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PT9111 - Test 4 > Lec 49 - Postural stability > Flashcards

Lec 49 - Postural stability Flashcards

1
Q

define postural stability

A

the maintenance of equilibrium through the interaction between the person, task and environment by keeping the centre of mass over the base of support

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2
Q

what are the 5 functions required of postural stability (“keep us”)

A

keeps us
1. steady at rest
2. steady while moving
3. adjusts in anticipation of moving
4. adjusts to changing conditions
5. adjusts to steady in response to a sudden unexpected disturbance/pertubation

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3
Q

what is the base of support?

A

the area beneath a person that
includes every point of contact
that the person makes with the
supporting surface.

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4
Q

when do we start to lose our balance?

A

when the center of mass (COM) goes outside of our base of support

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5
Q

what is postural sway

A

the natural movement of the COM within our BOS. we expect to see some movement as even things such as breathing can change the location of the COM which requires us to make compensatory movements.

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6
Q

T or F: postural stability involves only certain areas of the bran

A

False, Postural stability is a whole-brain
phenomenon

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7
Q

what structures of the brain have key roles in postural stability?

A
  • Cerebellar grey matter
  • Superior cerebellar peduncle
  • Basal ganglia
  • Thalamus
  • Hippocampus
  • Inferior parietal cortex
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8
Q

what are the 3 main control systems involved in postural stability and how do they interact?

A

Brain
motor
somatosensory

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9
Q

what 3 sensory systems have a role in stability

A

vision
proprioception
vestibular

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10
Q

what 3 cognitive functions have a role in postural stability

A
  1. memory
  2. executive function
  3. attention
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11
Q

list the 9 major components required for the maintenance of postural stability

A
  1. Sensory strategies
  2. Cognitive processing
  3. Motor system
  4. Static stability
  5. Dynamic stability
  6. Functional Stability Limits
  7. Reactive Postural Control
  8. Anticipatory Postural Control
  9. Verticality/Orientation in space
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12
Q

T or F: if just one of the 9 major components for the maintenance of postural stability isn’t working it can lead to instability

A

true

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13
Q

define sensory strategies

A

Ability to reweight sensory information (vision, vestibular, somatosensory) when input is altered (ex. eyes closed or foam pad)

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14
Q

define cognitive influence and what cognitive process does it require?

A

Ability to maintain stability while responding to commands during a task or attend to
additional tasks (e.g., dual task)
requires attention

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15
Q

what is the sensory system contributing to postural stability when a client has their eyes closed and is standing on a foam pad

A

vestibular

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16
Q

define motor system

A

Includes features related to strength, coordination, endurance and range of motion

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17
Q

what are the peripheral and central factors of the motor system?

A
  • Muscle properties
  • Force production
  • Timing
  • Sequencing
  • Coordination
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18
Q

define static stability and some common orientations

A

Ability to maintain positions of the CoM in unsupported stance when BOS does not change
sitting, standing, wide stance, tandem

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19
Q

define dynamic stability

A

Ability to exert ongoing control of CoM when the BOS is changing ex. walking

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20
Q

T or F: walking is an inherently unstable activity

A

true

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21
Q

define functional stability limits

A

Ability to move the CoM as far as possible
in the anteroposterior and mediolateral directions within an unchanging BOS

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22
Q

define reactive postural control

A

Ability to recover stability after an external perturbation to bring the CoM within the BOS through corrective movements

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23
Q

what are the 2 fixed support strategies and 2 change-in-support strategies seen in reactive postural control?

A

**hip is used for larger perturbations than ankle

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24
Q

define anticipatory postural control

A

Ability to shift the CoM before a discrete voluntary movement (ex. standing on one leg)

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25
Q

define verticality

A

Ability to orient appropriately with respect to gravity

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26
Q

what is the name of a condition where damage to the parietal lobe causes a patient to misalign themselves vertically

A

pusher syndrome

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27
Q

what are 3 key questions to ask during a subjective assessment of postural stability?

