying difficulty
=Scores range from 0-4, determined by ability to perform activity
==Item scores are then summed
Maximum score = 56
what is gait termination
The COP and COM trajectories during termination were virtually mirror images of that reported for the initiation trials.
During termination of gait
the COG must return
within the base of support.
what is the earliest finding of yoga
Earliest findings of yoga can be traced back to 5,000-10,000 years ago
what is the effect of age on daul task
Aging increases difficulty to perform dual-task activities due to:
Decreased walking speed Change in postural stability Gait deviations Cadence discrepancies Stride length difference
what are some limitations for yoga geriatric
crunches and sit-ups
Rounded back motions
End range sidebending and twisting
Forced rotation of the femur
what does the DGI involve
Walking on level surface Walking with change in gait speed Walking with horizontal head turns Walking with vertical head turns Walking with pivot turn Stepping over an obstacle Stepping around obstacles Walking up steps
what is severe osteoporosis
BMD more than 2.5 standard deviation below adult peak mean with history of one or more fracture
what is functional definition
Lose the ability to perform activities of daily living and need assistance (institutionalized, Dependent on others for ADL care, Debilitated and could not survive without substantial help, Need long-term help with basic ADLs)
what is the hallmark of PD
Pathologic hallmark:
degeneration of the substantia nigra in association with production of Lewy bodies
Progressive loss of dop
what do we do with acute care phase in pt
Pain management with modalities
Bed rest
Therapeutic exercise
—Addressing postural awareness
how does independent mobility outside the home associate with
Independent mobility outside of the home has been found to be associated with lower risk of institutionalization
In nursing home, 66% difficulty transferring from bed to chair, 66% have difficulty with ambulation.
what are some problems associated with institutionalization of latrogenic illness
Adverse drug reaction
Fluid and electrolyte imbalance
Falls or other accident
Nosocomial infection(UTI, bacterial infection, pneumonia and wound infection)
what is the max score for the berg
14 items with 4 being the highest score for each item
Max score is 56
what is vestibular
equilibrium
spatial awareness
rotation
linear movement
DGI ability to predict fall in older adults
Older Adults (mean age 73)
Specificity: 86%
Sensitivity: 67%
what are the normal bestest socres
60 – 69 yr old
86.5 ± 15.6
70-79 yr old
82.6 ± 14.5
80 – 89 yr old
72.6 ± 15
what is center of gravity
The vertical projection of the Center of Mass (COM) onto the ground
Point of origin about which all particles of body are equal distributed
Refers only to vertical direction in which gravity acts
what are the sensory orientation (bestest)
15 points
Sensory Integration for Balance (EO, EC, Firm, and Foam)
Incline – Eyes Closed
what is cerebral cortex
contributes higher level thinking and memory
what is release phase
the COP moves posteriorly and towards the swing limb
This will accelerating the COM forward and towards the stance limb.
how long does it take for the DGI to administer
10-15 minutes
<10 minutes if experienced
No prior training required to perform the test
Just need to know how each task is scored
what is the importance of the physical function in the elderly in relation to ADL
An individual’s dependence on others for ADLs.
It is estimated that 60% of people older than 65 years who are dependent in 5-7ADLs reside in nursing homes
what is their gait and balance impairments in someone with PD
Characteristic Gait Patterns
Balance Impairments: Retropulsion, Freezing Episode’s
what is visual
sight
what are the ability to predict fall risk of the Tinetti
Sensitivity of 68% - true positives
Specificity of 78% - true negatives
what is Crystallized intelligence:
knowledge that must be learned or memorized.
what are some problems associated with institutionalization hostile physical environment
- raised beds
- shiny floors
- restraints
what is Fluid intelligence:
the ability to process new general information that requires no specific knowledge.
what is the stability in gait (bestest)
21
Gait – Level Surface Change in gait speed Walk with Head turns – horizontal Walk with Pivot Turns Step over Obstacles Timed ”Get up and Go” Timed “Get up and Go” with dual task
what has no impact on bone mineral density
swimming
what are some pathologic changes the contribute to posture changes
Neurologic Disease Pain and joint limitation cause by arthritis Cardiopulmonary complications Postural hypotension Hypokinesis
what are the different type of yoga
-pre classical
classical
post classical
modern
what are some fear of falling interventions
Home-based exercise and fall-related multifactorial programs and community-based tai chi delivered in group format.
Balance training reduces fear of falling
what do you do with sub acute phase in pt
Walking program
Therapeutic exercise
Strengthen abdominals, back extensors, —scapular retractors
—-Avoid lifting >10 #, avoid flexion
why count velocity into consideration PART 2
Conversely, it is possible for the COM to be initially located outside the BOS, and still be able to achieve upright standing, provided that sufficient horizontal COM velocity is directed toward the BOS.
