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נארו > Quiz 4: Balance/Transfers + Bed Mobility > Flashcards

Quiz 4: Balance/Transfers + Bed Mobility Flashcards

1
Q

Impairments Affect Function

  • basic movements are needed for___
  • how are transfers defined?
  • what can limit mobility and transfers?
A
  • basic movements are needed for mobility
  • Transfers-operationally defined as a movement or a series of movements organized to get from one position to another
  • difficulty in range, strength, control, sensation etc can limit these
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2
Q

Name 4 Transfers:

A
  1. sit stand
  2. sit sit
  3. supine sit
  4. supine sidelying
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3
Q

Sit Stand

Things to consider (3)

A
  1. amount of assist needed
  2. where assisted (hand placement, amount of force, phase)
  3. use of hands (where patient puts his hands)
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4
Q 
Sit  Stand 
critical components 
1. \_\_ to edge of the mat
2. \_\_\_ flexion
3. Knee flexion past \_\_
4. Ankle dorsiflexion past \_\_  
5. \_\_\_ weight shift
6. extension of \_\_, \_\_\_, \_\_\_,\_\_\_
7. \_\_\_\_ in standing
A
  1. IT to the edge of the mat
  2. trunk flexion (or trunk extension with hip flexion)
  3. knee flexion past 90 degrees
  4. ankle dorsiflexion past 90 degrees
  5. forward/diagonal weight shift
  6. extension of trunk, hips, knees, ankles, plantarflexion
  7. stabilization in standing
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5
Q

stand to sit: what to tell patient

eccentric or concentric of ___

A

reach for floor, forward weight shift as sit back down

unwinding
controlled descent
eccentric control of extensors (lengthen them)

hands free stand to sit even if cannot stand without hands

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6
Q

Stand to sit considerations (4)

A
  1. use of hands
  2. height of seated surface
  3. seating surface stability
  4. seated surface angle (sometimes it is tilted back, sometimes it is cushy)
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7
Q

30 second sit to stand test:

  1. what is it
  2. what score correlates with high falls risk? In what patient types (2)?
  3. quality vs quantity
A

do as many sit to stand as possible in 30 seconds

  1. hands free
  2. less than 8 reps correlates with high falls risk for community dwelling elderly and CVA
  3. assess quantity not quality (assess of falls risk is quantity)
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8
Q

Rolling/bed mobility (3)

A

supine sidelying
sideliying prone
sidelying sit

log roll: roll body as one unit vs a segmental roll

supine to sit if abs are strong, rare

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9
Q

Berg Question 1

Sit –>Stand

A

Stand without hands for support

4: stand independently without using hands and stabilize independently

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10
Q

Berg Quetion 2

Standing Unsupported

A

Stand for 2 minutes without holding

4: able to stand safely for two minutes

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11
Q

Beg Question 3

Sit with back unsupported but feet supported on floor or stool

A
  1. Able to sit securely for 2 minutes

3. with supervision

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12
Q

Berg Question 4

Standing to Sitting

A
  1. Able to go stand –> sit without using hands
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13
Q

Berg Question 5

Transfers

A

Pivot transfer: one way to a seat with armrests and one way to a seat without armrests
4. Able to transfer safely with minor (or without) use of hands

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14
Q

Berg Question 6

Stand Unsupported With Eyes Closed

A
  1. able to stand 10 seconds safely
  • -if sway more than normal
  • someone with a lesion will sway because lack proprioception
  1. need supervision
  2. not able 3 seconds
  3. cannot do with eyes closed
  4. needs help to not fall
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15
Q

Berg Question 7

Stand Unsupported with Feet Together

A
  1. Able to independently place feet together and stand for one minute safely
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16
Q

Berg Question 8

Reaching Forward With Outstretched Arm While Standing

A

Pt lift arm 90 degrees flexion and stretch out fingers to reach forward as far as he can
examiner places a ruler at the end of fingertips when arm is at 90 degrees. fingers should not touch ruler when reaching forward. measure taken when pt is in most forward leaning position

  1. can reach forward confidently >25cm (10 inches)
  2. 12
  3. 5
  4. need supervision
  5. lose balance
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17
Q