A
  • Do you feel unsteady when walking or standing?
  • Are you worried about falling?
  • Have you fallen in the past year?
    If yes, then ask “How many times?” and “Were you injured?”
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28
Q

what is the medical definition for a “fall”?

A

unintentionally coming to rest on the ground, floor or other lower-level

29
Q

what additional information related to a fall is important to make note of in a subjective assessment?

A
  • Circumstances of fall
  • Symptoms pre/post fall
  • Pain, dizziness, giving way of LE
  • Loss of consciousness
  • Any post-fall interventions implemented
  • Any change in ADLs, mobility status or confidence with mobility pre/post fall
  • Recurrent falls
  • Laying on the floor and unable to get up independently for at least one hour
  • Physical activity level (including fear)
  • Comorbidities
  • Medications
  • Side effects that include dizziness
  • Pain – chronic or new since fall
  • Mobility aid use
  • Frail
  • Home environment
  • Eye examinations
30
Q

what are things to consider when selecing which objective assessment to use for postural stability?

A
  1. What is the intent of administering the test: (benchmark, identifying inpairment, outcome measure, etc.)
    d. Prediction (e.g., falls risk)
  2. Patient population
  3. Activity level of the client
  4. Cognitive impairment
  5. Time to administer the test
  6. Space and/or equipment requirements
31
Q

T or F: objective assessments have ‘safe thresholds’ that allow the examiner to predict the falls risk of a client

A

false, there are NO safe thresholds

32
Q

what are examples of objective assessments that can be performed for postural stability? (and their abbreviations)

A
  • Single Leg Stance Test
  • Timed Up & Go Test (TUG)
  • Modified Clinical Test for Sensory Integration in Balance (mCTSIB)
  • Tinetti Performance-Oriented Mobility Assessment (POMA)
  • Berg Balance Scale (BBS)
  • Fullerton Advanced Balance Scale (FABS)
  • Community Balance & Mobility Scale (CB&M)
  • Balance Evaluation Systems Test (BESTest)
33
Q

what are some reasons it is important to learn these tests?

A
  • some tests are better suited for specific populations, environments and timing
  • reflects the current patterns of PT in canada
  • studies show PTs use the clinical tools they were taught in school
34
Q

describe the single leg stance test (time to administer, score, equipment, population)

A

how long can someone stand on one leg (max time 45seconds) done on both legs

35
Q

describe parameters of the timed up & go test (TUG) (time to administer, score, equipment, population, normative value)

A

normative value = less than 12seconds

36
Q

Modified clinical test for sensory integration in balance - mCTSIB (time to administer, # of items in test, score, equipment, population)

A
37
Q

Tinetti’s performance-oriented mobility assessment - POMA (time to administer, # of items in test, score, equipment, population)

A
38
Q

Berg Balance Scale (time to administer, # of items in test, score, equipment, population)

A
39
Q

Fullerton Advanced Balance Scale - FABS (time to administer, # of items in test, score, equipment, population, clinical setting)

A
40
Q

community balance & Mobility scale - CB&M (time to administer, # of items in test, score, equipment, population, clinical setting)

A
41
Q

Balance Evaluation Systems Test - BESTest (time to administer, # of items in test, score, equipment, population, clinical setting)

A
42
Q

when wanting to perform a quick screen of balance when time is limited and want to know if you need to do a more in-depth scan what 2 tests are used (core outcome)?

A
  • berg balance scale
  • mini-BESTest
43
Q

summary chart of which of the 9 components each assessment tests for

A
44
Q

which objective assessment tests for verticality?

A

BESTest, the only one that tests for verticality

45
Q

what are the 3 most commonly used objective tests for postural stability?

A

SLS test,
BBS (berg-balance scale)
TUG

46
Q

why is functioning ability level important when deciding what test to use to assess balance?

