Lecture 15 Flashcards
3 Stages of information processing
Sensory input
sensorimotor integration
motor output generation
Sensorimotor integration impairments
impairments in: basal ganglia, cerebellum, motor area
brain, afferent, sensory
Results of sensorimotor impairments
impairment in processing of incoming sensory info
difficulty utilizing sensory info from changes in environment
decreased coordination
disruption of anticipatory and reactive postural adjustments
Motor output generation
cannot properly execute the action
peripheral problem, efferent, motor
neuromusculoskeletal impairment
compromised posture
compromised joint instability
ROM limitations
decreased muscle performance
pain
Neurologic impairments
disorder of peripheral nerve, unable to generate muscle force for balance
CMT = results in abnormal myelin that is unstable and spontaneously break down. Foot drop, high-step gait
Intrinsic factors that are risk factors for falls
muscle weakness
visual deficit
history of falls
arthritis, diabetes, stroke, dementia, incontinence
gait & balance problems
fear of fallings
age > 80
Extrinsic factors that are risk factors for falls
lack of stair handrails
poor stair design
lack of bathroom grab bars
dim lighting or glare
tripping hazards
slippery or uneven surfaces
psychoactive medications
improper use of assistive devices
Screening Tool Questions
Have you fallen in the past year?
Do you feel unsteady when standing or walking?
Do you worry about falling?
Yes to ANY = conduct fall risk assessment
No to ALL = prevent future fall risk
Exam and Eval of Impaired Balance and Mobility
Balance: static, dynamic, anticipatory, reactive, sensory organization
Functional activities
Safety during gait, locomotion, balance
Static balance control
used during stationary tasks, standing or sitting
Dynamic balance control
used when support surface or body is moving. Sit to stand, walking, sports
Static Balance Test
used to determine ability to maintain different postures
Dynamic Balance Test
Determines ability to sit or stand on unstable surface; perform walking, jumping, hopping
Anticipatory postural control
mechanisms predict disturbances and produce preprogrammed responses that maintain a desired state
Reactive postural balance control
mechanisms are activated by sensory events following the loss of desirable posture or in response to sensory signals compared to desired state. split second decisions
Functional Reach Test
anticipatory
reach as far as possible w/o changing BOS
Push and Release Test
reactive
pt pushes scapulae into examiner’s hands, then examiner removes hands. score on steps to regain balance
Functional Balance Tests
used to determine activity and participation restrictions, to identify tasks that pt needs to practice, to assess risk fall in elderly
TUG test = timed up and go test. walk 3 meters.
<10s = completely independent
>30s = requires assistance/dependent in most activities
Foam and Dome Test
ability to balance under 6 different conditions.
EO, EC, vision, solid surface, thick foam.
Helps to differentiate between visual, somatosensory, vestibular
Contraindications of balance exercises
inherently unsafe when balance is challenged
cognitive impairments
condition that prevents ability to understand the purpose or hazard of activity
medication or drugs
EO/EC
eyes open, eyes closed
Sensory input challenges
visual: EO/EC
vestibular: head turning
proprioceptive: stable/unstable
Perturbations
include anticipatory and reactive tasks
Environmental complexity
changing surfaces, lights, quiet to busy, etc
Prevention of Falls in Older Persons
exercise should be included
programs should target strength, gait, balance
home environment assessment
perturbation training
Internal perturbations
self-initiated generation of power
External perturbations
caused by forces outside participants control
Dosage ACSM Neuromotor Exercise
2 or 3 days per week
20-30 minutes per session
balance, agility, coordination, gait
