Posture, Balance and Gait Changes Across the Lifespan Flashcards
Types of postural control:
-
Static (Steady State)
- Ensures stability by maintaining COM within the BOS
-
Reactive
- Governs unexpected movements of the COM within or outside the BOS
-
Anticipatory (Proactive)
- Postural adjustments made before a movement
-
Adaptive:
- modification of a motor response due to a change in environmental conditions or task
demands
- modification of a motor response due to a change in environmental conditions or task
Which type of postural control governs unexpected movements of the COM within or outside the BOS:
Reactive
Type of postural control when postural adjustments are made before a movement
Anticipatory (Proactive) postural control
Modification of a motor response due to a change in environmental conditions or task demands
Adaptive postural control
righting or equilibrium reactions are an example of what type of postural control?
reactive postural control
An unexpected perturbation on a force platform is an example of what type of postural control?
reactive postural control (or balance)
We typically make this type of postural control adjustments before reaching, lifting, and stepping:
anticipatory postural control
experience is important in acquiring anticipatory postural control.
Most individuals change their speed and step width when walking on slippery ground.What type of postural control does this behavior demostrate?
Adaptive postural control
The body perceives changes in the COM in a posture by detecting amplitude of…
center of pressure (COP) motion
Components of a Postural Control System
Until age __ vision is the primary sense relied upon.
3
As children learn to use somatosensory information from LE, this becomes primary
what is the primary sense relied upon until age 3?
vision
As children learn to use somatosensory information from LE, this becomes primary
Vestibular function in relation to standing postural control does not reach adult levels until…
young adulthood (18/20 to 40 yr)
When there is a conflict between visual, somatosensory and vetibular systems in organization of postural control _____________ is the tie breaker
vestibular system
Vestibular function in relation to standing postural control does not reach adult
levels until young adulthood
Somatosensation is the combined input from touch and proprioception. Adults use somatosensation as their primary source for postural response. When there is a sensory conflict, the _______system acts as a tiebreaker in making the postural response decision.
vestibular
If somatosensation says you are moving and vision says you are not, the vestibular input should be able to resolve the conflict to maintain balance. however, vestibular function relative to standing postural control does not reach adult levels, even at the age of 15, according to hirabayashi and Iwasaki.
If somatosensation says you are moving and vision says you are not, the _______ input should be able to resolve the conflict to maintain balance.
vestibular
function to keep the head oriented to the body and to gravity and to keep the eyes level with the horizon
Righting Reactions
adjust for changes of the body in space, to keep you balanced over a point
equilibrium reactions
When held upright in vertical and tilted in any direction, the head and trunk right or tilt in the opposite direction. Type of reaction?
Righting reaction
In summary, the common concept of posture has two facets: the idea of balance, or preserving alignment, and the function of righting, or moving from one posture to another to attain erect standing posture.
From the text-book
When we can stand with-out assistance, we move out of the period of infancy and enter ________.
childhood.
Thus the postural function of rising is so important to our development that it has been used as a marker of transition to
Many changes in movement patterns seen in older adults are due to _______and lack of motor practice
inactivity
Posture and balance decline with age due to:
- Change in static posture
- Loss of flexibility and muscle strength and muscle tone
- Vestibular impairments
- Sensory input and integration
- Visual Changes
- Medications and poly-medications
With age, how does visual changes affect balance?
less able to pick up contours and depth cues
How is the vestibular system affected by age?
Loss of hair cells that sense direction of the endolymph in the semicircular canals
How is the vestibulocochlear nerve system affected by age?
can have a reduction in fibers
true or false, vibratory sense does not change in the LE with aging
false, Vibratory sense in the LE’s declines
true or false: PT’s should focus their efforts on evaluation and reinforcement of stepping responses as compared to hip and ankle strategies
true
Research has shown that it may be more
natural to react to loss of balance by taking a step
gait patter at 2 to 3 years of age
- Reciprocal arm swing
- Heel strike
gait pattern at 3 to 4 years of age
- Narrowing of BOS
- Increased time in single limb stance
- Demonstrate mature gait pattern by 4 years of age
Gair pattern at 7 years old:
- COM at L3
- Adult kinematic pattern more refined
- May see further refinement of spatial & temporal aspects of gait up to 15 years of age
Critical variable in development of independent ambulation =
extensor muscle strength
Key parameters that show change as gait matures :
- Single limb stance duration increases with age & maturation
- Walking velocity increases with age & limb length
- Cadence decreases with age & limb length
- Step length increases with age & limb length
Disproportionately greater ________ l instability compared with nonfallers
medial-lateral
older adults have ___________ stride frequency across a range of imposed gait speeds and an inability to obtain the highest imposed gait speed
Greater
3 questions from American Geriatrics Society (AGS):
- Have you fallen in the past year?
- Have you had an acute fall?
- Does the patient has difficulty with walking and balance?
- TUG: more than 14-15
Screening tool for falls:
- American Geriatrics Society (AGS): 3 questions
- Center for Disease Control and Prevention (CDC): CDC algorithm
American Geriatrics Society (AGS) recommendations that all individuals ______ y.o. and older should be screened for fall risk
65
If screen for falls (DCD and AGS) is positive, what do you do next?
comprehensive falls risk assessment should be performed
- Accurately assess level of risk and implement appropriate interventions
Comprehensive Falls Risk Examination:
- Medication review
- Vision screen
- Environment review/assessment
- Cognitive screen
- Heart rate & rhythm
- Postural hypotension
- Proprioception and sensation
- Neurological impairment
- Feet and footwear
Walking speed _______ or slower = risk for increased falls
1.0 m/s
normal is 1.4 m/s
How would a PT assess strength related to risk for falls?
- All LE major muscle groups
- Functional leg strength:
- 30-second chair rise
- Timed Chair rise
Increased variability of stride length & step width =
increased risk for falls
Single Leg Stance <5 sec =
greater risk for injurious fall
- Single leg stance <5 sec = greater risk for injurious fall
- Timed chair rise
- 30-sec Chair stand
- 4-Stage Balance test
- Timed Up & Go (TUG)
- Tinetti/POMA
- Dynamic Gait Index (DGI)
- Berg Balance Scale (BBS)
- Fullerton Advanced Balance Scale (FAB)
Balance/Functional Measures
Intervention for Fall Risk/Prevention:
- Balance training
- Dynamic gait training
- Dual-task training
- Strength training
- Aerobic training/walking
Otago Exercise Program:
- Most common fall preventative strategies
- Designed to be taught by PT or nurse
- Series of 17 exercises taught over 4 visits in 8 weeks
- Otago Exercise Program
- Designed to be taught by PT or nurse
- Series of 17 exercises taught over 4 visits in 8 weeks
- Matter of Balance (behavioral change program)
- Stepping On
- Fallproof!
- Tai Chi: Moving for Better Balance
- Stay Active and Independent for Life (SAIL)
Fall Preventative strategies programs
