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Term 3 > Neuromuscular Unit 7 Balance > Flashcards

Neuromuscular Unit 7 Balance Flashcards

1
Q

What are common subjective reports of a balance impairment?

A
  • “My balance is not the same as before”
  • “I do not feel as coordinated when I am standing or walking”
  • “I fell last week”
  • “I use the AD on/off”
  • “I have a tendency to walk around holding onto furniture or walls”
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2
Q

What may you see during the Task Analysis that may point you in the direction that the the patient might have a balance impairment?

A
  • Any form of postural abnormality in sitting or standing (Trunk lean, asymmetrical weight bearing, etc.)
  • Use of an AD for standing
  • Use of UE support for sitting or standing
  • Actual LOB noted
  • Need for physical assistance from someone
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3
Q

What 3 systems must be intact for normal postural control?

A
  • Sensory System
  • Neuromuscular System
  • Musculoskeletal System
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4
Q

With Sensory, what 3 sources provide input to the body to properly attain normal postural and balance control?

A
  • Visual
  • Vestibular
  • Somatosensory

Somatosensory inputs provide the greatest and most reliable information, if compromised Visual assumes a greater role

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5
Q

With Motor Strategies, what is Postural Strategy?

A

This is when normal muscles synergy whereby a group of postural muscles are constrained to work together as a unit

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6
Q

With Motor Strategies, what is the difference between Adaptive Postural Control and Anticipatory Postural Control?

A

Adaptive Postural Control: The bodies ability to react to external stimulus and respond
Ex.: Getting pushed, walking on a rope bridge

Anticipatory Postural Control: The use of past experience of predict needed motor response
Ex.: Stepping into an escalator

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7
Q

With Motor Strategies, what are fixed support strategies?

A

Movement strategies used to control the COM over a fixed BOS

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8
Q

With Motor Strategies, what are 3 different Compensatory Postural Strategies?

A
  • Ankle Strategy
  • Hip Strategy
  • Stepping Strategy
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9
Q

With Compensatory Postural Strategies, what is Ankle Strategy?

A
  • These response to small perturbations on a firm support surface.
  • Muscles of the ankle fire distal to proximal
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10
Q

With Ankle Strategy, what are 2 possible responses that may occur and what muscles are active with the responses?

A
  • Forward Sway: Pushed forward or platform moves backward
    Gastroc, Hamstrings, Paraspinals
  • Backward Sway: Pushed backward or platform moves forward
    Tibialis Anterior, Quadriceps, Abdominals
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11
Q

With Compensatory Postural Strategies, what is Hip Strategy?

A
  • Responses to larger, faster perturbations or when the support surface is compliant or very narrow, like a balance beam
  • Muscles fire proximal to distal
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12
Q

With Hip Strategy, what are 2 possible responses that may occur and what muscles are active with the responses?

A
  • Forward Sway: Pushed forward or platform moves backward (posterior)
    Abdominals, Quadriceps
  • Backward Sway: Pushed backward or platform moves forward (anterior)
    Paraspinals, Hamstrings
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13
Q

With Compensatory Postural Strategies, what is Stepping Strategy?

A
  • Response to large and fast perturbation when COM moves near or beyond the limits of stability
  • Can also occur due to ankle/trunk weakness or ineffective ankle/hip strategy
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14
Q

With Neuromuscular balance (Direct) impairments, what is Muscle Sequencing impairment?

A

Postural synergy muscles are activated in the wrong order.

For example, activating abs before anterior tibialis in response to small perturbations

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15
Q

With Neuromuscular balance (Direct) impairments, what is Coactivation impairment?

A

When the Agonist and Antagonist contract simultaneously preventing a normal ankle or hip strategy (Common in PD)

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16
Q

With Neuromuscular balance (Direct) impairments, What is Delayed Activation?

A

This is when the muscle does not contract at an appropriate time

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17
Q

With Neuromuscular balance (Direct) impairments, what is Difficulty Scaling Amplitude?
How does Cerebellar Dysfunction affect Neuromuscular Balance?

A

This is the appropriate activation of muscles

  • It affects the effective control of muscle tone at the appropriate time
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18
Q

With Neuromuscular balance (Direct) impairments, What is Motor Adaptation Issues?

A

When the UMN becomes fixed with a particular response even when not appropriate

Consider patients with abnormal synergies (Descending Corticospinal Tract)

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19
Q

With Neuromuscular balance (Direct) impairments, What is Muscle Paresis?

A

Muscle becomes unavailable for postural stability or regaining balance after loss of balance

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20
Q

With Neuromuscular balance (Direct) impairments, What is Loss of Anticipatory Control?

A

When the person can no longer used past experience

Consider visual and cognitive deficits

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21
Q

With Musculoskeletal Balance (Indirect) Impairments, what is Disuse Atrophy?

