Examination Of Posture And Balance Flashcards
How does balance problems generally affect children?
Balance dysfunction can potentially limit further development of movement and exploration and can affect their ability to produce coordinated and efficient functional movements.
kids may be fearful of movement
What activities should be included in a balance exam for infants/toddlers?
- Development of motor skills/milestones
- Ability to perform antigravity movements
- Postural reactions
What activities should be included in a balance exam for preschoolers?
- Play skills
- Performance of ADLS
- Higher level motor skill requiring balance
When does a child’s balance look like an adults?
15 years old
What is the dynamic equilibrium model?
Sensory and motor systems work in a constant look to generate movements and keep your balance.
- sensory system asks: “where am i”
- motor system asks “what am i going to do”
When does vision dominate during development to help maintain balance?
Birth to 3 years old
DO NOT OCCLUDE VISION
When does somatosensory dominate during development to help maintain balance?
4-6 year olds
When does vestibular dominate during development to help maintain balance?
7+ years old
vestibular reflexes fully mature by 11-15 years old
At what age are children able to integrate info from all systems and use it to adapt balance continuously?
12-15 years old
What factors contribute to balance dysfunction and what level of dysfunctions are they?
Sensor-vision, vest, somato
Motor- anticipatory, reactive
Biomechanical - soft tissue, bony torsional, impaired strength
all are impairment level dysfunctions
What is the effect of bracing on postural control?
If we provide patients with better alignment their balance will improve over time.
What are exam strategies to identify sensory impairments of balance?
Tilt board — reactive balance and somatosensory impairments
Eyes closed/open — vision impairments — NOT FOR KIDS UNDER 3
Surface compliance/Aires — testing for vest.
What is the grading for PCTSIB
0 = can’t assume position
1 = maintain stance 3 seconds or less
2 = can maintain stance 4-10 seconds
3 = maintain stance 11-20 second with >15 deg sway
4 = maintain 30 second with 6-15 deg sway
5 = maintain 30 seconds with less than 6 deg sway
What standard exams can you use to test for sensory impairments?
PTCISB
Sensory organization test
What are some standardized tests to evaluate motor impairments?
Observe movement strategies during PCTSIB, functional reach test, TUG, AIMS, PDMS-2, BOT-2, GMFM
How do you evaluate for biomechanical impairments
Assess strength, ROM, postural alignment
What are some considerations to improve reliability of balance examination in children
- Use quiet, non distractible setting
- Easy, simple to follow directions
- Do not excite the child or help them focus on balance.
What is the functional reach test
Pediatric standardized assessment that is easy to do but not the most reliable.
- kid gets 1 practice and 2 trials measured.
- reach forward and to the side. In sitting and standing.
What does the TUG measure
Measure of functional mobility and dynamic balance.
- 3 meters, chairs without arms.
- peds modification: time starts and stops when the kid’s bit leaves and returns to the seat NOT ON GO
- should encourage a normal walking pattern.
- reliable and can be used with kids as young as 3
- screening and outcome measure
What is the four square step test
Involves balance over a moving BOS and making rapid changes in direction.
- useful in kids with CP and DS
Highly correlated with TUG
What are the MDCs for the 4 square step test for kids with CP and DS
CP = 4SECONDS
DS = 6 SECONDS
What is the pediatric balance scale?
Peds version of berg
Differentiated for children in GMFCS levels 2-3
- can be used on kids 5-15
MDC with CP = 0.79 in static scale and 1.59 total
What is the segmental assessment of trunk (SATco)?
Reliable and valid outcome for sitting balance for children with neuromuscular disabilities.
- Determines the top most segment at which control of upright posture is poor.
- excellent Interrater reliability for kids with CP
- sensitive to change in patients with SCI
What is the Timed Up and Down stairs (TUDS)
Kid walks up and down 1 flight of stairs.
Time starts when standing on bottom step and stops when both feet return to bottom
