L2 Balance Treatment

Question 1

Categories of PT interventions addressed by balance

Answer 1

Patient or Client Instruction
Assistive Tech
Functional Training
Motor Function Training
Therapeutic Exercise

Question 2

Patient education to reduce fall risk addresses

Answer 2

vision related constraints
dynamic stability constraints
biomechanical constraints
medications

Question 3

Vision related constraints

Answer 3

optimize lighting
recommend eye exam
avoid progressive lenses while walking
improve contrast of objects w/tape

Question 4

Dynamic stability constraints

Answer 4

-decrease clutter
-place commonly used objects at eye level
-secure electrical cords
-bath mats
-secure edges of rugs
-grab bars in bathroom
-handrails

Question 5

Biomechanical constraints

Answer 5

-BOS–> footwear
-Strength–chairs w/higher floor to seat height
-firm surfaces instead of soft cushions
-LOS = grab bars and ADs

Question 6

Medications

Answer 6

recommend MD analysis of current meds
assess meds to see if they impact balance
ensure they are taking meds as prescribed

Question 7

Six Tips to Help Prevent Falls

Answer 7

-Talk with HCP about medication side effects
-Do strength and balance exercises
-Get your vision and hearing checked regularly
-Make your home safer with lights, grab bars, and securing rugs
-Use walker or cane
-stand up slowly to avoid dizziness

Question 8

Purpose of AD for Gait

Answer 8

1. to increase BOS to increase the patient’s stability
2. to offload a limb with weight bearing precautions or pain

Question 9

Considerations with ADs

Answer 9

-energy resources of patient
-patient’s cognitive abulities and safety judgement
-environment where it will be used
-proper fit of the device
-patient’s willingness to use the device

Question 10

Selection of AD

Answer 10

Balance measures
Observation
Trial
Safety
Space in home
Efficiency

Question 11

Documenting gait with AD

Answer 11

Include distance ambulated, AD used, amount of assistance

Question 12

Steps to creating therapeutic activity/exercise for balance

Answer 12

1. Identify constraints and impairments that might be causing the constraints
2. Activity should address both the balance constraint and the underlying impairments
3. Tie it back to an activity of interest, employ motor learning principles

Question 13

At home safety

Answer 13

-educate the patient to STAY ACTIVE but know the signs of fatigue
-signs of fatigue means you should use an AD
-choose a corner for static movements
-difficulty should be lower than at the clinic
-focus on low-risk impairment-based exercises

Question 14

During PT session safety

Answer 14

use a gait belt, harness system, etc
select activities that are moderately difficult

Question 15

How to make task easier/harder

Answer 15

1. manipulate the task
2. manipulate the environment
3. manipulate the individual’s balance resources/constraints

Question 16

Neuroplasticity principles to use with exercises

Answer 16

Feedback
Practice
Exercise variables (intensity)

Question 17

Reactive balance training is reliant on

Answer 17

feedback motor control

Question 18

Anticipatory balance training is reliant on

Answer 18

feedforward motor control

Question 19

Reactive Balance Training

Answer 19

–PT intentionally exposes patient to a perturbation with increasing challenge over time
–includes wearing a harness for safety
-SR suggests that RBT can reduce falls by 46-48%

Question 20

Anticipatory Balance Training

Answer 20

-training to activate postural muscles in a feedforward manner before voluntary movement begins
-includes tasks where patient is made aware of task and knows the desired movement
-no external perturbations

Question 21

Training for anticipatory balance should include

Answer 21

variable magnitude and direction of movement
predictability
the activity that causes the pts fear of falling

Question 22

Activities for dynamic constraints

Answer 22

think about strength AND power

controlling small movements of COM progressing to larger movements of COM

Question 23

Considerations for Cognitive Constraints

Answer 23

Task needs to be relevant to the pt
Task complexity varies by patient
Perform baseline assement of several tasks