A
  • Place same role as Paresis but more widespread
    Muscle becomes unavailable for postural stability or regaining balance after loss of balance
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22
Q

With Musculoskeletal Balance (Indirect) Impairments, how would Muscle Stiffness and loss of ROM affect balance?

A

This will limit ability for hip/ankle strategies to work effectively

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23
Q

With Musculoskeletal Balance (Indirect) Impairments, what will the Use of an Orthotic affect balance?

A

This acts as an external restriction to “normal” movement
- Limiting normal ankle strategy

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24
Q

When doing a Balance Assessment with patients with a Cerebellar Dysfunction, what would their Weight Bearing/BOS look like?

A

Wide BOS

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25
Q

When doing a Balance Assessment with patients with a Cerebellar Dysfunction, what would be the Findings with LOB?

A
  • Incoordination and Ataxia with Stepping Strategy
  • Difficulty Scaling
  • (+) Oscillations before regaining balance
26
Q

When doing a Balance Assessment with patients with a Cerebellar Dysfunction, will they have more difficulty with Anticipatory or Adaptive Response?

A

More Difficulty with Adaptive Response due to difficulty with scaling

27
Q

When doing a Balance Assessment with patients with a Basal Ganglion Dysfunction (PD), what would be their postural alignment?

A

They would have increased flexion

28
Q

When doing a Balance Assessment with patients with a Basal Ganglion Dysfunction (PD), what would be the Findings with LOB?

A
  • Use of multiple steps to regain balance (Possible festination)
  • (+) Coactivation of agonist and antagonist due to rigidity (increased LOB)
29
Q

When doing a Balance Assessment with patients with a Basal Ganglion Dysfunction (PD), will they have more difficulty with Anticipatory or Adaptive Response?

A

More difficulty with Anticipatory due to Bradykinesia

30
Q

When doing a Balance Assessment with patients with a Cortex Dysfunction (Stroke), what would their Weight Bearing/BOS look like?

A

Asymmetrical

31
Q

When doing a Balance Assessment with patients with a Cortex Dysfunction (Stroke), what would be their postural alignment?

A

Asymmetrical

32
Q

When doing a Balance Assessment with patients with a Cortex Dysfunction (Stroke), what would be the Findings with LOB?

A
  • They will usually rely on reaching with uninvolved UE or stepping with uninvolved LE
  • Overall delay in motor strategies
33
Q

When doing a Balance Assessment with patients with a Cortex Dysfunction (Stroke), will they have more difficulty with Anticipatory or Adaptive Response?

A

More difficulty with Adaptive due to lack of hemimotor control

34
Q

Using the Pic, what system is the patient dependent on if they have increased sway or LOB on conditions 2, 3, 5, and 6 during the Sensory Organization Test and Foam and Dome?

A

This will indicate that the patient is dependent on Vision for Postural Control

35
Q

Using the Pic, what system is the patient dependent on if they have increased sway or LOB on conditions 4, 5 and 6 during the Sensory Organization Test and Foam and Dome?

A

This may indicate that the patient is dependent on Somatosensation for Postural Control

36
Q

Using the Pic, what system did the patient loss if they have increased sway or LOB on conditions 5 and 6 during the Sensory Organization Test and Foam and Dome?

A

This may indicate that the patient is has Vestibular Loss

37
Q

With Outcome Measures, what is Reliability?

A

The ability for tests to be accurately repeated

38
Q

With Outcome Measures, what is Validity?

A

Measures what it is intended to measure

39
Q

With Outcome Measures, what is Standard Error of Measurement (SEM)?

A

Degree to which scores vary across repeated measurements

40
Q

With Outcome Measures, what is Minimal Detectable Change (MDC)?

A

The amount of change required in a score to rule out the change due to error

41
Q

With Outcome Measures, what is Minimal Clinically Important Difference (MCID)?

A

The amount of change required in a score that has a meaning to the patient

42
Q

What is the Tinetti Outcome Measure?

A
  • This Assess Gait and Balance in older adults
  • Measures Perception of balance during ADLs
  • Its an indicator of Fall Risk
43
Q

What is the 10m Walk Outcome Measure?

A

A 14m walkway is needed; Measure 10m distance that’ll be the start and finish mark; Start the person 2m in front of the start and have the person walk 2m past the finish mark

  • Assesses Gait speed which correlates with level of functional independence and participation capacity
  • Divide the distance by time, this will give you the speed in meters per second

To set up, use a chair at both ends of the test to allow seated rest

44
Q

What is the 6 Min Walk Outcome Measure?

A
  • This is a sub-maximal exercise test to assess aerobic capacity and functional endurance

To set up, use a chair at both ends of the test to allow seated rest

45
Q

With walking speed, what is the Full Community Ambulation Gait Speed (able to safely cross street)?

A

> 1.2 m/s

46
Q

With walking speed, what is the Community Ambulation Gait Speed?

A

> 0.8 m/s

47
Q

With walking speed, what is the Household to limited Community Ambulation Gait Speed?