Balance may be impossible
if COM velocity is directed outward.
look at slide in the psychosocial aspects of aging
15
what is the visual system
lighting, movement, self
what is the motor output
- vestibuloocular reflex
- motor impulse
- motor impulses
how would you decrease decline in the intelligence
Healthy remained mentally active demonstrated less decline.
what is another impairments that affects balance
-posture
-
what is the reliability of the TUG
Inter-rater: ICC 0.992 - 0.91
Intra-rater: ICC 0.0.749 - 0.99 (decreases as time between tests increases)
Test-retest standard of error: 1 second (2-7 days)
what is the target population for dance
Parkinson’s Disease!!! Stroke Multiple Sclerosis Spinal Cord Injury Huntington’s Disease Elderly (>60)
Basically, older people with neurological conditions would respond well to dance interventions!
what is the cognitive factor of influencing frailty
high levels of education are reported to have favorable effects on the health of aging people. Cognitive impairment is an independent risk factor for admission to an institution.
what are some clinical presentation of cognition impairment in someone with stroke
impaired orientation, problem solving, impulsivity, decreased insight into deficits, cautious
Language Deficits: aphasia, dysarthria
what are the aspects of the transitions- anticipatory postural adj. (bestest)
18 points
Sit to Stand Rise to Toes Stand on One Leg Alt Stair Touching Standing Arm Raise
what are the normative scores of the Functional Reach
< 6-7 in. indicates limited functional balance
> 10 in. indicates functional balance
Look at pp of aging
slides 29-31
what is the history of the Fullerton Advanced Balance Scale
California State University, Fullerton Center for Successful Aging
—– Debra Rose
Established in 2006
Revised in 2008
what is the TUG
- 10 ft measured from the start position/front of chair
- ensure the subject is sitting all of the way back in a standard arm chair
- “On the word GO you will stand up from the chair, walk to the line on the floor, turn around, and walk back to the chair and sit down.”
- timing begins on the signal go and ends when the buttock returns to the chair
- patient should be given 1 practice trial that is not included in the score
what is the prevalence of fear of falling
The prevalence of fear increased with age and women.
Associated with decreased satisfaction with life
Increased frailty and depressed mood and recent falls.
Decreased mobility and social activities.
Decline in physical and mental performance, an increased risk of falling and progressive loss of health-related quality of life.
how long does the berg take to administer
15-20 min and the time goes down with experience
how does the SES affect the elderly
Poor and near-poor elderly people are more likely to be experiencing health problems for which they require medical services than elderly people who are economically better off.
what is the affective symptoms of depression
Sadness Anxiety Irritability Fear Anger Depersonalization Feelings of isolation
what is the Recap of the DGI
8 items with 3 being the highest score for each item
Max score is 24
A score of <19 is an indication of increased risk for falls
what is the reliability of Functional Reach
Inter-rater: ICC 0.54 - 0.98
Intra-rater: ICC 0.83
Test- retest: 0.75 - 0.89
what does the DGI assess
Assesses individual’s ability to modify balance while walking in the presence of external demands
what are the types of dementia
- alzheimers
- vascular
- other
what is mobility in relation to motor control
Dynamic Sitting and Standing
Gait (initiation and termination )
Motor output- vestibular system function info
Head position in space
Linear movements of the head
Rotational movements of the head
Linear and angular accelerometer
what is the outcome measure selection: evidence
Population of interest
Is the measure reliable?
Is the measure valid?
Is the measure responsive the change?
what are some common causes of TBI
Motor Vehicle Accidents Falls Sports Related Injuries Drugs/ETOH Abuse Human Error
what is neuromuscular jx
contact inefficiency
–exercise has been shown to improve nerve conduction velocity, reaction times and strength.
what is skilled nursing facility
SNF differ from other senior housing facilities in that they also provide a high level of medical care
what is center of pressure (COP)
A vertical line projecting downward from the actual center of gravity onto the force plate a representation( indirect measure) of center of gravity
The point location of the vertical ground reaction force vector.
It represents a weighted average of all the pressures over the surface of the area in contact with the ground.
what does the scoring process mean of the Tinetti
Scored 0-1 or 0-2 (max: 28)
Minimum (0) = most impaired
Maximum (1 or 2) = least impaired, independent
16 items 9 balance (16 points) 7 gait (12 points)
what are some limitations of tai chi
muscle soreness
what is base of support (BOS)
The area of the object that is in contact with the support surface (anteroposterior length of the foot and the mediolateral width of stance
what is osteoporosis
BMD at least 2.5 standard deviation below adult peak mean without evidence of fractures
what is brainstem
integrates and sorts sensory information
what are some problems associated with institutionalization of latrogenic illness
Unintended and harmful condition resulting from a diagnostic or therapeutic intervention
Or an accidental injury occurring in an institutional setting.
how do you manage patient with dementia
Simplify—keep it simple! Explain Reorient Slow down Avoid change One step at a time Take care of yourself
what is MCID
Minimal clinical important difference (MCID)
Clinical Bottom Line: The MCID is a published value of change in an instrument that indicates the minimum amount of change required for your patient to feel a difference in the variable you are measuring.
