P5 - Balance Rehabilitation

Question 1

What is balance in the context of human movement?

Answer 1

Balance is the ability to maintain an upright posture and move from one posture to another against gravity, keeping the body in equilibrium whether at rest or in steady-state motion.

Question 2

What is the Base of Support (BOS)?

Answer 2

The Base of Support (BOS) is the area of the object that is in contact with the supporting surface.

Question 3

What is the Centre of Mass (COM) in human movement?

Answer 3

The Centre of Mass (COM), or centre of gravity, is a point located at the centre of the total body mass.

Question 4

How is balance maintained in relation to the Base of Support (BOS)?

Answer 4

Balance is the ability to maintain the Centre of Mass (COM) within the limits of the Base of Support (BOS).

Question 5

Which body systems contribute to maintaining balance?

Answer 5

Somatosensory system (afferent/efferent pathways)
Muscle strength and range of motion (ROM)
Vestibular system
Vision
Proprioception
Cognition

Question 6

What are common causes of reduced balance?

Answer 6

Frailty and ageing
Neurological conditions (e.g., stroke, Parkinson’s disease, multiple sclerosis)
Vestibular conditions (e.g., BPPV, labyrinthitis)
Diabetes and peripheral neuropathies
Sarcopenia or muscular atrophy
Injury, trauma, or pain

Question 7

What biopsychosocial factors contribute to balance issues and falls?

Answer 7

Loss of confidence
Reduction in physical activity
Environmental hazards

Question 8

How does the World Health Organization (WHO) define a fall?

Answer 8

A fall is an event resulting in a person unintentionally coming to rest on the ground, floor, or a lower level. It excludes major internal events (e.g., stroke) or being hit by an external force.

Question 9

What are the two main causes of falls?

Answer 9

Medical cause (e.g., collapse due to health conditions)
Mechanical cause (e.g., tripping over an object)

Question 10

What are some key risk factors for falls in frail older adults?

Answer 10

Previous falls (one of the highest risk factors)
Older adults should be routinely asked about falls in the past year (NICE Guidelines 2019)

Question 11

What percentage of falls lead to major injuries such as lacerations, traumatic brain injuries (TBIs), or fractures?

Answer 11

About 40-60% of falls lead to major injuries, including lacerations, TBIs, or fractures.

Question 12

What is recommended for older adults who seek medical treatment after a fall?

Answer 12

They should undergo a risk assessment, including gait analysis and balance testing. Multifactorial falls risk assessments should also be offered (e.g., at multidisciplinary falls clinics).

Question 13

What are intrinsic and extrinsic risk factors for falls?

Answer 13

Intrinsic: Medical conditions, visual impairments, polypharmacy, balance deficits, weakness
Extrinsic: Environmental hazards, poor lighting, uneven surfaces, pets

Question 14

What are some common outcome measures for assessing balance?

Answer 14

BERG Balance Scale
Tinetti test
Romberg test
Functional reach test
BESTest

Question 15

What are some common outcome measures for assessing mobility and gait?

Answer 15

Timed Up and Go (TUG) test
Turn-180 test
Lindop Mobility test
10-metre walk test
30-second sit-to-stand test

Question 16

What role do strength and ROM assessments play in balance evaluation?

Answer 16

These assessments help evaluate the muscle strength and joint flexibility necessary for maintaining balance and functional mobility.

Question 17

What exercise interventions are recommended for preventing falls in community-dwelling older adults?

Answer 17

Exercise programs that include balance-challenging and functional exercises (e.g., sit-to-stand, stepping) should be offered at least 3 times a week, for a minimum of 12 weeks, and should be individualized and progressed in intensity.

Question 18

According to NICE Guidelines, what interventions should be offered to older adults at risk of falling?

Answer 18

Strength and balance interventions, combined with a holistic multidisciplinary approach, should be offered to all older adults at risk of falls.

Question 19

What are the benefits of the Otago exercise program for older adults?

Answer 19

The Otago program improves dynamic and static balance, increases lower limb (LL) strength, enhances postural control, and boosts cognitive function (Yang et al., 2022).

Question 20

What should be the primary focus areas in balance interventions?

Answer 20

Strength and Range of Motion (ROM)
Proprioception and sensation training
Dynamic and static balance exercises
Fun and engaging activities (individual or group-based, e.g., Tai Chi, games)

Question 21

How frequently should balance interventions be conducted for optimal results?

Answer 21

Interventions should be conducted 2-3 times per week for effective improvement in balance and fall prevention.