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Neuro Rehab 1 > PT Activity Examination: Balance and Trunk Control > Flashcards

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
when is hip strategy used
elicited w faster, larger amplitudes of COG displacement
26
when is hip strategy most effective
when COG is near BOS or when support surface is small, variable
27
when is hip strategy required
lateral displacement in COG via hip ABD/ADD - due to nature of movement at hip
28
when is stepping strategy used
when COG displaced beyond BOS and outside LOS
29
how does stepping strategy work
establish new BOS in which COG is maintained - take a step or steps to prevent a fall - in sitting may have UE ext also
30
when is stepping strategy elicited
by larger and/or fast amplitude and external perturbation
31
how is BOS changed by someone sitting down
BOS includes all body parts in contact w a support surface
32
describe postural responses in sitting
trunk moves on hips -if feet on supporting surfaces, gastroc and soleus may be activated
33
describe postural responses in sitting to posterior excursion of COG
ie leaning back - hip flexors fire first - then abs - then neck flexors extensors fire for anterior displacement of COG
34
what postural responses in sitting do you see to large, quick excursions in COG
protective extension step responses trying to establish larger, more stable BOS
35
what is required for sensorimotor integration in balance
complex interactions of musculoskeletal and neural systems required
36
what provides sensory input for balance
joint and muscle proprioceptors cutaneous and pressure receptors
37
what information are your sensory receptors providing in terms of balance
relationship of body to supporting surface
38
what sensory input is provided by visual proprioception (3)
1. perceive movement of objects 2. recognition of environmental factors 3. perception of verticality or orientation of self to the environment
39
sensory input from the vestibular system: otoliths vs semicircular canals
OTOLITHS - position of head in relation to gravity and linear acceleration SEMICIRCULAR CANALS - info on angular/rotary motions of the head
40
what are the two otolith organs? how does their function differ?
saccule - vertical info utricle - horizontal info
41
what is the role of CNS integration in balance
CNS "weight" of different sensory input varies w task and sensory environment, health conditions
42
how does CNS weigh sensory input when on a firm surface
70% somatosensory 20% vestibular 10% vision
43
how does CNS weigh sensory input when on an unstable surface
10% somatosensory 60% vestibular 30% vision
44
why does the CNS weigh somatosensory input less on unstable surfaces
giving you inaccurate info
45
3 vestibular reflexes
VOR VSR VCR
46
what does the VOR do
stabilize gaze during head movements
47
what does the VSR do
helps detect head movement/position postural tone adjustment
48
what does the VCR do
adjusts firing of the neck muscles to stabilize the head
49
what does CNS integration do after receiving sensory inputs from task & environment
sensory organization to compare, select, and combine senses - determine body position & movement - select & adjust muscle activation
50
how is motor execution achieved after CNS integration
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
what is CNS integration doing when comparing and selecting inputs
deciding which source is more reliable and has been more reliable
52
what is a screening tool
not a standardized test and outcome measure
53
what is a static control clinical exam
ability to maintain a posture or position statically - either standing or sitting
54
what is dynamic control
anticipatory - head turns - reaching within and outside BOS - WTS reactive - external perturbations in A/P and lateral directions
55
how are clinical balance exams usually described
screening tools
56
what should you use to select outcome measures
sound clinical reasoning based on pt pop - rationale? psychometric properties level of functioning and abilities practice setting
57
what are two dynamic sitting balance tests
Trunk Impairment Scale (TIS) Function in Sitting Test (FIST)
58
what are subscales of the trunk impairment scale (TIS)
static sitting balance dynamic balance trunk coordination
59
what pt population was the trunk impairment scale (TIS) initially developed for? what populations are tested by it now?
CVA CP MS, PD
60
what are 3 static standing tests
romberg test single leg stance test mCTSIB
61
what is a positive Romberg? what does this indicate of the patient
loss of balance w eyes closed visually dependent
62
what is a Romberg test mostly testing for
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
how is a sharpened Romberg different from a regular Romberg
standing in a tandom stance vs standing w feet together
64
what is included in a full CTSIB but not in. a mCTSIB
visual conflict - on firm and on foam - able to open eyes but giving you inaccurate input
65
what is the CTSIB really testing about balance
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
what is the ABC scale
self report measure of confidence in maintaining balance
67
from an assessor's POV what do you look at in someone's ABC scale
see if they are aware of their own deficits - look at their judgment level
68
the ABC scale has benchmarks established for what pt population
hx of CVA, PD
69
why is the BERG highly used
functional motions
70
what is an important consideration when determining if a patient is an appropriate candidate for a BERG
can't require an AD, or have had an AD if person never had an AD and considering it now, do this test
71
what is the goal of a BERG
not to need AD
72
what is the TUG related to
fall risk and functional mobility
73
what is the TUG responsive to
change in acute stroke rehab
74
what is an advantage to the TUG vs the BERG
can use an AD
75
what is a dual task TUG
add a cognitive or manual task to complete while doing the TUG - count back from 7 - hold a cup of water
76
what patient population would you do a dual task TUG with
if cognitive impairment - ex: Parkinsons
77
what are you looking to see during a dual task TUG
if can multitask - see what they are will to sacrifice if can't multitask (motor over cog or cog over motor)
78
what does a FTSST look at
lower limb strength (gluts, quads, power) assess risk for falls
79
what are the 6 categories the Bestest looks at
1. biomechanical constraints 2. stability limits/verticality 3. anticipatory postural adjustments 4. postural responses 5. sensory orientation 6. stability in gait
80
mini BESTest vs BESTest
mini addresses 4 of the 6 original areas 1. anticipatory postural adjustments 2. reactive postural control 3. sensory orientation 4. dynamic gait
81
what are the bony structures associated w the trunk
vertebral columns ribs and sternum pectoral girdle (clavicle, scapula) pelvic girdle (SI joint, ilia)
82
what is the function of the vertebral column
designed for stability and motion
83
what is the function of the ribs and sternum
stability, protection, and motion required for respiration
84
what is the function of the pectoral girdle (clavicle and scapula)
connects UE to axial skeleton - via SC joint scapula is highly mobile and moves glenoid fossa
85
what is the function of the pelvic girdle (SI joint, ilia)
connects trunk to LE designed for stability and shock absorption muscle, fascia attachments for lower trunk and LEs
86
what are the core trunk muscles
extensors flexors rotators lateral flexors
87
what are other (not core) trunk muscles
pecs traps lats serratus rhomboids quad lumborum iliopsoas
88
what are 5 functions that contribute to trunk function of stability and postural control
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
what are 5 functions that contribute to trunk function of mobility
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
how is wt shifting initiated in upper vs lower trunk
upper - shoulder girdle lower - pelvis
91
what is trunk wt shifting
movements that result in changes of wt distribution, posture, and moves COG
92
what are 4 possible directions of weight shifting
anterior posterior lateral diagonal
93
normal trunk movements (5)
flex/ext lateral flex rotation upper and lower trunk dissociation tilts
94
process of trunk wt shifts exam
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
what is the significance of a hands on technique when assessing trunk wt shifts
by putting hands on, can trigger activation that wasn't before
96
what population is a trunk control test (TCT) usually utilized in
CVA, geri pop w acute illness
97
what are the 4 functional items included in a TCT
rolling to weak side rolling to strong side sitting balance sit up from lying down
98
what are some PT interventions w trunk control (6)
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
what are some pedi PT interventions for trunk control
wheelbarrow tug of war ball toss
100
what are 4 PNF techniques for trunk control
stabilizing reversals (alternating isometrics) -- more intuitive rhythmic stabilization combined isotonics lift and chop

Neuro Rehab 1 (27 decks)

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