what is WU
characterized by softness and emphasis on redirecting incoming force
what si the protocol for PD for late disease for yoga
Chair Cat Pose Chair Cow Pose Chair Gate Post Chair Spinal Twist Chair Pigeon Pose Modified Low Lunge Chair Without chair Modified Extended Angle Pose
what is Parkinson disease
A disorder of the subcortical gray matter in the basal ganglia
Basal ganglia Function: provide a feedback mechanism to the cortex for the initiation and control of motor responses
what is hyperactive deliruim
agitated, with mood swings, at times angry, belligerent, and aggressive towards caregivers.
what is some info about homehealth
The home health agency caring for you must be approved by Medicare (Medicare-certified).
what is system definition
Take into account various interlocking physical, psychological and social complexes. (Diminished ability to carry out practical and social activities of daily living, Have poor functioning in physical, cognitive, emotional, sensory and social functions. )
what is swelling joint distention
modalities and anti-inflammatory medication.
what is kyphosis causes
Respiration
Scapular resting position
what is tai chi
A traditional martial art that embraces the mind, body, and spirit
Movements are conducted slowly, deliberately, and gracefully with continuous movements
Principles are based on philosophy of Taoism, which stresses the natural balance in all things
Things perfectly balanced in harmony are at peace, leading to longevity
how is more affected by lower social relationships
Women less affected than men
how do you score the Bestest
Score each category 0-3
what is the time to administer the Functional Reach
5 min
what are the aspects fo the biomechanical (bestest)
15 points Base of Support CoM Alignment Ankle Strength & range Hip/Trunk Lateral Strength Sit on Floor and Stand up
what is the normative data of the Tinetti
slide 6 + 7
what are some limitations for yoga decreased balance
Chair yoga
Single leg stance
Avoid many body position changes
Always practice with others.
what are the 3 systems that have sensory input into balance
- vestibular
- visual
- proprioception
what is Hao
Characterized by slow and internally loose movements
how much does it cause to treat injuries from fall
costs more than $19 billion each year to treat injuries from falls
what is the target population for dual tasking traing
Stroke TBI Alzheimer Parkinson’s Disease older population
what is the task description of the Functional Reach
- stand close to the wall, but not touching
- yardstick is affixed to the wall at the level of the patient’s acromion
- lift arm closest to the wall to 90 deg of shoulder flexion w/ a closed fist- start position recorded on yardstick at 3rd metacarpal head
- instruct subject to “reach as far as you can forward without taking a step”
- location of the third metacarpal is recorded in inches
- 5 trials → two practice trials followed by three test trials that are averaged to provide the final score
what is the ability to predict fall risk and cut off of the Fullerton Advanced Balance Scale
“The probability of falling increased by 8% with each 1-point decrease in total FAB scale score … a cut-off score of 25 out of 40 on the FAB scale produced the highest sensitivity (74.6%) and specificity (52.6%) in predicting faller status.”
what is the take home message for dance
encourage your patients to stay active and get moving. If they enjoy dance, they can get the added benefit of improving their balance!
what is forward head cause
Cervical pain
what are some self reports (outcome measures)
The Activities-Specific Balance Confidence Scale (ABC Scale)
The Tinetti Falls Efficacy Scale
what is intermediate care facility
facilitating the transition from hospital to home. Other aims include avoidance of admission and improvement of pre-acute and post-acute care.
what is postural stability
The ability to maintain the body’s center of gravity (COG) over the base of support (BOS) in a given sensory environment
what is the education for pain
Purpose of pain mgmt, scheduling in consideration of therapy sessions (when patient receives prn)
Importance of communicating with healthcare team about pain
Importance of activity in pain mgmt
what are the reliability and validity of the bestest test
ICC = .91
Excellent
Validity: r=.636, P
what are arthrogenic contractures
capsular tightness, collagen of joint capsule will shrink, cartilage loss.
what is somatic symptoms of depression
Fatigue Altered sleep patterns Weight gain or loss Tearfulness Agitation Heart palpitations Overall weakness
what are some age related changes related to posutrue
- disc impairment
- flexibiliy t
- modification
- education
- strength
- pain
- hypokinesis
what causes a greater likelihood of being institutionalized
Time in hospital—greater likelihood of being institutionalized in a nursing home.
how do we determine the quality of instruments
Sensitivity
Specificity
Reliability
Validity
Likelihood ratios
- slide 26
what are some physical impairments of tai chi that it addresses
Range of motion Flexibility Strength Postural stability Bone density CV system
what are way to lower your risk of having a low social relationship in the elderly
People who had spouses or pets and belonged to social support groups had a lower risk
what are some functional balance assessments (outcome measures)
Berg Balance Test Dynamic Gait Index Functional Gait Assessment Timed Up and Go (TUG) Tinetti Performance Oriented Mobility Assessment (POMA) Fullerton Advanced Balance (FAB) Scale The Balance Evaluation Systems Test (BESTest) High Mat
what is a flexibility with aging
Decrease in elastin and increase in collagen.
Collagen – main supportive protein in skin, tendon, bone, cartilage, connective tissue
Tendons and ligaments become more rigid and less resilient to length changes
Hypokinesis (decreased activity)****
what is disc impairments with aging
Decreased water in nucleus
Increased fibrosus of annulus
flatter less resilient disc
what is the DGI for reliability/ validity
some things are excellent
slide 13
what does a low score mean for Tinetti
higher risk of falling in the next year
how do you manage patient with delirium
Hydration!
