exam 3: dynamic standing assessment & interventions Flashcards
What are the 3 types of postural control:
steady-state, reactive, proactive
Standing unsupported = _________ holds
BOS changes: _________,_______ stance
Compliant vs ________ surfaces
Sensory integration changes:
Which type of postural stability is being described:
isometric
Romberg, tandem
firm
EO vs. EC
steady state
Perturbations =
Sensory integration challenges =
Which type of postural stability is being described:
nudges or pulls
compliant vs. firm surfaces
reactive
Dynamic reaching or ________
_______ limb movement
Preparing for Transfer or movement =
Which type of postural stability is being described:
weight shifts
resisted
SLS, look over shoulder
proactive
Balance grading scale: - patient able to maintain a steady balance without handhold support (static)
4- normal
Balance grading scale: - patient unable to maintain balance
0- absent
Biomechanics of Standing:
ASIS is _____ with each other
______ pelvis
Head in _______ with “chin in”
______ muscles active maintaining upright posture
Feet flat on floor weight disturbed ______
level
neutral
midline
trunk
evenly
Posture changes with age: True or False?
True
As a PT you need to assess the patients ________ to inform evaluation and POC
limit of stability (LOS)
What is limit of stability:
maximum excursion in any direction without losing balance
Where does balance fall in the ICF domain?
body function and structure domain
You should likely always be assessed with support on _________ side
-cueing for:
affected
hip/knee/truck extension
Physical therapist is testing the patient with a neurological condition and they have an assistive device. What is the highest grade pt. can score
2- fair: patient able to maintain balance with handhold support; may require occasional min assistance (static)
Standing is maintained by:
postural tone with antigravity muscles throughout trunk and LEs
Task oriented:
Dual cognitive task:
Environmental changes:
folding clothes, put shoes on
organizing pills, counting cards
lights on/off
Key elements to observe and document:
BOS, COM, use of UE, and LE support
Explain the setup assessment for Sit>Stand:
a. Initial condition-
b. Weight-bearing symmetry-
c. Use bedside table as AD-
a. feet are both flat on floor; hips and knee flexed 90º
b. both arms placed in a position of WB, use UEs to
push off, DO NOT use unilat. ADs for standing activities
c. provide stable surface for WB through BL arms
You are a physical therapist performing a push-and-release test on a patient. The patient takes 4 or more steps backward but recovers independently. What would you grade them?
2
High score on push-and-release test/ retropulsive pull test =
increase risk of fall
The ______ provides the clinician with a means to quantify postural control under various sensory conditions
-conditions include:
clinical test of sensory interaction on balance (CTISB) “foam & dome”
normal, eyes closed, dome
If patient is timed for 30 secs. in each condition and unable to maintain the position they can get unlimited attempts. True or False?
False; 2 additional attempts
Fill in the blanks: Example of Postural Stability Goals:
Postural adjustments become more _______
________ goals
Independently self-corrects to midline =
Decreased _______ dependence
Improved _________ of posture or limb
automatic
timed
orientation
care giver
awareness
What does your assessment of a patient’s dynamic postural stability mean?
fall/safey risk -
support needed -
limits of stability -
DC planning
-nursing, SLP needed, OOB safety
-is a caregiver needed for cueing, needs physical assistance for transfers
-upper/lower body dressing standing, balance strategies present
-safety with out of bed independently
Highly recommended measures for Patients with Stroke in Acute Care: (3)
Orpington porgnostic scale
Postural assessment Scale for Stroke Patients
Stroke Rehabilitation Assessment of Movement
What are the core measures of gait, balance, and transfers recommended for -
Lists the test: (6)
ALL adults with neurologic disorder
6 min walk test
10-meter walk test
Berg Balance Scale
Functional gait assessment
Activities Specific Balance Confidence Scale
5 time Sit to Stand test
Standing assessment: Postural stability outcome measure (5)
Postural Assessment Scale for Stroke (PASS)
Berg Balance Scale (BBS)
Activities-Specific Balance Confidence (ABC) Scale
Tinetti (POMA)
Mini BESTest
What stroke assessment is highly responsive to change in acute patients 14-30 days poststroke
postural assessment scale for stroke patients (PASS)
A patient score was <45 on BBS what does that indicate:
high fall risk
The ABC scale is a ______-_______ measure
self-report
Measures confidence in performing various activities without losing balance or experiencing unsteadiness -
ABC scale
Biggest disadvantage of the ABC scale:
subjective to patient
The Tinetti Performace Oriented Mobility Assessment (POMA) is specifically for elderly patients to measure balance and gait function. True or False?
