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Neuro Science > MC Posture and Balance > Flashcards

MC Posture and Balance Flashcards

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1
Q

Balance – definition

A

The ability to control one’s center of mass (COM) with respect to the base of support (BOS).

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2
Q

Base of Support (BOS)

A

BOS is the area of the body in contact with the support surface

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3
Q

Postural Stability = Balance

A

Balance is the ability to keep the vertical projection of the center of mass (COM) within the limits of base of support

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4
Q

Center of Pressure (COP)

A
  • COP is the center of the distribution of total forces applied to the support surface
  • COP represents the average “location” of these forces. It is a point on a 2-D plane!
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5
Q

Stability Limits or “cone of stability”

A

Stability limits refer to the boundaries within which the body can maintain stability without changing the base of support.

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6
Q

Balance: Commonly described subjectively…

A
  • Zero: unable to maintain balance or no attempt made
  • Poor: able to balance with or without UE support for 5 seconds or less
  • Fair: able to balance with or without UE support from 15 - 60 seconds and/or able to hold against slight resistance
  • Good: able to hold balance against moderate resistance
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7
Q

4 Types of Balance

A

Static
Dynamic
Protective
Functional

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8
Q

Static Balance (Time)

A
  • time as objective measure

- maintain position over time

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9
Q

Static Balance (resistance)

A
  • resistance is the objective measure

- maintain position against manual resistance measured using HHD

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10
Q

Static Balance (AFF)

A
  • Anticipatory, feed-forward

- Reach in various directions within arm’s length

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11
Q

Dynamic Balance (RFB)

A
  • Reactive, Feedback

- Manually displace COM toward the edges of the BOS to elicit the equilibrium reactions

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12
Q

Dynamic Balance (AFF)

A
  • Anticipatory, Feed-forward

- Reach in various directions beyond arm’s length to elicit trunk and arm balance reactions

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13
Q

Protective Reactions

A
  • Reactive, feedback

- Slow/quick displacement of the COM outside the BOS to elicit a change in BOS (arm and/or leg movement)

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14
Q

Functional Balance

A
  • Anticipatory, feed-forward and reactive feedback

- Utilization of effective balance strategies while performing a set of functional tasks which progress in difficulty

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15
Q

Balance(T)

A
  • Time is the objective measure
  • BalanceT is frequently tested in sitting and standing
  • However, balance can be tested in any of the developmental positions
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16
Q

Static BalanceT - Time

A

Maintain a position over time

17
Q

Static BalanceR - Resistance [Subjective Assessment]

A
  • Attempt to assume near-normal posture with/without BUE support
  • -sit, stand, developmental positions
  • Maintain the position against gradual, matched manual resistance (“min, mod, max”)
  • -Co-contraction-rhythmic stabilization
  • -Tonic holding-alternating isometrics
  • Verbal cue: “hhhhoooolllllddd”
18
Q

Static BalanceR - Resistance [Objective Assessment]

A
  • Objectively measured using a hand-held dynamometer
  • Published as Sitting Strength
  • -Procedures for sitting strength written in details i
19
Q

MicroFet2 - Hand-Held Dynamometer

A
  • measures peak force (pounds)
  • Low threshold – 0.8–150 lbs. (0.1 lb. increments)
  • High threshold – 3–150 lbs. (1.0 lb. Increments)
20
Q

Static Balance Basic Procedures Patient Position - Sitting

A
  • Sitting on a height-adjustable table
  • Feet flat on the floor
  • Hips and knees at 90 dg
  • Maximize thigh contact on support surface - stable BOS
  • UE unsupported or supported
  • -Supported – using bilateral upper extremities for support
  • -Unsupported – hands not in contact with the support surface
21
Q

Static Balance Basic Procedures: PT force application

A

-Anterior – mid-sternum
-Posterior – mid-upper back between scapula
-Right and left lateral – acromion
Instructions “hold, do not let me move you” or “push as hard as you can”
-Gradual build up of force (over 3-4 seconds) and gradual release of force (over 3-4 seconds)
-Stop test when displace the subject approximately 1 inch (break test)
-2 practice trials and 3 actual trials (mean of actual trials)

22
Q

Sitting Strength (Static Balance) Test – Intra-Rater Reliability

A 
Unsupported:
Intra-class Correlation Coefficients (ICCs) = 0.80 – 0.98

BUE Supported:
ICCs = 0.83 – 0.99

23
Q

Sitting Strength (Static Balance) Test – Inter-Rater Reliability

A

Unsupported:
ICCs = 0.93 – 0.98

BUE Supported:
ICCs = 0.95 – 0.99

24
Q

Static Balance AFF -Anticipatory, feed-forward

A
  • Reach in various directions within arm’s length (goal = stability)
  • Patient is anticipating what muscle actions or motor control is necessary to prevent falling due to the progressive weight of the arm
  • Biomechanics of weight of arm (COM of arm relative to distance from axis of rotation)
25
Q

Dynamic Balance RFB - Reactive, feedback

A
  • Manually displace the COM toward the edges of the BOS to elicit the equilibrium or balance reactions
  • Reactive, Feedback balance = Patient is responding to therapist manual perturbations (stimulus > response = feedback)
26
Q

Sitting Equilibrium Reactions

A
  • Lateral right displacement or perturbation
  • Lateral left displacement or perturbation
  • Anterior displacement or perturbation
  • Posterior displacement or perturbation
27
Q

Standing Equilibrium Reactions

A
  • Lateral right displacement or perturbation
  • Lateral left displacement or perturbation
  • Anterior displacement or perturbation
  • Posterior displacement or perturbation
28
Q

Dynamic BalanceAFF - Anticipatory, feed-forward

A
  • Reach in various directions beyond arm’s length to elicit trunk and arm (sitting) and whole body (standing) balance reactions
  • Pt is anticipating what muscle actions or motor control is necessary to prevent falling due to the progressive weight of the arm
  • Know AFF actions of the trunk and legs in sitting and in standing
29
Q

Multi-Directional Reach test (MDRT)

A

Objective measure of dynamic sitting and standing AFF balance

“reach as far as possible;
you must return to upright
independently”

30
Q

MDRT Procedures - Sitting

A
  • Equipment - metal meter stick, rolling chair with out arm rests (preferably brakes), clear clipboard
  • Begin in an erect sitting posture, feet flat on floor, arm near wall (not touching), hand in a fist, shoulder raised to 90° flexion
  • Meter stick placed at acromion height
  • Initialreading taken using the 3rd PIP joint of fisted hand
  • “Reach as far as you can in the (appropriate-forward, diagonal, sideways) direction; you must return to upright independently.”
  • 3 trials are recorded in the anterior, right lateral, right diagonal, left lateral, and left diagonal directions.
31
Q

Dynamic Balance – Protective Reactions

A
  • Protective reactions - Reactive, feedback balance
  • PT manual perturbations to elicit patient change in BOS to accommodate COM beyond BOS
  • 1st Slow perturbations to just beyond BOS or “edge of cone of stability”
  • -Sitting arm movements
  • -Standing leg movements – step and cross-overs
  • 2nd, relatively faster perturbations (yet safe)
32
Q

Functional Balance

A
  • Utilization of effective balance strategies while performing a set of functional tasks which progress in difficulty
  • Example Outcome Measures
  • -Berg Functional Balance scale
  • -Tinetti balance scale
  • -Mini-BEST test

Neuro Science (10 decks)

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