Calm and quiet environment
Low level of lighting without shadows, natural lighting
Simple clear explanations.
Familiar objects, individuals
Visual hearing aids
Avoid restraining agitated patient with delirium.
what can dementia cause
May also cause personality changes
what is unloading
is achieved by a rapid activation of the stance limb.
what increase with falls
Reduced gait speed, stride velocity, Increase gait variability.
Significantly longer postural anticipatory adjustment phase during gait initiation
Difficulty with dual task
what is standing goal
keep the body com sately within the base of support
what is the indication of the Tinetti
Geriatric fall risk*
Neurologic Rehabilitation
–Parkinson’s Disease
–Stroke recovery
what is the validity and reliability of the Fullerton Advanced Balance Scale
Test/Retest Reliability - total score
Excellent
r = 0.96
Test/Retest Reliability - single items
Adequate to Excellent
r = 0.52 - 0.82
Interrater Reliability
Excellent
ICC = 0.955 - 0.999
Concurrent Validity
Excellent Correlation w/ BBS scores
r = .75
what are some abnormal balance due to specific pathologies
-stork
what is the validity of the TUG
High correlations to ambulatory mobility, disability status, mod: balance confidence
what is the history of the Tinetti
AKA Tinetti Mobility Test (TMT) or Performance-Oriented Mobility Assessment (POMA)
Created by Mary Tinetti (Yale University) in 1986
Used to predict patients that will fall at least once in the next year
what is stability in relation to motor control
Maintain our Center of Mass over our base of support
Minimize motions of our center of mass
Restore our Center of Mass in changing Environments
what are the symptoms of depression
- cognitive
- somatic
- affective
what are some functioan limitations that tai chi helps with
Balance and coordination
Gait improvements
what are some limitations of dual task
They are already a fall risk!
Fear/apprehension during training
Difficult to measure progress
look at slide of balance assessment
33 + 34 +35 +36 == this is all talking about the equipment in the new lab
what is the psychological factor of influencing frailty
Self-rated health
what is the osteoprosis NIH definition
“a systemic, skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a constant increase in bone fragility and susceptibility to fracture”
what are thsome training effects of Tai chi
Fear of falling Single leg stance Rate of falling Flexibility Walking velocity* Berg Balance Scale TUG Functional reach Ankle and knee joint strength and ROM Decrease stress Enhance sleep quality Enhance immune system Improve joint pain Improve symptoms of congestive heart failure Increase aerobic activity
what are the risk factors for osteoporosis
Sex Age Race Family History Tobacco Lifetime exposure to estrogen (amenorrhea) Medications (steroids, thyroid hormones, heparin..) Calcium Sedentary lifestyle Alcoholism Depression
what is proprioceptive
touch
what are some treatment of osteoporisis through drugs
- hormone replacement
- selective estrogen receptor modulators
- bisphosphonates
- calcitonin
what is the physical factor of influencing frailty
Physical ability appears to be an important asset and impaired ability an important deficit in establishing frailty.
what is dynamic conditions
COM can be outside of BOS as long as the COM velocity is large enough = balance can be maintained
what is the Sn and SP of the TUG
Specificity: 0.31 - 0.56
Sensitivity: 0.74 - 0.8
what is the vestibular system
Gravity, linear, angular, head/eye movements
DGI ability to predict falls in elderly
Elderly (>65)
Specificity: 64%
Sensitivity: 59%
what is classical yoga
Organized to contain the eight-limbed path which contained steps toward obtaining enlightenment
what are some ways to help with pain
- modification
- education
Falls and the elderly
Falls
are the leading cause of
injury-related deaths
among people age 65 and older
what are considered basic ADLs
Basic ADL: in nursing home bathing> dressing > toileting > eating
what is gait goal
move the body outside the base of support and prevent falling.
what is chen
- Developed by Chen Wangtingin
- Characterized by emphasis on spiral force
- Movements are slow and soft combined with fast and hard
- Explosive power and low stances
what are some other clinical presentations for someone with MS
Sensory changes
Heat Sensitivity
Spasticity
Fatigue
Balance Impairments: secondary consequence of immobility
what is gait initiation
Move body over the ground just one step the criterion of balance are drastically altered.
what task are in the berg
Sitting unsupported Change of position: sitting to standing Change of position: standing to sitting Transfers Standing unsupported Standing with eyes closed Standing with feet together Tandem standing Standing on one leg Turning trunk with feet fixed Retrieving objects from floor Turning 360 degrees Stool stepping Reaching forward while standing
what is a positive test for fudkda
> 30 degrees
what could causes delirium
Medication, life-threatening illness
what is hypoacive delirium
extreme drowsiness, fatigue, and indifference.
