postural control lecture with disease combinations

Question 1

what is the postural control considerations for stroke? how do you test these patients? what treatments are beneficial?

Answer 1

• 83% of pts. 2-4 wks post
  stroke! balance disability
• Motor control impairments
  (caused by reduction in # and
  firing rate of motor units): slow
  movements, weakness, fatigue,
  incoordination, decreased force
  production, co-contractions

3 global impairments in balance:
* sensation (to detect or anticipate postural
disturbance),
* neural processing (to select appropriate feedback/
feedforward postural control ),
* effective motor output

Impairment to the timing, magnitude
and sequencing of muscle activation

Asses with:
berg balance scale
dynamic gait index
functional reach test
tug

interventions
✅ (balance/wt. shifting and gait training effective)-

Question 2

what is the postural control considerations for PD? how do you test these patients? what treatments are beneficial?

Answer 2

With ds progression ! loss in postural stability, gait
dysfunction, frequent falls
* Postural instability less responsive to drug therapy
* Up to 68% falls in later stages of ds
* Lack of balance reaction, flexed posture, decreased
trunk rotation, difficulty executing simultaneous
movements/sequential movements

Basal Ganglia
* controlling the flexibility of postural
tone
* scaling up the magnitude of postural
movements
* selecting postural strategies for
environmental context
* automatizing postural responses and
gait

postural sway is limited in the posterior region for the patient

Asses with:
berg ballance scale
dynamic gait assessment
functional gait assessment
mini best test
timed up and go

interventions:
(exercise interventions probably reduce rate of falls- Cochrane Database Syst Rev, 2022; mod
intensity PRE, 2-3x/wk over 8-10 wks-

Question 3

what is the postural control considerations for MS? how do you test these patients? what treatments are beneficial?

Answer 3

Due to extensive damage to CNS
* Demyelination! sensorimotor cortex, basal
ganglia, cerebellum, spinal pathways
* Motor learning preserved in early phase of MS!
capacity dependent on severity

Critical deficit: slowed spinal SS conduction!
delayed postural latencies and increased
postural sway

berg balance scale
dizziness handicap scale
tug cog and manual

interventions:
⚠ (balance interventions have a medium effect on outcomes; high intensity* & taskspecific
interventions are associated with better outcomes)-

Question 4

what is the postural control considerations for SCI? how do you test these patients? what treatments are beneficial?

Answer 4

Aberrant synapse formation leads to inappropriate muscle
recruitment and poor coordination
* Changes in excitability of spinal locomotor networks
render some synapses hyperexcitable and some
hypoexcitable
* Chronic SCI- progressive deterioration of muscle
properties diminishes the ability to generate movements

asses: tug

interventions:[weak evidence for BWST (+ stimulation – FES or tDCS), small scale studies on VRbased
balance training show promise]-

Question 5

what is the postural control considerations for MTBI? how do you test these patients? what treatments are beneficial?

Answer 5

Balance disorders- one of the most common
symptom
* 23-81% report dizziness
* Postural instability due to dysfunction in
sensory integration
* Deficits in cognition! attention affects
postural control

assess using:
coma recovery scale
moss attention rating scale
high level mobility assessment (HiMAT)

intervention:
(weak evidence for vestibular rehab exercises, subthreshold aerobic exercise)-

Question 6

what is the postural control considerations for vestibular disorders? how do you test these patients? what treatments are beneficial?

Answer 6

Vestibular system roles:
1. Perception of body position
and self-motion
2. Orientation of trunk to vertical
3. Controls COM (postural
reactions)
4. Stabilize head in space

asses:
dynamic gait index
dizziness handicap inventory
functional gait assessment

intervention:
⚠ (moderate evidence for improved postural stability following vestibular rehab
exercises)

Question 7

what is the postural control considerations for stroke?

Answer 7

83% of pts. 2-4 wks post
stroke! balance disability