A

0.4-0.8 m/s

48
Q

With walking speed, what is the Household only Gait Speed?

A

<0.4 m/s

49
Q

What is the Fall Indicator for the Functional Reach Outcome Measure?

A

Dynamic Balance with task of reach (Forward, Backward, or Lateral)

*Fall Risk Indicator if they are less than 6 inches *

50
Q

What is the Functional Gait Assessment (FGA) Outcome Measure?

A
  • Assesses postural stability during walking and an individuals ability to perform multiple motor task while walking

The Functional Gait Assessment is similar to the Dynamic Gait Index and was developed to improve reliability and decrease the ceiling effect

51
Q

What is the Dynamic Gait Index Outcome Measure?

This is a Gait OM

A
  • Assesses individuals ability to modify balance while walking in the presence of external demands

This test mimics everyday gait activities involving
adjustment to disruptions in balance, direction change, and gait speeds

52
Q

What is the focus for the Rhomberg/Sharpened Rhomberg Outcome Measure?

A

Assesses static Balance with task of standing in two postures:
- Rhomberg: feet shoulder width apart with arms crossed
- Sharpened: Feet in tandem with arms crossed; strong leg posterior

(Can be done with eyes open or closed)
Indictor for fall Risk

53
Q

What is the purpose for the Timed Up and Go?

A
  • TUG assesses mobility, balance and walking ability in one test to determine fall risk.
  • Time is taken when the individual stands up walks a distance of 3m, turns around and sits back down; with no physical assistance

The timed up and go is a reliable test of physical mobility and it provides the examiner with a quick snap
shot of the patient’s dynamic balance, gait speed, and functional ability

Fall Risk Indicator

54
Q

What does it mean when the patient completes the test in <10 seconds in the TUG?

A

They are freely Independent

55
Q

What does it mean when the patient completes the test in >30 seconds in the TUG?

A

Dependent in most activities, not a community ambulator, FALL RISK

56
Q

What does it mean when the patient completes the test in >13.5 seconds in the TUG?

A

Cut off score for community dwelling adults (Risk for Fall)

57
Q

What is the Timed “UP & GO” with Dual Task?

A
  • TUG Dual Task is the same as TUG but while completing the test and additional task:
    Physical like carrying a cup of water; A difference of >4.5 sec is associated with a greater fall risk for elderly
    or
    Cognitive like subtracting 3 from a random number between between 20 and 100. Or reciting a 7 item grocery list that was previously presented.

A TUG of > or = to 15 seconds discriminates fallers from non-fallers

Fall Risk Indicator

58
Q

What is the focus for the Berg Balance Outcome Measure?

What score will indicate a fall risk?

A
  • Objectively determines the patients ability to safely maintain postural control/balance during a series of 14 tasks

A total score for this exam is 56; A score of 45 and below indicates a risk for fall

59
Q

What is the focus for the Mini Best Outcome Measure?

A

Static/Dynamic Balance; Fall Risk

Focuses on Dynamic Balance

60
Q

What it Focus for the PASS Outcome Measure?

A

Assesses postural control in stroke survivors

61
Q

What is the Criteria for the Sitting Balance Screen?

A

1. Unchallenged static sitting balance is tested (student times duration of unsupported sitting before LOB, if no LOB student assesses for at least 30sec)
2. Challenged static sitting balance tested with EC (student times duration of EC unsupported sitting before LOB, if no LOB student assesses for at least 30sec)
3.Challenged static sitting balance tested with perturbations (reactive postural control is assessed with
UNEXPECTED perturbations in multiple directions/begins with small quick nudges and progress to maximal as appropriate)
4. Unchallenged dynamic sitting balance is tested with min (2-4in), mod (4-8in), and maximal trunk excursions (>8in) in multiple directions. Student checks arm’s length first and ensures intentional trunk movement
5. Challenged (student’s choice) dynamic sitting balance is tested with min, mod, and maximal trunk excursions as above in multiple directions

Criteria for overall “0” - patient is allowed UE support throughout test whereby balance is not effectively assessed

62
Q

What is the Criteria for Standing Balance?

A

1. Unchallenged static standing balance is tested (student times duration of unsupported standing before LOB, if no LOB student assesses for at least 30sec)
2. Challenged static standing balance tested with EC (student times duration of EC standing time before LOB, if no LOB student assesses for at least 30sec)
3. Challenged static standing balance tested with perturbations (reactive postural control is assessed with
UNEXPECTED perturbations in multiple directions/begins with small quick nudges and progress to maximal as appropriate)
4. Unchallenged dynamic standing balance is tested with min (2-4in), mod (4-8in), and maximal trunk
excursions (>8in) in multiple directions. Student checks arms length first and ensures intentional trunk movement
5. Challenged (student’s choice) dynamic standing balance is tested with min, mod, and maximal trunk excursions as above in multiple directions

Criteria for overall “0” - patient is allowed UE support throughout test whereby balance is not effectively assessed

Term 3 (50 decks)

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