Neurology - Part 2 Flashcards
Balance
Orient to surrounding environment while maintaining center of gravity within base of support
Can be static or dynamic
Requires integration of many body systems
MUST ASSESS FALL RISK
Body Systems contributing to Balance
- Sensory
- Visual
- Somatosensory (Bottom of foot, monofilaments)
- Vestibular - Sensorimotor
- Integration in CNS (Cerebellum) - Motor Output for postural control
- Cognition
Each system must function effectively to maintain balance
- If they lose balance, which system is affected…drives intervention
Visual System
Visual System
* Light
* View obstacles
* Position of head relative to environment
* Relative motion of other objects in environment
Damage to visual system
* CVA (CN involvement)
* Central brain issues
* Pathologies of the eye
Assessment: Vision Testing and CN assessment (oculomotor testing)
Somatosensory System
-Provides information from receptors of the skin, mm, tendons, joints relative to position of body parts relative to other body parts
-Damage/Injury to somatosensory system:
(Central: CVA, SCI, MS, etc. ; Peripheral: Neuropathies)
- Assessment: Sensory Testing
Vestibular System
- Provides information about position and movement of head relative to gravity and inertial forces
- Controls Posture
- Pathology to vestibular system: (Central and Peripheral)
- Vestibular system dysfunction leads to Vertigo and balance deficits when head is moving
- Assessment: Complex and specialized.
Vestibular System: Peripheral System
- Semicirular canals (detect angular movements of head)
- Otholithic organs of inner ear (detect linear movement of head and orientation of gravity
Sensorimotor integration in CNS
Information is processed in:
- Basal Ganglia
- Cerebellum
- Motor Cortex
Assessment
- Balance
- Pattern recognition of conditions (Ex: Parkinson’s Stroke)
Fear of Falling
- Changes movement patterns
- Fear can increase tone in muscles
- Decreased activity (decline in strength, endurance)
- Social isolation
Base of Support
- Area beneath a person that incudes every point of contact that person makes with the supporting surface
- Ex: Split stance is larger than narrow stance; Babies use whole body for support
Cone of Stability
Distance center of gravity can move over base of support without losing stability
Motor Output
Sensory motion received and processed in the brain results in a motor response
Motor strategies – Typically reflexive (arm, Stepping, Ankle, Hip)
- Arm toward ground before falling
Assessment:
- MMT
- Assessment during balance testing
Balance Assessment
Must ensure patient safety (proper guarding, gait belt, etc.
Prior to standing balance screen:
-General screen first (Vision, motion, strength)
-Cognitive screen
-Somatosensory screen
-Questionairres (Confidence of balance)
-Sitting balance
After balance screen
-Gait assessment: Deviation noted consistent with balance deficits
Balance Assessment – Tests
Sitting
Static standing balance tests
- Romberg test
- Single-limb stance test
Anticipatory balance tests
- Functional reach tests
- Catching
Reactive balance tests
- Nudge/push test
Dynamic balance tests
- Berg Balance Scale
- Tinetti Balance and Gait
Balance Testing Priority
- History of falls or episodes of instability
- Known or suspected CNS dysfunction that affects postural stability
- Somatosensory loss to lower extremities
- Frequent injury or surgery of lower extremity (affects motor)
- Gait deviations or in need of an assistive device
- Patients of the age of 65 or older
CN - Common causes of dysfunction
12 pairs of peripheral nerves
Common causes
- Trauma
- Tumor
- Ischemia
- Diseases that affect peripheral nerves
