PT Activity Examination: Balance and Trunk Control Flashcards

1
Q

base of support (BOS)

A

boundary created by body parts in contact w supporting surface

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2
Q

center of mass (COM)

A

mean/avg location of total mass in the body

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3
Q

center of pressure (COP)

A

theoretical position under BOS through which all forces act on the body
- weighted avg (net force) of all forces acting on supports

ie imaginary point where all pressure is located (right vs left, toes vs heels)

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4
Q

center of gravity (COG)

A

mean location of moments and forces acting on a body
- imaginary point about which sum of forces and moments equal ZERO

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5
Q

limits of stability (LOS)

A

COG approaches BOS; further distance a person can WTS without LOB or altering the original BOS
- influenced by a person’s height, foot length, confidence

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6
Q

what are two ways to define balance

A

ability to control COG relative to BOS

ability to achieve and maintain postural orientation and stability for function

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7
Q

what does adaptive postural control require

A

sensory and motor modifications as task and environment changes

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8
Q

balance is an ACTIVITY that emerges from the complex interaction of:

A
  • sensory systems responsible for detection of body position and motion
  • CNS integration processes
  • motor systems responsible for execution of motor responses
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9
Q

how does the incidence falls related to age

A

inc as you get older
- 30 at >65yo
- 42-49 at >75yo
- 83 at >85yo

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10
Q

how is neurological dysfunction related to the incidence of falls

A

5x more likely

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11
Q

why is the inc incidence of falls w age so significant

A

falls account for 50% of injury related deaths in older adults d/t
- severe disability
- wounds/infections
- ability to mobilize
- people might not know they fell

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12
Q

what is the impact on the healthcare system from inc incidence of falls w age

A

costly public health crisis
- surgery, hospital stay, rehab/SNF

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13
Q

what are 6 anatomical and physiological functions/processes contribute to balance

A

sensory orientation
motor function
biomechanical constraints
stability limits
anticipatory postural adjustments
- proactive balance
postural responses
- reactive balance

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14
Q

what is anticipatory or proactive balance

A

anticipation of a destabilizing force
- ms activation prior to expected COG disturbance by an internal perturbation

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15
Q

what drives proactive balance

A

feedforward mechanisms drive response based on past experiences and established motor programs

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16
Q

how is proactive balance seen in infants and young children

A

presence of righting and equilibrium reactions

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17
Q

what is reactive postural response

A

displacement of COG requiring motor response and/or changes in BOS

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18
Q

what drives reactive postural responses

A

sensory inputs drive corrective response (feedback)

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19
Q

what are displacement forces that trigger reactive postural responses

A

external forces or perturbations
- train stops, someone bumps into you

internal forces - LOB

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20
Q

what are perturbations

A

something that is destabilizing

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21
Q

what are reactive balance responses (3)

A

ankle strategy
hip strategy
stepping strategy

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22
Q

describe ankle strategy

A

small shifts of COG within LOS
- feet maintained on ground

body rotates as a rigid mass about the ankle joints

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23
Q

how does ankle strategy often manifest itself

A

anterior/posterior sway

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24
Q

when is ankle strategy used

A

ALLLLLL THE TIME
- smaller forces

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25
Q

when is hip strategy used

A

elicited w faster, larger amplitudes of COG displacement

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26
Q

when is hip strategy most effective

A

when COG is near BOS or when support surface is small, variable

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27
Q

when is hip strategy required

A

lateral displacement in COG via hip ABD/ADD
- due to nature of movement at hip

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28
Q

when is stepping strategy used

A

when COG displaced beyond BOS and outside LOS

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29
Q

how does stepping strategy work

A

establish new BOS in which COG is maintained
- take a step or steps to prevent a fall
- in sitting may have UE ext also

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30
Q

when is stepping strategy elicited

A

by larger and/or fast amplitude and external perturbation

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31
Q

how is BOS changed by someone sitting down

A

BOS includes all body parts in contact w a support surface

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32
Q

describe postural responses in sitting

A

trunk moves on hips
-if feet on supporting surfaces, gastroc and soleus may be activated