what are the balance impairment of TBI clinical presentation
Altered sequencing of muscle activation
Lack of awareness to balance deficits
what is calcitonin
– hormone that regulates bone metabolism; reduces bone resorption and may slow bone loss
what are some types of delirium
- hyperactive deliruim
- hypoacive delirium
what is osteopenia
BMD between 1 and 2.5 standard deviation below adult peak mean without evidence of fractures
what is the validity and reliabiltiy of the Tinetti
Excellent test-retest reliability ICC 0.96
Good interrater reliability ICC 0.84
Criterion validity - excellent correlation r=0.81
Better test-retest, discriminative, and predictive validities than TUG, one-leg stand, and functional reach tests
what sit he financial factor of influencing frailty
socioeconomic factors
what are the integration of input
- cerebellum
- cerebral cortex
- brainstem
what is during this single support time
the COM now accelerates forward and away from the stance limb.
what are some modification with aging
Slow, prolonged stretching
Focus on FUNCTIONAL range not normal
how does the memory change in later life
No definitive conclusions
Difficulty with multi-memory tasks
Frontal lobe shrink–working memory decline
Generally, long term memory less affected than short term memory.
what does the time to administer the Tinetti
10-15
what is the protocol for dancing
Could include ballroom, swing, pop, folk, even “traditional Greek!”
Partnered dancing vs. non-partnered dancing showed equal improvement, but “partnered dancing patients expressed more enjoyment and interest in continuing” (Hackney et al)
Dynamic movement with flow!
what is motor control in relation to balance
- stability
- mobility
- controlled mobility
- skill
what is the normal limits of stability for medial to lateral
ML total 16 degrees (8 both right and left)
what is the take home message for the aging population for non injured .
Figure out the causes to an abnormal posture.
Extension, Extension, Extension!!!
Weight bearing aerobic exercise is beneficial for preventing osteoporosis.
Motor output- vestibular system function impact of the system
Gaze Stability
Balance and Postural Stability
Orientation in Space
what is post classical yoga
Rejuvenate the body and prolong life
Embraced the physical body as the way to obtain enlightenment
what is postural alignment for osteoporosis
Extension! Extension exercise reduce the incidence of spine fracture reoccurrence.
what are the types of intelligence
- fluid intelligenece
- crystallized intelligence
bergs ability to predict falls
Older Adults (mean age 75)
Specificity: 82%
Sensitivity: 91%
balance PP
slide 36
what is the history of the TUG
- initially established in 1986 as the “Get Up and Go Test” by Mathias et al
- modified to integrate time in 1991 by D Podsiadlo and S Richardson
- is used to assess mobility, balance, walking ability, and fall risk
what is after unloading
of the right limb the COP under the stance moves forwards.
what is walking distance of outcome measures
Walking distance: 6 minute walk test (6MWT)
what are some results form a stroke
Compensatory patterns of recovery
Abnormal motor patterns – flexor and extensor
Impaired balance and functional mobility
what are the 4 cardinal signs of PD
Rigidity
Bradykinesia
Tremor
Postural Instability
what is alzheimers disease
The most common type of dementia.
It is more likely to affect women or those who have a parent, brother, or sister with dementia
what is therapeutic exercises for strengthening
High impact activities are better at increasing BMD than low impact activities.
what is adult day care
Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day.
how does health perception affect the elderly
A person’s subjective assessment of his or her personal health condition
Good health perception has been found to be an asset even when ADLs are impaired.
Level of independence and social support affect health perception
what is dual task training
Ability to perform two or more cognitive and motor activities simultaneously while maintaining postural control (Shin, An, 2014)
“The ability to divide one’s attention between two or more concurrent tasks is an important aspect of functional movement during ADL (Shin, An, 2014)”
what are some limitation of dnace
- safety - guarding
- environment
- suboptimal compliance
- —classes offered through community centers
- –encourage participation
- aging effect
- -cognitive impairments
- –moving impairments
what is the Bestest
Developed by Dr. Fay Horak in 2008
Balance Evaluations Systems Test
Breaks down balance into 6 sub-categories
what are some surgery
- cement injected (vertebroplasty)
- kyphoplasty
what is home health
Highly technological services, Skilled services, Pharmaceutical and infusion services, Home medical equipment services, Custodial care service
what is COM (center of mass)
An imaginary point in space that is at the center of the total body mass
unique point where body forces sums to zero
All particles of body are equally distributed
Does not depend on vertical orientation
The point where if a force is applied it moves in the direction of the force without rotating
what are some physical therapy intervention of post fractures
- acute phase
- subacute phase
what are the mean score for the ages for the berg
60's= 55 70's= m 54 f53 80's= m 53 f50
what is gait acceleration
move COG in a forward direction and voluntarily initiate the start of a forward fall to accelerate the COG ahead of the base of support
what is the training effect of dance
Improvements in BERG and TUG outcome measures
Increased:
- **Postural stability, proprioceptive control, and core activation
- **Ambulatory velocity and cadence rate (assessed by 6 minute walk test)
Helps maintain and improve mineral bone density
Enhanced cardiovascular functioning
Develops static and dynamic balance
look up virtual reality
slides
what is the scoring of the berg balance
Scoring specific to each task, with 4 meaning patient can independently perform activity meeting time/distance criteria and 0 meaning patient is unable to perform activity
what is pre classical yoga
Collection of texts containing songs, mantras, and rituals
what is the berg cut off score
A score of <45 is an indication of increased fall risk
how can we prevent falls
In order to prevent falls, it is important to identify the causes of falls, especially the modifiable risk factors for falling.