Berg Question 9

Pick up object from the floor from standing position

A

can be done in anyway as long as do not grab onto something for support
4. able to pick up slipper safely and easily

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18
Q

What can Berg Question 9: Pick up object from the floor from standing position
Tell us for treatment

A

if they can reach down but cannot pick up the slipper we can practice reaching less low

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19
Q

Berg Question 10:

Turning to look behind over left and right shoulders while standing

A

Turn to look directly behind you over towards the left shoulder, then repeat to the right. PT may pick an object to look directly behind at.
4. Looks behind from both sides and weight shifts well

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20
Q

Berg Question 11

Turn 360 Degrees

A

turn completely around in a full circle. pause. then turn the other way
4. able to turn 360 degrees safely in 4 seconds or less [in both directions]

21
Q

Berg Question 12

Placing Alternate Foot on Step Or Stool While Standing Unsupported

A

Tap the front of the step: alternating right and left (20 seconds to do it)
4. able to stand independently and safely and complete 8 steps in 20 seconds

22
Q

Berg Question 13
STANDING UNSUPPORTED ONE FOOT IN FRONT

weakness of this question and what we tell them to do instead

A

Place one foot directly in front of the other: heel of one foot touching the toe of the other
4. Be able to get into the heel to toe position hold position 30 seconds without supervision

they put the strong leg behind, we want them to put the weaker leg behind–have them try both sides and look at the worse one

23
Q

Berg Question 14

Standing on One Leg

A

Stand on one leg as long as you can without holding

  1. able to lift leg independently and hold for more than 10 seconds
24
Q

Items on the Berg Balance Scale

A

TEM DESCRIPTION SCORE (0-4)

  1. Sitting to standing _____
  2. Standing unsupported _____
  3. Sitting unsupported _____
  4. Standing to sitting _____
  5. Transfers _____
  6. Standing with eyes closed _____
  7. Standing with feet together _____
  8. Reaching forward with outstretched arm _____
  9. Retrieving object from floor _____
  10. Turning to look behind _____
  11. Turning 360 degrees _____
  12. Placing alternate foot on stool _____
  13. Standing with one foot in front _____
  14. Standing on one foot _____

TOTAL (maximum 56) _____
FALLS RISK BELOW 42

0–20, wheelchair bound
21–40, walking with assistance
41–56, independent

25
Q

Dynamic Gait Index

1. Gait level surface _____

A

Instructions: Walk at your normal speed from here to the next mark (20’)
Grading: Mark the lowest category that applies.
(3) Normal: Walks 20’, no assistive devices, good sped, no evidence for imbalance, normal gait pattern

26
Q

Dynamic Gait Index

2. Change in gait speed _____

A

Instructions: Begin walking at your normal pace (for 5’), when I tell you “go,” walk as fast as you can (for
5’). When I tell you “slow,” walk as slowly as you can (for 5’).

(3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a
significant difference in walking speeds between normal, fast and slow speeds.

27
Q

Dynamic Gait Index

3. Gait with horizontal head turns ___

A

Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking
straight, but return your head to the center.

(3) Normal: Performs head turns smoothly with no change in gait

28
Q

Dynamic gait Index

4. Gait with vertical head turns _____

A

Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head
down. Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the center.

(3) Normal: Performs head turns smoothly with no change in gait.

29
Q

DGI

5. Gait and pivot turn _____

A

Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to face the opposite direction and stop.

(3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance

30
Q

DGI

6. Step over obstacle ____

A

Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it, and keep walking.

(3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.

31
Q

DGI

7. Step around obstacles _____

A

Instructions: Begin walking at normal speed. When you come to the first cone (about 6’ away), walk around the right side of it. When you come to the second cone (6’ past first cone), walk around it to the left.

(3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of
imbalance.

32
Q

DGI

8. Steps _____

A

Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down.

(3) Normal: Alternating feet, no rail.
(2) Mild Impairment: Alternating feet, must use rail.
(1) Moderate Impairment: Two feet to a stair, must use rail.
(0) Severe Impairment: Cannot do safely

33
Q

Total Score DGI

A

24

34
Q

Spastic Diplegia Gait

A

2 extremities affected, lowers more than uppers

  • Flex hip/flex knees/PF toes
  • IR hip
  • high guard arms
  • no weight shift, pure sagittal plane movement

video: foot slaps, no weight shift, wide BOS< lack of knee flexion??, no arm swing, quadricep spasticity lacking knee flexion, pelvic retraction, using momentum

35
Q

Spastic Hemiplegia Gait

A

one side affected
-arms flexed/adducted/IR in high guard
-drag affected leg with circumduction due to footdrop and lack of hip extension
wide BOS

36
Q

How is balance is an Emergent Property?

