Lecture 6: Exam and Treatment for Balance Flashcards
What two kinds of balance must be tested?
- static and dynamic sitting
2. static an dynamic standing
Are balance exams a standardized outcome measure?
no only a screening tool
What is the Romberg test?
a clinical test used for balance although not very functional, therefore useful as a scrren
What are parts of Romberg?
pts stand with feet together and arms crossed, do eyes open and closed and max time is 30 seconds
What is a positive romberg?
loss of balance with eyes closed
What is a sharpened Romberg?
standing in tandem stance same procedure
What is another test similar to the Romberg?
SLS
What are two standardized measures for static and dynamic sitting balance?
Trunk Impairment Scale (TIS)
Function in sitting test (FIST)
What is the FIST?
14 items, with scored as 0 (complete assist) to 4 (ind.)
What are examples of static and dynamic standing balance?
ABC scale, CTSIB, FRT, Berg, TUG, DGI, BESTest
What is the ABC scale?
self report of confidence with maintaining balance
What is score on ABC that indicates fall risk?
under 67% (84% accuracy)
bench marks established for people with history of CVA, PD
What is the CTSIB?
clinical test for sensory interaction in balance
“foam and dome” test
indicates where functional deficit is coming from (sensory modality)
How many different conditions are tested in the CTSIB?
6, firm and foam with eyes open/closed/dome
What is the functional reach test testing?
ability to reach forward in bilateral stance = internal pert and test of proactive balance
What is cut off score for Berg Balance?
45 (max is 56) indicates greater fall risk
What does 5 time sit to stand measure?
LE strength and fall risk
What is the DGI?
dynamic gait index, assess individual ability to modify balance while walking in the presence of external demands
What is FGA?
functional gait assessment, assess postural stability during various walking tasks
Why is the BESTest so good?
it allows clinicians to differentiate balance into 6 underlying systems that may constrain balance and in turn design more effective treatments
What are 6 different areas of BESTest?
- biomechanical constraints
- Stability limits
- APA
- postural responses
- sensory orientation
- Stability in Gait
What kind of perturbation is reaching?
internal bc patient must brace themselves for movement
What is general cut off score for BESTest?
69% (sensitivity 0.86)
What areas are tested in the Mini BESTest?
- APA
- reactive postural control
- sensory orientation
- dynamic gait
For the Brief BESTest what areas of 6 original areas are tested?
- Biomechanical- hip strength
- stability limits- reach forward
- APA- stand on one limb
- postural responses- compensatory stepping each leg
- Sensory orientation- stance on foam eyes closed
- stability in gait: get up and go test
How can you train vision to help balance?
visual fixation, VOR exercises, scanning the environment
How can you train somatosensation?
unstable surface training, if promoting recovery use exercises to appertain sensory input
How can you train the vestibular system?
functional activities with head turns, habituation, VOR exercises
What are examples of training internal perturbations?
head turns, weight shifts, reaching, sit to stand, walking, stairs, obstacle courses
How can a PT train ankle or hip strategies?
large supporting surface with slow and low amplitude external perturbations
How can a PT train stepping strategies?
small supporting surface with large fast perts
What are other ways to train external pertubations?
moving surfaces, walking in crowded hallway, catching a ball thrown in unpredictable directions