It was hypothesized that muscle weakness and balance performance were modifiable risk factors for falls in the elderly [Tinetti M.E. et al. 1994, Buchner D.M. 1997].
At what age is there a restricted mobility
> 80 years old
what is dementia
Enlarge ventricles, shrinkage cortex and hippocampus
Loss of memory
Lose daily living skills
what are the take home messages
- addresses physical impairment s
- addresses functional limitations
- enhances mindfulness
what are the cut off of the Tinetti
≤18 High
19-23 Moderate
≥24 Low
what are things that need to evaluated with balance issues
Vitals Cognition Motor Sensory Balance Function
what is static conditions
an object is considered stable when the center of mass (COM) is maintained over its base of support (BOS).
what is balance confidence of outcome measures
Balance confidence: Activities Specific Balance Confidence Scale (ABC)
what is Sun
Created by Sun Lu-Tang
Youngest of all the styles
Characterized by agile steps, movements are smooth
High stances, easier for older people
Compact, doesn’t require large space
Holds learners’ interest
what is the activity pyramind for seniors
- sit as little as possible
- do yard work or house cleaning (2-3)
everyday walk more at home take stairs park further from store
what is the healthcare interdisciplinary team role =
Must address
balance and vestibular dysfunction
In the neurological population
Decrease Risk For Falls
Decrease Risk for Injury
Improve functional mobility
Improve Quality of Life
what is the age of the Bestest
65+
what are the 6 areas of the bestest
biomechanical constrains stability limits/ vertically anticipatory postural adjustments postural responses sensory orientation stability in gait
what is bisphosphonates
- inhibit bone breakdown/bind permanently to bone surfaces and limit osteoclast activity
what are the scores of the mini mental state examination
Scores of 25-30: normal
21-24 : mild,
11-20 : moderate
<10 : severe impairment.
Elderly patients with college education who present with complaints of cognitive decline and score < 27 on the MMSE are at greater risk of being diagnosed with dementia.
by 2020 what is the annual cost of falls
By 2020, the annual costs
for fall-related injuries are expected
to reach $54.9 billion
what are some key description for DGI
Can be performed with a marked distance of 20 feet
Can be performed with or without an assistive device
Scores based on a 4-point scale
Maximum score = 24 points
what is vascular dementia
It is more likely to affect men.
High blood pressure, high blood fat (cholesterol), diabetes, and smoking all increase the chances of having vascular dementia.
what is limits of stability
The furthest distance in any direction a person can lean away from midline (upright vertical) without altering the base of support (BOS), reaching or falling
how does learning change in later life
Slower but once something is learned the rate of forgetting is no faster than young ones
Sensory deficits affect learning.
what is the balance and posture in human gait
Total body center of gravity and the center of pressure under the support feet during level walking.
The COG moves forward along the medial border of each support foot and during single support it is accelerated away from the support foot towards the future position of the swing foot.
what si modern yoga
Yoga masters traveled to the West and it became more modernized
look at slide of balance assessment
32 - basically is saying that the slower we walk the more likely you will fall and the faster you walk the less likely you will fall
how does the TUG have the ability ot predict falls
Related to many factors: age, footwear, cognition, AAD
TUG = shouldn’t be used alone to determine fall risk
what is the ultimate goal for yoga
Ultimate goal of Yoga is to attain balance between mind and body for a joyous and healthy lifestyle
*******Meditation, yoga postures, and breathing
Research has shown that Yoga has many benefits, regardless of religion, race, age, and origin
****Including balance
what are some strengthening considerations
- cardiovascular
- neuromuscular jx
- swelling joint distention
- other= Pathology, such as Parkinson’s and stroke(muscle tone)
what is delirium
Acute brain syndrome
what are some clinical presentation of asymmetry in someone with a stroke
Sensation Impairments:
Motor: Weakness, Spasticity/Tone
what does a low quanity of social relationship relate to in the elderly
Increased risk of death and institutionalization among persons with a low quantity of social relationships.
what is cognitive symptoms of depression
Poor concentration Low self-esteem Indecisiveness Guilt Hopelessness Inability to concentrate Suicidal ideations
what is the cutt off score of the TUG
> /= 12 sec in older adults is indicative of being at risk for falls
Community Dwelling Frail Older Adults > 14 sec associated with high fall risk
Post-op hip fracture patients at time of discharge > 24 sec predictive of falls within 6 months after hip fracture
Frail older adults > 30 sec predictive of requiring assistive device for ambulation and being dependent in ADLs
how do we achieve posture stability
- maintain - COM and BOS
- minimize- motions of the com and cop
- restoring- com or cop to an optimal location
what is the modification for pain
Rate pain
Point to exact location of pain
Effective pain mgmt – TENS, visual imagery, relaxation, coordination with MD re: medications
what are the clinical presentation of PD hallmark
motor disorder
what is walking speed of outcome measures
Walking speed: 10 meter walk test (10mWT)
what are some clinical presentation of balance impairments with a stroke
New center of mass
Delayed Motor Response
Frequent losses of balance towards the involved side
what does stability limits depend on
Stability limits depend on
interaction between
position and velocity of the COM.