A

due to the ceiling and floor effects of different objective assessments
and the progression of task difficulty

47
Q

list objective assessments in order of task difficulty

A
48
Q

T or F: The berg-balance scale is a more appropriate measure of balance for people who occasionally use mobility aids compared to the CB&M

A

true

49
Q

what is some of the criteria for selecting outcome measures to perform virtually

A
  1. safety
  2. feasibility
  3. acceptability
  4. scoring has a natura; zero score
  5. reliability, validity, sensitivity to change
50
Q

what 3 tested are commonly administered virtually?

A
  1. 7-item berg balance scale
  2. 30-second sit to stand test
  3. step test
51
Q

define posture

A

The relative position of different joints
of the body relative to one another at
one moment of time

52
Q

define optimal posture

A

alignment of body segments requiring the least amount of work to maintain a given position.

53
Q

define faulty posture

A

Any static position that increases the
stress to the joints.

54
Q

what are contributing factors to faulty posture?

A
  1. Stiff joints (hypomobile)
  2. Hypermobile joints
  3. Weak, shortened or lengthened
    muscles
    All result in misalignment
55
Q

what 2 factors effect posture and how can they be treated

A
  1. positional factors - can be corrected with strengthening, stretching or education/awareness
  2. structural factors (changes in bone) - not easily corrected without surgery
56
Q

what are some key points for a postural assessment?

A
  1. primarily observational (comparing position to established reference line - plum line)
  2. subject minimally clothed and not wearing shoes
  3. instruct patient to assume a comfortable, habitual and relaxed posture
  4. Subjects who use orthotic or assistive devices should be assessed with and without them to determine their effectiveness in influencing posture.
  5. evaluate symmetry
  6. your making an inventory - it is not diagnostic on its own
57
Q

describe what you are observing in an anterior view of posture

A
  • Head, Neck & Shoulders - Eyes and ears should be level and clavicles
    symmetrical,
  • Chest - Ribs on each side should be symmetrical,
  • Abdomen - Right and left waist angles should be symmetrical,
  • Hips/Pelvis - ASIS should be level,
  • Knee - Patella should be symmetrical and facing straight ahead,
  • Ankles/Feet - Malleoli should be symmetrical, toes should not be curled / overlapping / deviated to one sides
58
Q

describe what you are observing in a posterior view of posture

A
  • Head - straight, with no lateral tilting, angles
    between shoulders and neck should be equal
  • Arms - should hang naturally so that the palms of the hands are facing the sides of the body
  • Shoulder/Spine - Scapulae lie flat against the rib cage, be equidistant from the line of gravity,
    separated by about 4 inches
  • Hips/Pelvis - PSISs should be level, gluteal folds should be level and symmetrical
  • Knee - should be level
  • Ankles/Feet - Achilles tendon should be vertical, Malleoli should be level and symmetrical
59
Q

describe the pathway of the line of gravity in a lateral view

A
  • Anterior to atlanto-occipital joint (C1-C2)
  • Posterior to cervical joints
  • Anterior to thoracic joints
  • Posterior to lumbar joints
  • Anterior to sacroiliac joint
  • Posterior to hip joint
  • Anterior to knee joint
  • Anterior to ankle joint
60
Q

define kyphosis

A
  • Posterior curvature of spine (concave anteriorly) - alignment of thoracic spine
61
Q

define lordosis

A

Anterior curvature of spine (convex anterior) in cervical and lumbar spine

62
Q

define the pelvic angle and what is normal

A

Angle produced by the intersection of a
horizontal line drawn between the superior margin of the pubic ramis & S2
normal alignment = 30 degrees

63
Q

what are 5 types of postural misalignments

A
  1. swayback
  2. flat back
  3. round back
  4. kypho-lordotic
  5. scoliosis
64
Q

describe a swayback alignment

A
65
Q

describe a flatback alignment

A
66
Q

describe a round back alignment also what is a common slang term for it

A
67
Q

describe a kypho-lordotic posture

A
68
Q

describe scoliosis

A
69
Q

what are ways we can intervene on posture as PTs?

A
  • education
  • workplace design
  • foot wear
  • avoid prolonged static postures
  • maintain a neutral posture
  • prescribe strength, stretch, endurance
  • awareness of posture

PT9111 - Test 4 (14 decks)

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