Exercise for Impaired Balance Flashcards
risk factors for falls
previous falls decreased strength UE and LE gait balance impairments depression visual impairment specific medications cognitive impairment age >80 years
how can older adults prevent falls
exercise change medications get eyes checked improve the lighting reduce hazards in their home
center of mass
point corresponding to the total body mass
point where body is in equilibrium
center of gravity
vertical projection of COM to the ground
slightly anterior to S2
base of support
perimeter of contact area with supporting surface
limits of stability
sway boundaries in which an individual can maintain equilibrium without changing BOS
constantly changing
sensory systems and balance
visual
somatosensory
vestibular
visual
position of head relative to environment
orientation of head to maintain level gaze
direction and speed of head movements
somatosensory
position and motion of body and body parts relative to each other and support surface
fastest processing
vestibular
position and movement of head
slowest processing
types of balance control
static
dynamic
automatic
static balance
maintain stable antigravity position at rest- sitting or standing
ex Romberg, tandem, single leg balance, stork stand test
dynamic balance
stabilize body when support surface moving or when body moving on stable surface- sit to stand or walking
ex sit to stand
automatic balance
maintain balance in response to unexpected external perturbations- standing on bus, train
motor strategies
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
ankle strategy
small perturbations, slow speed, static stance, large-firm surface
hip strategy
large perturbations, fast or for movements with COG near the limits of stability
cannot be used on slippery surfaces because feet will slip
stepping strategy
large force displaces COM beyond limits of stability, a forward or backward step is used
proprioceptive deficits
joint position, increased postural sway
somatosensation deficits
peripheral neuropathy associated with increased risk of falls/balance deficits
visual deficits
acuity, contrast sensitivity, peripheral, depth associated with increased risk of falls/balance deficits
vestibular deficits
viral infection, TBI, or aging may experience vertigo and postural instability
deficits with aging
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
what is the number on risk factor for falls
a previous fall
Screen for Fear of Falling
Activities-Specific balance scale
deficits from medications
increased risk with 4 or more medications
specific medications
7 recommendations -sherrington
- exercise must provide a moderate or high challenge to balance
- must be a sufficient dose
- ongoing exercise is necessary for continued reduction of risk
- should be targeted at general community and at those who are “high risk”
- exercise may be in a group or home based setting
- 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
- strength training may be included in addition to balance training
how to provide a moderate or high challenge to balance
reduce base of support
movement o the center of gravity
reduce need for upper limb strength with exercises
tai chi
slow, controlled whole-body movements
postural awareness
control COM, increased LE strength and flexibility
reduction in number of and risk of falls
neuromuscular impairments that lead to impaired balance
damage to basal ganglia
cerebellum or motor area
common outcome measures and cut offs
BBS: 45
TUG: >13.5
functional reach test: 6-10 2x risk of falling
anticipatory
patient knows what is coming
ex. catching ball, opening door, functional reach test
reactive
response to perturbation
ex. pull test, push them
sensory organization test
reduce visual inputs and reduce somatosensory cues
common consequences of falls
fracture tbi soft tissue damage institutionalized more falling
