Exercise for Impaired Balance

Question 1

risk factors for falls

Answer 1

previous falls
decreased strength UE and LE
gait
balance impairments
depression
visual impairment
specific medications
cognitive impairment
age >80 years

Question 2

how can older adults prevent falls

Answer 2

exercise
change medications
get eyes checked
improve the lighting
reduce hazards in their home

Question 3

center of mass

Answer 3

point corresponding to the total body mass

point where body is in equilibrium

Question 4

center of gravity

Answer 4

vertical projection of COM to the ground

slightly anterior to S2

Question 5

base of support

Answer 5

perimeter of contact area with supporting surface

Question 6

limits of stability

Answer 6

sway boundaries in which an individual can maintain equilibrium without changing BOS
constantly changing

Question 7

sensory systems and balance

Answer 7

visual
somatosensory
vestibular

Question 8

visual

Answer 8

position of head relative to environment
orientation of head to maintain level gaze
direction and speed of head movements

Question 9

somatosensory

Answer 9

position and motion of body and body parts relative to each other and support surface

fastest processing

Question 10

vestibular

Answer 10

position and movement of head

slowest processing

Question 11

types of balance control

Answer 11

static
dynamic
automatic

Question 12

static balance

Answer 12

maintain stable antigravity position at rest- sitting or standing
ex Romberg, tandem, single leg balance, stork stand test

Question 13

dynamic balance

Answer 13

stabilize body when support surface moving or when body moving on stable surface- sit to stand or walking
ex sit to stand

Question 14

automatic balance

Answer 14

maintain balance in response to unexpected external perturbations- standing on bus, train

Question 15

motor strategies

Answer 15

feedback in response to perturbation
body continually adjust position in space to keep COM over BOS or bring COM back after perturbation
ankle, hip, stepping strategies

Question 16

ankle strategy

Answer 16

small perturbations, slow speed, static stance, large-firm surface

Question 17

hip strategy

Answer 17

large perturbations, fast or for movements with COG near the limits of stability
cannot be used on slippery surfaces because feet will slip

Question 18

stepping strategy

Answer 18

large force displaces COM beyond limits of stability, a forward or backward step is used

Question 19

proprioceptive deficits

Answer 19

joint position, increased postural sway

Question 20

somatosensation deficits

Answer 20

peripheral neuropathy associated with increased risk of falls/balance deficits

Question 21

visual deficits

Answer 21

acuity, contrast sensitivity, peripheral, depth associated with increased risk of falls/balance deficits

Question 22

vestibular deficits

Answer 22

viral infection, TBI, or aging may experience vertigo and postural instability

Question 23

deficits with aging

Answer 23

strength decline
endurance decreases
skeletal muscles lose both Type 1 and Type II fibers, motor unit recruitment declines, number of myelinated fibers decrease
more use of hip strategy
reduced balance with external perturbations
decreased spinal flexibility
decreased ankle joint flexibility
declines in all sensory systems

Question 24

what is the number on risk factor for falls

Answer 24

a previous fall

Question 25

Screen for Fear of Falling

Answer 25

Activities-Specific balance scale

Question 26

deficits from medications

Answer 26

increased risk with 4 or more medications

specific medications

Question 27

7 recommendations -sherrington

Answer 27

1. exercise must provide a moderate or high challenge to balance
2. must be a sufficient dose
3. ongoing exercise is necessary for continued reduction of risk
4. should be targeted at general community and at those who are “high risk”
5. exercise may be in a group or home based setting
6. walking training may be included in addition to balance training but high risk indiv. should not be prescribed brisk walking programs- do not include at expense of balance training
7. strength training may be included in addition to balance training

Question 28

how to provide a moderate or high challenge to balance

Answer 28

reduce base of support
movement o the center of gravity
reduce need for upper limb strength with exercises

Question 29

tai chi

Answer 29

slow, controlled whole-body movements
postural awareness
control COM, increased LE strength and flexibility
reduction in number of and risk of falls

Question 30

neuromuscular impairments that lead to impaired balance

Answer 30

damage to basal ganglia

cerebellum or motor area

Question 31

common outcome measures and cut offs

Answer 31

BBS: 45
TUG: >13.5
functional reach test: 6-10 2x risk of falling

Question 32

anticipatory

Answer 32

patient knows what is coming

ex. catching ball, opening door, functional reach test

Question 33

reactive

Answer 33

response to perturbation

ex. pull test, push them

Question 34

sensory organization test

Answer 34

reduce visual inputs and reduce somatosensory cues

Question 35

common consequences of falls

Answer 35

fracture
tbi
soft tissue damage
institutionalized
more falling