what are the validity of Functional Reach
Adequate correlation with Berg, TUG
Other factors play into balance besides limits of stability
what are the normal scores for hte TUG
60-69: 8.1 sec
70-79: 9.2 sec
80-89: 11.3 sec
What is MDC
Minimal detectable change (MDC)
Clinical Bottom Line: The MDC is the minimum amount of change in a patient’s score that ensures the change isn’t the result of measurement error
what is the Normal limits of stability for anterior to post.
AP total 12.5 degrees (8 forward, 4.5 backward)
how many people fall
Every 18 seconds, an older adult is treated in an emergency room for a fall, and every 35 minutes a senior dies following a fall.
One out of every three people aged 65 and older falls each year, despite the fact, that research shows most falls are preventable.
what is motor impulses
to control the eye movements
and
to make postural adjustments
what are some education with aging
Effects of sedentary lifestyle
Encourage FREQUENT activity
what is the living arrangement factor of influencing frailty
prolonged stays in hospital, admission to an institution
what is assisted living
Assisted living is designed for individuals who require assistance with everyday activities such as meals, medication management, or physical assistance with bathing, dressing, and transportation.
what are some spinal compression for osteoporosis
- pain
- orthosis– lumbosacral
- transitional movements within a safe environment
what is the bestest test used for
MS, PD, Stroke, Cerebral Palsy, and other neurological disorders
what is Wu/Hao
- Rich with hand techniques, emphasis on internal force
- Tends to have a slightly forward leaning posture
- Uses a higher, more narrow stance, so it may be easier for beginners and ideal for improving balance
berg reliability/ valididty
this a excellent stats
slide 6
what is the training effect of dual task
Improves gait velocity and stride length
May improve balance and cognition
Improves balanced weight distribution, BOS
what is normative data for the DGI
30= 24 40= 24 50= 23.9 60= 23.9 70= 23.9 80= 22
when does delirium start and how long does it last
Abrupt onset (typically hours to weeks)
Look at slide
24 of the clinical assessment of blance
what are the aspects of the stability limits (bestest)
21 points
Sitting Vertically and Lateral Lean
Functional Reach Forward
Functional Reach Lateral
what is selective estrogen receptor modulators
(SERMs; Raloxifene [Evista]) – synthetic drugs mimic estrogen’s beneficial effects on bone density; block the effect of estrogen on breast and uterine tissues
what are the time to administer the Fullerton Advanced Balance Scale
10 functional test items
10-12 minutes to administer the test depending on the functional level of the patient
Test is designed for higher functioning, active elderly patients
what are the most common fractures
hip
spine compression
wrist
was is the average cost from a fall
Average hospitalization for a fall
costing $17,500.
what are some problems associated with institutionalization: undernutrition
Failure to thrive Impaired physical function Weight loss Depression Cognitive impairment
Dehydration—Check hydration!
what are some limitations for yoga pregnant
No poses on the back after the first trimester.
Avoid stretching the abdominals too much.
Ensure enough balance or use chairs/walls for stability.
what are are the phases of gait initiation
- releasee phase
- unloading
- after unloading
- during this single support time
what are the reactive postural response (bestest)
18 points
In Place Response (Forward, Backward)
Compensatory Stepping Correction (Forward, Backward, Lateral)
what is the history of Functional Reach
established in 1990 by PW Duncan et al to measure limits of stability
what is static and dynamic sitting and standing balance of outcome meausres
Static and Dynamic Sitting and Standing Balance: Berg Balance Scale (BBS)
what are some exericese for posture correction
extension and prevention
what is the balance while walking of outcome measures
Balance while walking: Functional Gait Assessment (FGA)
what is target population of tai chi
Anybody
Older Adults
***Especially for those suffering from complicated conditions with disruptions in their visual and somatosensory systems.
***More beneficial for the less frail older adults
what happens with age and anterior posterior motion
Significant age differences did exist for antero-posterior motion of the COM and it’s relationship with the COP
what is a primary injury of TBI
Primary Injury: Direct Consequence of the Mechanical trauma at the time of injury
what is the interpersonal factor of influencing frailty
Social resources are important to frail elderly people
who is eligible
under the care of a doctor, and getting services under a plan of care established and reviewed regularly by a doctor.
a doctor must certify that you need, one or more of the following: Intermittent skilled nursing care , Physical therapy , Speech-language pathology services, occupational therapy
what is biomedical definition
Disease and illness oriented descriptions of the frail population (Multiple diseases, Numerous chronic conditions, Require long-term hospital care)
what is balance both made of
intergrated
interactive
what are some biological changes the contribute to posture changes
Discs Ligaments Joint capsule Articular cartilage Muscle Bone density
what is the target population for yoga
Arthritis TKA Chronic Low Back Pain Parkinsons Multiple Sclerosis
slide ageing of m.