A

–different motor skill emerge due to the constraints of the task, the individual, and the environment
All movement is therefore emergent
The CNS organizes movement to meet the constraints

37
Q

what does balance achieve?

A

keep center of mass over base of support

38
Q

What is the Motor Control Model? (3)

A

Balance is an interaction between:

  1. the balance task
  2. the environment the task is occuring in
  3. the individual performing the task

each of these factors constrains the act of balance in a certain manner

39
Q

The Balance Task: what are its constraints? (3)

A
  1. Spatial Constraints- space where the task is occurring in: how far do i have to move my body
  2. Kinetic Constraints - how much force do i have to generate to accomplish the task (relax/contract muscles)
  3. Temporal Constraints- at what speed do i need to move to accomplish the task
40
Q

The Balance Environment: what are its constraints? (4)

A
  1. Surface the individual is standing, sitting, balancing or rolling on (height, firmness)
  2. Temperature (MS affected by heat, PD affected by cold)
  3. Light (if poor sensation so rely on vision)
  4. Medium (air, water, snow…)
41
Q

The Balance Individual Factors: what are its constraints? (10)

A
  1. Spinothalamic: sensation
  2. Dorsal Column/medial lemniscus: sensation [proprioception and kinesthetic]
  3. Force Production (strength: central and peripheral components)
  4. Motor Control: correct force, correct time, initiating and terminating appropriately [correct grading]
  5. ROM
  6. Endurance
  7. Attention (ie stroop test)
  8. Mood
  9. Vestibular [where PNS meetscerebellum, pons, vestibular cortex]
  10. Vision (least important for balance)
42
Q

Balance Testing

–what limits balance and how must we therefore practice

A
  • balance is a task and therefore we must examine the task
  • the task differs depending on the environment, therefore we must practice in different environments
  • individual impairments limit the individuals ability to complete the task
43
Q

How can we use balance test in treatment?

A
  • look at specific balance task that the individual is having difficulty with
  • what impairments are preventing effective completion of the task
  • tx then becomes remediation of the underlying impairments with graded practice of the task
44
Q

How may pathology affect balance test?

A

depending on pathology (CVA, MS, TBI) the individual impairments may differ

MS: poor endurance will result in poorer balance when fatigued than otherwise

PD: initiation of balance strategies will be delayed

45
Q

Task Specific Balance Scales

A
  1. Berg Balance Scale
  2. Dynamic Gait Index
  3. Time Up and Go Test
  4. Mini Best Test
46
Q

ankle balance strategy

A

ankle (push back and toes come up, push forward and heels come up)

hip (flexion/extension)

step (if neither ankle or hip work, then use step strategy)

47
Q

Berg Balance Scale

  1. what does it test
  2. how many items
  3. what kind of scale, how is it graded
  4. how it acts/what is the purpose
  5. what is it based on
A
  1. Tests standing balance
  2. 14 items on an ordinal scale
  3. items are graded 0-4
  4. Acts as a screen: 56 is perfect score, 42 or less is correlated with 100% falls risk
  5. based on functional movements: the movements that the patient has difficulty with can therefore become interventions

screen above or below 42
lets you know what functional issues are limitations

weakness: only loos at stand/sit not at balance during gait

48
Q

Dynamic Gait Index

  1. what does it test
  2. how many items
  3. what kind of scale
  4. how is it graded
  5. what is the purpose
  6. what is it based on
A
  1. Tests balance during gait
  2. 8 items on an ordinal scale
  3. Items are graded 0-3 (0-normal /1: mild impair/ 2: moderate impair / 3: severe impair)
  4. Acts as a screen: score below 19 is a high falls risk
  5. based on functional gait movements: the movements that the patient have difficulty with become interventions

-more provocative and solves the problem of the 25 ft walk test that only looks at speed

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