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33
Q

describe postural responses in sitting to posterior excursion of COG

A

ie leaning back
- hip flexors fire first
- then abs
- then neck flexors

extensors fire for anterior displacement of COG

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34
Q

what postural responses in sitting do you see to large, quick excursions in COG

A

protective extension
step responses

trying to establish larger, more stable BOS

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35
Q

what is required for sensorimotor integration in balance

A

complex interactions of musculoskeletal and neural systems required

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36
Q

what provides sensory input for balance

A

joint and muscle proprioceptors
cutaneous and pressure receptors

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37
Q

what information are your sensory receptors providing in terms of balance

A

relationship of body to supporting surface

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38
Q

what sensory input is provided by visual proprioception (3)

A
  1. perceive movement of objects
  2. recognition of environmental factors
  3. perception of verticality or orientation of self to the environment
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39
Q

sensory input from the vestibular system: otoliths vs semicircular canals

A

OTOLITHS - position of head in relation to gravity and linear acceleration

SEMICIRCULAR CANALS - info on angular/rotary motions of the head

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40
Q

what are the two otolith organs? how does their function differ?

A

saccule - vertical info
utricle - horizontal info

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41
Q

what is the role of CNS integration in balance

A

CNS “weight” of different sensory input varies w task and sensory environment, health conditions

42
Q

how does CNS weigh sensory input when on a firm surface

A

70% somatosensory
20% vestibular
10% vision

43
Q

how does CNS weigh sensory input when on an unstable surface

A

10% somatosensory
60% vestibular
30% vision

44
Q

why does the CNS weigh somatosensory input less on unstable surfaces

A

giving you inaccurate info

45
Q

3 vestibular reflexes

A

VOR
VSR
VCR

46
Q

what does the VOR do

A

stabilize gaze during head movements

47
Q

what does the VSR do

A

helps detect head movement/position
postural tone adjustment

48
Q

what does the VCR do

A

adjusts firing of the neck muscles to stabilize the head

49
Q

what does CNS integration do after receiving sensory inputs from task & environment

A

sensory organization to compare, select, and combine senses
- determine body position & movement
- select & adjust muscle activation

50
Q

how is motor execution achieved after CNS integration

A

ankle, hip, trunk, and neck muscles were selected and adjusted for muscle activation

generate body movement via reflexes, automatic & anticipatory postural responses & voluntary movements

51
Q

what is CNS integration doing when comparing and selecting inputs

A

deciding which source is more reliable and has been more reliable

52
Q

what is a screening tool

A

not a standardized test and outcome measure

53
Q

what is a static control clinical exam

A

ability to maintain a posture or position statically - either standing or sitting

54
Q

what is dynamic control

A

anticipatory
- head turns
- reaching within and outside BOS
- WTS

reactive
- external perturbations in A/P and lateral directions

55
Q

how are clinical balance exams usually described

A

screening tools

56
Q

what should you use to select outcome measures

A

sound clinical reasoning based on pt pop
- rationale?
psychometric properties
level of functioning and abilities
practice setting

57
Q

what are two dynamic sitting balance tests

A

Trunk Impairment Scale (TIS)
Function in Sitting Test (FIST)

58
Q

what are subscales of the trunk impairment scale (TIS)

A

static sitting balance
dynamic balance
trunk coordination

59
Q

what pt population was the trunk impairment scale (TIS) initially developed for? what populations are tested by it now?

A

CVA

CP MS, PD

60
Q

what are 3 static standing tests

A

romberg test
single leg stance test
mCTSIB

61
Q

what is a positive Romberg? what does
this indicate of the patient

A

loss of balance w eyes closed

visually dependent

62
Q

what is a Romberg test mostly testing for

A

proprioception
- relying on orientation in space and joints telling you where you are in space, and info from the surface

firm surface - vestib not as high

63
Q

how is a sharpened Romberg different from a regular Romberg

A

standing in a tandom stance vs standing w feet together

64
Q

what is included in a full CTSIB but not in. a mCTSIB

A

visual conflict - on firm and on foam
- able to open eyes but giving you inaccurate input

65
Q

what is the CTSIB really testing about balance

A

Clinical Test for Sensory Interaction in Balance (CTSIB)

is the person relying on one sensory input more than others
- eliminate vision w eyes closed
- inaccurate somatosensation w foam
- can’t get rid of vestib

66
Q

what is the ABC scale

A

self report measure of confidence in maintaining balance

67
Q

from an assessor’s POV what do you look at in someone’s ABC scale

A

see if they are aware of their own deficits
- look at their judgment level

68
Q

the ABC scale has benchmarks established for what pt population

A

hx of CVA, PD

69
Q

why is the BERG highly used

A

functional motions

70
Q

what is an important consideration when determining if a patient is an appropriate candidate for a BERG

