Examination Of Posture And Balance

Question 1

How does balance problems generally affect children?

Answer 1

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

Question 2

What activities should be included in a balance exam for infants/toddlers?

Answer 2

1. Development of motor skills/milestones
2. Ability to perform antigravity movements
3. Postural reactions

Question 3

What activities should be included in a balance exam for preschoolers?

Answer 3

1. Play skills
2. Performance of ADLS
3. Higher level motor skill requiring balance

Question 4

When does a child’s balance look like an adults?

Answer 4

15 years old

Question 5

What is the dynamic equilibrium model?

Answer 5

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”

Question 6

When does vision dominate during development to help maintain balance?

Answer 6

Birth to 3 years old
DO NOT OCCLUDE VISION

Question 7

When does somatosensory dominate during development to help maintain balance?

Answer 7

4-6 year olds

Question 8

When does vestibular dominate during development to help maintain balance?

Answer 8

7+ years old
vestibular reflexes fully mature by 11-15 years old

Question 9

At what age are children able to integrate info from all systems and use it to adapt balance continuously?

Answer 9

12-15 years old

Question 10

What factors contribute to balance dysfunction and what level of dysfunctions are they?

Answer 10

Sensor-vision, vest, somato
Motor- anticipatory, reactive
Biomechanical - soft tissue, bony torsional, impaired strength
all are impairment level dysfunctions

Question 11

What is the effect of bracing on postural control?

Answer 11

If we provide patients with better alignment their balance will improve over time.

Question 12

What are exam strategies to identify sensory impairments of balance?

Answer 12

Tilt board — reactive balance and somatosensory impairments
Eyes closed/open — vision impairments — NOT FOR KIDS UNDER 3
Surface compliance/Aires — testing for vest.

Question 13

What is the grading for PCTSIB

Answer 13

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

Question 14

What standard exams can you use to test for sensory impairments?

Answer 14

PTCISB
Sensory organization test

Question 15

What are some standardized tests to evaluate motor impairments?

Answer 15

Observe movement strategies during PCTSIB, functional reach test, TUG, AIMS, PDMS-2, BOT-2, GMFM

Question 16

How do you evaluate for biomechanical impairments

Answer 16

Assess strength, ROM, postural alignment

Question 17

What are some considerations to improve reliability of balance examination in children

Answer 17

1. Use quiet, non distractible setting
2. Easy, simple to follow directions
3. Do not excite the child or help them focus on balance.

Question 18

What is the functional reach test

Answer 18

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.

Question 19

What does the TUG measure

Answer 19

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

Question 20

What is the four square step test

Answer 20

Involves balance over a moving BOS and making rapid changes in direction.
- useful in kids with CP and DS
Highly correlated with TUG

Question 21

What are the MDCs for the 4 square step test for kids with CP and DS

Answer 21

CP = 4SECONDS
DS = 6 SECONDS

Question 22

What is the pediatric balance scale?

Answer 22

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

Question 23

What is the segmental assessment of trunk (SATco)?

Answer 23

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

Question 24

What is the Timed Up and Down stairs (TUDS)

Answer 24

Kid walks up and down 1 flight of stairs.
Time starts when standing on bottom step and stops when both feet return to bottom

Question 25

What is the standardized walking obstacle course (SWOC)

Answer 25

Purpose is to determine ambulation capacity by measuring stability and speed during gait under different circumstances in a safe, reproducible and efficient way.