L1 Balance Exam Flashcards
Postural control standing vs sitting
standing & sitting are the same = static, proactive, reactive
Stable trunk for limb motion standing vs sitting
Standing = to allow for gait
Sitting = to allow for standing and gait
Direction of control standing vs sitting
standing = A/P
sitting = lateral and A/P
BOS standing vs sitting
Standing = feet
Sitting = feet, thighs, buttocks
Somatosensory input standing vs sitting
standing = feet
sitting = feet, thighs, buttocks
LE contribution standing vs sitting
Standing = multiple degrees of freedom
sitting = less degrees of freedom
Verticality
ability to orient appropriately with respect to gravity
Dynamic stability/balance
ability to maintain stable upright posture during self-initiated body or body-segment active movement
Static stability/balance
ability to maintain stable upright posture without self-initiated movement
Anticipatory/Proactive postural control
ability to activate muscles to shift the COM before a discrete voluntary movement
relies on fedforward motor control
Reactive postural control/balance
ability to recover a stable position following an unexpected perturbation to bring the COM within the BOS through corrective movements
relies on feedback motor control
Perturbation
deviation of an object from its normal state or path by an outside influence
Sensory integration
ability to integrate all sensory systems inputs to influence selection of motor output to maintain postural control
Sensory reweighting
ability to reweight sensory information when input is altered
individuals will reweight sensory input based on changes to environment. Individuals with impaired sensory systems will have limited ability to re-weight sensory info
Cognitive influences
ability to maintain stability while responding to commands during the task or attend to additional tasks
Postural constraint
a deficit in one or more balance resources that leads to impaired postural control or balance.
a body structure/function impairment can be the underlying cause of the postural constraint
Balance emerges from the interaction of…
individual
task
environment
Individual (postural control systems framework)
motor
sensory
cognitive
Postural tasks (postural control systems framework)
proactive
reactive
steady state
Environment (postural control systems framework)
support surfaces
sensory context
cognitive load
Balance Resources
Biomechanical
Movement Strategies
Sensory Strategies
Orientation in Space/Verticality
Control of Dynamics
Cognitive Processing
Biomechanical Resources
BOS
LOS
DOF (degrees of freedom)
Strength
Movement Strategies
Strategies to maintain balance: Voluntary, Anticipatory, Reactive. Also includes ankle, hip, stepping, protective reactions.
Protective Reactions
used to attempt to increase the BOS to either prevent the fall or to lessen injury if a fall occurs
protective extension
grasp for stable object
Sensory Strategies
sensory information is integrated in the CNS to interpret complex sensory environment to create a motor plan to maintain equilibrium
somatosensory, visual, vestibular
Posturography
test and examine sensory conditions with technology
Modified Clinical Test of Sensory Interaction in Balance
used for when you don’t have technology
Record time, including amount of sway or loss of imbalance, and recovery strategy
Eyes open and firm surface
baseline observation for sway
Eyes closed and firm surface
increased sway indicates balance problem, possible vestibular or somatosensory impairment
Eyes open and on foam
increased sway indicates balance problem and visual or vestibular problem, OR over-reliant on somatosensory
Eyes closed and on foam
increased sway indicates balance problem and likely vestibular problem OR over reliant on vision and somatosensory systems
Orientation in Space/Verticality
-ability to orient the body parts with respect to gravity, the support surface, visual surround and internal references
-healthy nervous systems automatically alter how the body is orientated in space depending on the context and the task
Control of Dynamics
ability to control balance during gait and while changing from one posture to another. requires complex control of COM.
body structure/function impairments in any part of this complex control system can interfere with control of dynamics
stability during gait comes from placing the swing limb under the falling COM, essentially a controlled fall
Cognitive Processing
control of posture and other processing share cognitive resources
balance task difficulty increases or cognitive challenge increase, one will decline to compensate. If you have decreased cognitive processing, you will have decreased balance
What is a significant risk factor for falling?
cognitive impairment
less able to dual task
What is the most dangerous patient subjective impression vs performance?
high confidence, low performance
ABC scale
Activities-specific balance confidence scale
most commonly used by PTs
higher score indicates more confidence
score below 67% indicates increased risk of falling
Total score of balance exam
use to document severity of balance
change over time of balance impairment
predict fall risk and safety at home, guiding towards need for AD, helping decide if they need PT
Item by Item of Balance Exam
gives you idea of what balance contraints and tasks need to be addressed
