Examination of Balance Flashcards
List the components of postural control (2)
- Postural stability
- Postural orientation
Define postural stability
Balance
Define postural orientation
Ability to maintain appropriate relationship b/t body segments and b/t body and environment
List the areas to observe with a posture examination (3)
- Alignment [vertical, symmetry]
- Foot position [BOS]
- Weight scale/Force plates
List what should be noted about the initial position during a posture examination (3)
- Appropriate for functional tasks?
- Efficient [min mm to maintain position]?
- Stable [line of gravity with in stability limits]?
List reasons to examin a patients balance (3)
- ID fall risk
- Determine ability to participate in Pt
- ID impairment
List the 5 types of balance scales and their goal
- Quiet standing [goal to stand still]
- Active standing [goal of voluntary weight shift
- Sensory Manipulation [alt surface/visual condition to assess postural control]
- Functional scales [whole body movement]
- Dual task
List the quiet standing balance scales (4)
- Romberg
- Sharpened Romberg
- One-legged stance test
- Postural sway
List the active standing balance scales (2)
- Functional reach test
- Multi-directional reach test
List the sensory manipulation balance scales (2)
- Sensory organization test
- Clinical Test of Sensory Interaction and Balance (CTSIB)
List the functional scales (5)
- Berg Balance Scale
- TUG
- Tinetti
- DGI
- Functional Gait Assessment
List the dual task balance scales (2)
- Walk and Talk
- Mutliple Tasks Test [8 item]
List considerations when selecting an appropriate test (5)
- Purpose/Population
- Reliability/Validity/Ease of Use
- Modifications
- Norm data available for comparision
- Which components of posture will be assessed
Test:
- Quiet Standing
- Fold arms across chest, picks one leg and holds hip in neutral and knee flexed to 90 [test both sides]
- Normal = 30 sec
- Go intra-rater reliability
- SLS required for gait, steps, ADLs
One leg stance test
Test:
- Quiet standning
- Feet together, assess sway EO vs. EC
- Abnormal = excessive sway, LOB, stepping
- Subjective
Romberg
Test:
- Quiet standing
- Feet in heel-toe position, arms folded across chest, EC for 60 sec
Sharpened Romberg
Test:
- Active standing
- Quick screen for balance
- Norm = > 10” [less = fall risk]
- Reliable and Valid
- Modifications include sitting and multi-directional
Functional Reach Test
Test: Examine the limits of stability in forward, backward, and medial/lateral directions
Multi-directional Reach Test
Test:
- Measure balance by assessing functional task
- 14 item, total score 56, higher score = better function
- Sitting component
- Reliable and Valid
- Has ceiling effect
Berg Balance Scale
Low fall risk = 41-56
Medium fall risk = 21-40
High fall risk = 0-20
Test:
- Gait and Balance sub scores
- Total score = 28
- Reliable and Valid
Tinetti
Low fall risk = 25-28
Moderate fall risk = 19-24
High fall risk = < 19
List the test with the best test-retest reliability and predictive ability for fall risk in people > 65 yo
POMA
List the items of the Tinietti that are for
- Steady state balance
- Proactive balance
- Reactive balance
- Sensory component
- 1 and 5
- 2, 3, and 9
- 6
- 7
List the self report measures and what they assess (3)
Activity Specific Balance Confidence Test [fear of falling]
Falls efficacy scale [fear of falling
Dizziness Handicap inventory [self perfeived handicap]
Test:
- Assess balance in lying, sitting, standing
- 12 item
- Looks at how they maintain balance and change posture
Postural Assessment Scale for Stroke
Test:
- Steady state balance
- Center of gravity location
- Amount of sway
- Functional performance
- Objective, uses force plates
Balance Master Assessment
Test:
- USes movable force plate and moveable visual surround to alter the surface and visual environment systematically
- Stand on force plate, 3, 20 sec trials under each condition
Sensory Organization Test
Test:
- Sensory integration test
- 3-5 trails of 30 sec
- Use stopwatch and visual observation
- foam and dome
- normal = 30 sec w/o LOB
CTSIB
Test:
- Assess gait
- Change surface, speed, horizontal and vertical head position
DGI
Goals of Balance Tx (4)
- Objectivity for assessment of prorgression
- ID impairments to be addressed
- Effective sensory and motor strategies
- Consider stead state/reactivity/anticipatory control in functional environments
A _________ approach should be used to treat balance
Systems
Treatment Strategy (4)
- Postural alignment [efficient, stable, functional]
- Motor strategies
- Sensory strategies
- Gradually increase demand
Types of augmented feedback for posture tx (4)
- Verbal cue
- Manual cue
- Visual cue
- Forceplate
Posture Tx (3)
- Augmented feedback on symmetric/verticla posture
- EO vs. EC
- Effect of AD
Motor Strategies (5)
- Ankle strategy = small perturbations, sway A/P
- Hip strategy = larger perturbations
- Stepping strategy = largest perturbation
- Add functional meaning
- Strength and ROM
Control of COG (5)
- Establish a stable BOS and transfer weight over it
- Progression: establish > maintain > reduce BOS to produce automatic/anticipatory responses to weight shift
- Sitting [remove UE, move LE]
- Sit to stand [alter surface and height]
- Standing [stable > reach> narrow BOS > SLS]
Sensory Strategies (4)
- Goal: learn to coordinate/select appropriate sensory info for postural control
- Reliance on vision = remove vision to increase somatosensation
- Reliance on surface = alter surface to increase vision
- Enhance vestibular by altering surface and removing vision
** hard surface rocker bottom = challenges somatosenation
** soft surface rocker bottom = takes somatosensation out of the picture
Physical Problems to address in elderly with fall risk (5)
- Mm strength
- Hearing loss
- Vision deficit
- AD
- Activity level