A

can’t require an AD, or have had an AD

if person never had an AD and considering it now, do this test

71
Q

what is the goal of a BERG

A

not to need AD

72
Q

what is the TUG related to

A

fall risk and functional mobility

73
Q

what is the TUG responsive to

A

change in acute stroke rehab

74
Q

what is an advantage to the TUG vs the BERG

A

can use an AD

75
Q

what is a dual task TUG

A

add a cognitive or manual task to complete while doing the TUG
- count back from 7
- hold a cup of water

76
Q

what patient population would you do a dual task TUG with

A

if cognitive impairment
- ex: Parkinsons

77
Q

what are you looking to see during a dual task TUG

A

if can multitask
- see what they are will to sacrifice if can’t multitask (motor over cog or cog over motor)

78
Q

what does a FTSST look at

A

lower limb strength (gluts, quads, power)
assess risk for falls

79
Q

what are the 6 categories the Bestest looks at

A
  1. biomechanical constraints
  2. stability limits/verticality
  3. anticipatory postural adjustments
  4. postural responses
  5. sensory orientation
  6. stability in gait
80
Q

mini BESTest vs BESTest

A

mini addresses 4 of the 6 original areas
1. anticipatory postural adjustments
2. reactive postural control
3. sensory orientation
4. dynamic gait

81
Q

what are the bony structures associated w the trunk

A

vertebral columns
ribs and sternum
pectoral girdle (clavicle, scapula)
pelvic girdle (SI joint, ilia)

82
Q

what is the function of the vertebral column

A

designed for stability and motion

83
Q

what is the function of the ribs and sternum

A

stability, protection, and motion required for respiration

84
Q

what is the function of the pectoral girdle (clavicle and scapula)

A

connects UE to axial skeleton
- via SC joint

scapula is highly mobile and moves glenoid fossa

85
Q

what is the function of the pelvic girdle (SI joint, ilia)

A

connects trunk to LE

designed for stability and shock absorption

muscle, fascia attachments for lower trunk and LEs

86
Q

what are the core trunk muscles

A

extensors
flexors
rotators
lateral flexors

87
Q

what are other (not core) trunk muscles

A

pecs
traps
lats
serratus
rhomboids
quad lumborum
iliopsoas

88
Q

what are 5 functions that contribute to trunk function of stability and postural control

A

COG contained w/i trunk
vital organs housed in trunk
required for AG postures
stable base for efficient limb movements
shock absorption and wt distribution

89
Q

what are 5 functions that contribute to trunk function of mobility

A
  1. minimal motor activity in supine, static sitting/standing
  2. transitional movements (supine to sit)
  3. change in orientation of head, face, and limbs
  4. extend functional range of limbs
  5. movement of our COG
90
Q

how is wt shifting initiated in upper vs lower trunk

A

upper - shoulder girdle
lower - pelvis

91
Q

what is trunk wt shifting

A

movements that result in changes of wt distribution, posture, and moves COG

92
Q

what are 4 possible directions of weight shifting

A

anterior
posterior
lateral
diagonal

93
Q

normal trunk movements (5)

A

flex/ext
lateral flex
rotation
upper and lower trunk dissociation
tilts

94
Q

process of trunk wt shifts exam

A

test in sitting
expose trunk
examine alignment, ms bulk
visualization of ms responses
assess for compensatory strategies

demonstrate - reaching/scooting for desired wt shift or passively move first

95
Q

what is the significance of a hands on technique when assessing trunk wt shifts

A

by putting hands on, can trigger activation that wasn’t before

96
Q

what population is a trunk control test (TCT) usually utilized in

A

CVA, geri pop w acute illness

97
Q

what are the 4 functional items included in a TCT

A

rolling to weak side
rolling to strong side
sitting balance
sit up from lying down

98
Q

what are some PT interventions w trunk control (6)

A
  1. PNF
  2. upper and lower trunk rotation, counter rotation
  3. bridging, rolling, scooting, transfers, amb, obstacle course
  4. WTS in sitting, standing
  5. external perturbations
  6. reaching activities
99
Q

what are some pedi PT interventions for trunk control

A

wheelbarrow
tug of war
ball toss

100
Q

what are 4 PNF techniques for trunk control

A

stabilizing reversals (alternating isometrics) – more intuitive

rhythmic stabilization
combined isotonics
lift and chop