3 plum lines
how long does it take to administer
less than 3 min
when does intelligence decline
Decline does not actually occur until the sixties or seventies.
what is ability to predict falls for the Functional Reach
Considers limits of stability, but balance is a more complex task;
Component of balance assessment but not used alone
What conditions must be fulfilled for balance to be maintained?
Static Sitting Dynamic Sitting Static Standing Dynamic Standing Translation
what is cardiovascular
inefficiency leading to poor nutrient exchange
–increase activity level—increase blood flow to the muscle
Look at Dance why dance slide
2
what are some institutionalization
- acute care facility
- inpatient rehabilitation facility
- skilled nursing facility
- intermediate care facility
- adult day care
- assisted living
- home health
- hospice
what is a stroke
A stroke produces a sudden change in an individual’s neurological functions #1 cause: HTN
Mismatch of sensation and motor functions that interferes with normal movement patterns
how long does it take to administer the Bestest
Time to Administer 20-30 minutes
what would increase BMD
weight training or running
what is the training effect for yoga
Improved breathing control ****Increase oxygen supply to fight fatigue Increased body awareness Increased mobility Decreased pain Decreased joint stiffness Improved self reported function ******Regional Interdependence 1.4 second decrease in TUG - Knee OA population ***MCID= decrease of .8-1.4 seconds
what equipment do you need for Tinetti
Hard, armless chair
Stopwatch
15 foot walkway
what is standard error of measureement (sem)
Standard Error of Measurement (SEM)
Clinical Bottom Line: The SEM is the amount of error that you can consider as measurement error
what are the task description of Fullerton Advanced Balance Scale
Stand with feet together and eyes closed Reach forward to retrieve an object held at shoulder height w/ outstretched arm Turn 360 degrees to left and right Step onto and over a 6 inch bench Tandem walk Single Leg balance Stand on foam with eyes closed Two footed Jump Walk with head turns Reactive postural control
what is MS
Autoimmune chronic Inflammatory demyelinating disorder
Destruction of myelin sheaths & oligodendrocytes
Repair produces scars or plaques
Axonal Loss (white matter) destruction early Cell Death (gray matter) over time
Patchy demyelination
what is net center of pressure
If both feet are in contact with the ground the net center of pressure (COPnet) lies somewhere between the two feet, depending on the relative weight taken by each foot.
how does the fall prediction work with the bestest
Sn = 0.86
Sp = 0.95
Cut off = 69%
Adequate ability to detect falls
what is Yang
Created by Yang Lu-Chan in early 19th century
Most popular form
Characterized by gentle, graceful, and slow movements
Easiest to learn
what is pain with aging
Decreased ability to localize pain
Decreased production/use of enkephalin
Decreased report of pain due to social pressures
what are some abnormal postures
- forward head
- kyphosis
- decreased lumbar lordosis
- increased lumbar lordosis
- loss of height
other
=Hip flexion contractures
=Knee flexion contractures
=Valgus/varus changes
what is the clinical assessment of balance
Observation
Sensorimotor
Assess Lower Extremity sensation
Proprioception
Static and Dynamic Sitting Balance
Static and Dynamic Standing Balance
Narrow Base of support
Eyes open and Eyes closed
Functional Reach
Assess Ambulation
Vestibular System (if indicated)
what is factors that influencing frailty
- financial
- cognitive
- interpersonal
- physical
- psychological
- living arrangement
what is the generic protocol of yoga
Instructor biased
Key elements
Breathing exercises, postures, and meditation
Do not hold body tightly, or jerk the body at any point of time
Perform the practices according to your own capacity
Persistent and regular practice is essential
Each session should end with meditation/deep silence
what are the protocol for PD for early/midl disease for yoga
Cat Pose Cow Pose Cobra Pose Downward Facing Dog Low Lunge Warrior II Pose
what is a TBI
Altered brain function as a result of a external physical force or trauma
what are the cut off scores of the Functional Reach
Community Dwelling Elderly < 7 in. indicated dependant on others to leave neighborhood, limited mobility skills, and most restricted in ADL’s
Frail Elderly: < 7.3 in. indicates fall risk
what is inpatient rehabilitation facility
Minimal 3 hours therapy
what are the interaction of com and bos
- static conditions
- dynamic condditions
what is gaze stability
The ability to maintain gaze or visual focus on an external target during movement
what does a high score mean for Tinetti
better performance
What are some contributing factors
- sensory impairments
- cognitive deficits
- pathologies
- medication
- environment - hoarding
- external factors (lead to slipping, tripping, bumping)
- faulty footwear
what is balance like in elderly
Reduced A-P motion of COM (limited mobility)
Reduced COM-COP separation
Reduced Anterior COM velocities
what are some strengthening types
Warm Up and Cool Down Periods
Repetition of functional activities
Circuit training
Strength program
Emphasis on spinal alignment
