M1 L8: Ax Postural Control III - Ax items

Question 1

Why do we assess postural control in children? What are 7 deficits in postural control shown in children with Neurological Disorders?

Answer 1

1. Cerebral palsy
2. Developmental co-ordination disorder
3. Spina Bifida
4. Downs syndrome
5. Autistic Spectrum Disorders
6. Premature birth
7. Sensorineural hearing loss

Question 2

What are 4 ways to measure postural control?

Answer 2

1. Age – expected milestones
   
   • Expected achievements on standardised assessment
2. Development – sequence for emerging skills
   
   • Changes that parallel the acquisition and development of sensory, motor & cognitive function and musculoskeletal growth
3. Task and environment challenges
   
   • Performance on specific tasks & in specific environments
   • Requirements for dual-tasking
4. Population-based expectations
   
   • Known / classic difficulties experienced by different population cohorts / conditions

Question 3

What is the 0-6 years NSMDA?

Answer 3

Neuro-sensory motor development assessment in children

Question 4

What are 4 postural responses for 0-2 months?

Answer 4

Some reproducible patterns of posture/movement

Elicited in response to:

1. Specific positions/altered position (vestibular)- In certain positions
2. Specific stimuli (touch/proprioception)- Eg. touch back of hand –> baby will open hand; put baby on feet –> will extend limbs
3. Stereotypical = non adaptive
4. Poor adaptive antigravity responses

Question 5

What are 3 postural responses for 3-6 months?

Answer 5

1. Head righting 3-6m
   
   • Very different of voluntary head control
2. Body righting 3-6m
   
   • Corrects in response to vestibular or vision feedback (almost involuntary)
3. Horizontal / vertical suspension

Question 6

What are 3 postural responses (Protective & Parachute reactions) for 6-10 month old?

Answer 6

Protective & Parachute reactions

• Lift baby and rapidly move the baby towards the supportive surface (will extend limbs out)

1. 6 months forward arms and downward legs
2. 8 months sideways arms
3. 10 months backward arms

Question 7

What are 3 postural responses (Equilibrium responses) for 6-10 month old?

Answer 7

1. From 10 months
2. Counterbalance disturbing forces
3. May inhibit the need for backward protection at 10 months

Question 8

What are 3 functional balance responses for 15 months to 2 years old?

Answer 8

1. Challenging LOS – reach outside of base and step forward
2. Postural control with a moving base of support
   
   • Walk and run
3. Weight shift
   
   • Varied BOS in sitting (Ring sitting –> side sitting)
   • To single leg stance

Question 9

What are 5 functional balance responses for 2 to 5 years old?

Answer 9

1. Challenging LOS – reach further outside of base
2. Unstable surfaces
3. Postural control with a moving base of support
   
   • Walk, run, jump
4. Advancing Weight shift to kick and hop
5. Introduction of simple items/equipment (eg. balls)

Question 10

What are 4 functional balance responses for 5 to 8 years old?

Answer 10

1. Challenging LOS - reach further outside base
2. Increasing speed during activities with a moving base of support
3. Controlled sequencing of dynamic weight shift
4. Incorporation of other items / equipment (eg. skipping ropes)

Question 11

What are 4 assessment considerations at school age?

Answer 11

1. Improved cognitive ability
2. Able to request performance of tasks
3. Participate in assessment
4. Aim to assess all postural control systems
5. Various assessments available
   
   • e.g. BOT-2 (Bruininks-Oseretsky)
   • e.g. Movement ABC
   • e.g. BESTest –> most comprehensive

Question 12

What is the Balance Evaluation Systems Test (BESTest)?

Answer 12

The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits

Question 13

What are examples of Kids-BESTest domain testing?

Answer 13

Question 14

What does the BESTest score sheet look like?

Answer 14

Question 15

What are the results like in the BESTest?

Answer 15

• Both the Full Kids-BESTest and Mini-Kids-BESTest can discriminate postural control abilities in school-aged children with and without CP
• Full Kids-BESTest has slightly better reproducibility
• Full Kids-BESTest better for treatment planning

Question 16

What are the 6 domains of the Kids-BESTest?

Answer 16

Question 17

What are the biomechanical constraints in BESTest?

Answer 17

Question 18

What are the stability limits/verticality in BESTest?

Answer 18

Question 19

What are Anticipatory postural adjustments in BESTest?

Answer 19

Question 20

What are Reactive postural responses in BESTest?

Answer 20

Question 21

What is sensory orientation in BESTest?

Answer 21

Question 22

What is Stability in Gait in BESTest?

Answer 22

Question 23

What is the management for the Kids-BESTest results of an 8 year old male with Left Hemiplegic CP, GMFCS I, MACS I, FMS 6,6,6?

Answer 23

Functional strength program

• Impacting transitions and biomechanics

Question 24

What is the management for the Kids-BESTest results of an 10 year old male with Left Hemiplegic CP, GMFCS I, MACS I, FMS 6,6,6?

Answer 24

Standing on moving surface (unpredictable perturbation)

Question 25

What is the management for the Kids-BESTest results of an 14 year old male with Spastic diplegic, GMFCS II, MACS I, FMS 6,6,6.?

Answer 25

Reactive balance

Question 26

What is the Age VS Kids-BESTest pattern/trend?

Answer 26