False: non-diagnosis specific
A patient scores a 21 on the POMA what is this indicating
patient is a medium fall risk
MiniBESTest 4 subcategories:
- Anticipatory postural response
- Reactive postural response
- Sensory orientation
- Stability in dynamic gait
What is the highest score a pt. can achieve on the Mini-BESTest
28 points per test directions
UE support devices and ADs are used to _______ shoulder subluxation during long periods of standing or gait
prevent
What are the pros of ADs
expands BOS
reduce WBing through LEs
What are the cons of ADs
-Learned nonuse
-If stability is maximized too much they will become reliant upon AD
-Compensation>Restorstaion
DO NOT have wheels, must pick up and place
Standard walker (SW)
has 2 large/small wheels anteriorly, can be pushed (glide) opposed to lifting
Rolling walker (RW)
Essentially a robust cane, very supportive, but cumbersome
hemi- walker
Four feet at the end of the cane, providing a wider base and greater stability
Large base vs Small Base Quad Cane
Order walker/cane from most stable to least:
Standard walker
Rolling Walker
Hemi Walker
Large/Small base quad cane
When fitting a patient to an AD make should elbows are in ______º of flexion in standing
20-25º.
Beside table, AD is utilized for bilateral arm support. Use dycem material and/or hand-over-hand supports to steady hemi side. True or False?
True
Roller walker (4WW or RW): if grip strength is an issue a _________ may be necessary.
arm trough
Pros/Cons of Unilateral devices (cane and hemi walker)
Pro: unilateral device may offer _______ to the patient.
Cons: Encourage _________ gait pattern with minimal weight-bearing. Usually ________ gait pattern is used.
independence
compensatory
step-to
Intervention goals of pt. handling:
-focused on improving _______ skills and motor learning
-interventions need to be ________ enough to promote behavioral change an neural reorganization
-final goal will be the __________ of the learned skill
functional - ADL improvement, gait. mobility
intense - challenges LOS
adaptability- transfer and retention test
Weight-bearing- increases ________ awareness through compression of the joint
-____% of balance is somatosensory input
Visual feedback - promotes awareness of _______ or ______
-_____% of balance is visual input
proprioceptive; 70%
posture/limb: 20%
Static stabilization exercises are ______ exercises for functional movements (transfers) and ADLs. Consider performing strengthening exercises in ________ positions. Challenge ______ integration and ________ postural strategies.
“lead up”; functional; sensory; reactive
Sit <> Stand interventions:
Eccentric control the descent from ______
______ hold for static strengthening
______control for dynamic strengthening
-facilitate anterior trunk positioning over _____ from pt. to maintain COG over BOS.
standing
isometric
eccentric
toes
Challenge all 3 aspects of balance by _________ the accuracy of one or two inputs. What are the inputs?
reducing; vision, somatosensory, vestibular
Reactive postural strategy interventions:
ankle strategy: small shifts in ______ alignment using ankle DF and PF.
-manual therapy or ________ by PT
hip strategy: larger, faster shifts in COM alignment when ankle strategy is _________
stepping strategy: inventions include (2)
COM; perturbations
not sufficient
push and release, push/pull testing
Adding resistance to limb movements strengthens and enhances control of limbs- proximal stability while creating _____ strength and mobility.
Increases automaticity of _____ control and postural awareness
distal
trunk
Your assessment ______ intervention. refer to slide 63*
drives
Pouring water from a pitcher into a glass, solving math problems, and playing naming games are examples of ________ tasks with cognitive load. Be sure to incorporate _____ patients.
dual; salience
Task-oriented standing interventions to increase the challenge of activities:
increase _______ to reach
vary _____ of target
vary weight or size of an ______
add ____constraint
involve multiple ____
distance
location
object
time
extremities
Visual biofeedback has been shown to improve _______.
all for ______cues to self correct. What is an example of visual biofeedback?
balance; internal; Wii/VR
Push against me forward, pull against me backward -
Hold don’t let me move you -
stabiliziang reversals
rhythmic stabilization
Pre-gait training is initiated for _____ level patients to emphasize ______ phase stability.
-stage of recovery?
-______% of gait cycle in stance phase
-introduce weight shifting toward ______ limb
low; stance
acute
60%
affected
Standing intervention leads to ______. Before advancing to gait perform ______ assessment.
gait; standing
