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Neuromuscular Exam and Rehab Exam 2 > Standing Balance/ Posture > Flashcards

Standing Balance/ Posture Flashcards

1
Q

What is postural control?

A

Maintain orientation of the relative positions of body parts with respect to each other and gravity

Ability to maintain normal alignment

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2
Q

What is balance?

A

All forces acting on the body are balanced so that the COM is within the stability limits, the boundaries of the BOS

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3
Q

What are the key features of standing posture?

A
  1. ASIS are level with neutral pelvis and no tilt
  2. Head in midline with “chin in”
  3. Trunk muscles are active and maintaining upright posture
    - Core stability, erector spinae and
    abdominal flexors
  4. Feet flat with weight distributed evenly
  5. Normal alignment minimizes the need for active muscle contractions
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4
Q

What are the common postural deviations associated with a stroke for the pelvis?

A

-Asymmetrical WB with the majority of weight borne on the stronger side
-In sitting: posterior pelvic tilt(sacral sitting)
-In standing: unilateral retraction and elevation on the more affected side

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5
Q

What are the common postural deviations associated with a stroke for the trunk?

A

-With sacral sitting, a flattened lumbar curve with exaggerated thoracic curve and FHP
-Lateral flexion with trunk shortening on more affected side

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6
Q

What are the common postural deviations associated with a stroke for the shoulders?

A

-Unequal height with more affected shoulder depressed
-Humeral subluxation with scapular downward rotation and lateral flexion or trunk
-Scapilar inability (winging) may be present

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7
Q

What are the common postural deviations associated with a stroke for the head/neck?

A

-Protraction with lateral trunk flexion
-Lateral flexion of the head ith rotation away from the more affected side

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8
Q

What are the common postural deviations associated with a stroke for the UE?

A

-More affected UE typically heald in a flexed, adducted position, with IR and elbow flexion , forearm pronation, wrist and finger flexion, limb is non WB
-Stronger UE used for postural support

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9
Q

What are the common postural deviations associated with a stroke for the LE?

A

-In sitting: more affected LE typically held in hip ABD, and hip ER with hip flexion and knee flexion (flexion synergy pattern)
-In standing: More affected LE typically held in hip and knee extension with ADD and IR (scissoring pattern); ankle PF
-Unequal WB on feet, similar to pelvis in sitting

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10
Q

What is reactive postural control?

A

Responses to external forces displacing the COM or BOS

Perturbations

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11
Q

What is anticipatory postural control?

A

Anticipated and internally generated
Destabilizing forces on the body
Catching a ball

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12
Q

What is adaptive postural control?

A

Modification to postural responses to changing tasks or environment

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13
Q

What is balance dependent on?

A

Sensory system detecting body position and motion
Motor system responsible for executing motor synergies
Higher CNS responsible for executing action plan

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14
Q

What are the 3 systems do we use for sensory strategies?

A

Vision
Vestibular
Somatosensory

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15
Q

Why are the vision, somatosensory, and vestibular systems important?

A

Provide CNS with important information about postural control and balance

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16
Q

How does the visual system work?

A

Percieves movement and detects the relative orientation of the body segment and orientation of the body in space

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17
Q

What does the visual system contribute to righting reactions to what …

A

Head, trunk, and limbs

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18
Q

How does the somatosensory system work?

A

Is the cutaneous and pressure sensation from the body segments in contact with the support surface and muscle and joint proprioception throughout the body

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19
Q

How does the CNS system integrate information?

A

Integrates the input and initiated goal directed conscious action and automatic, unconscious adjustments in posture and movement

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20
Q

How does the vestibular system work?

A

Detects angular acceleration and deceleration forces on the head and linear acceleration and deceleration of the head with reference to gravity

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21
Q

What is the function of the vestibular system?

A

Stabilize during head movements (VOR) and assist in regulation of postural tone and postural muscle activation (VSR)

22
Q

What system plays a greater if somatosensation is impaired?

A

Vision

23
Q

If both somatosensation and vision are impaired what system becomes more critical?

A

Vestibular

24
Q

What happens if more than one sensory system is deficient?

A

Balance impairments will be evident

25
Q

What is ankle strategy?

A

-COM shifts forward and back as a fixed pendulum around the ankle
-Muscles are activated distal to proximal sequence
-Forward sway, anterior tib is activated followed by quads then abdominals
-Sway is slow and low frequency

26
Q

What is hip strategy?

A

-Shifts COM by flexion and extending hips
- Proximal to distal muscle activation
- Backwards sway, paraspinals are activated first followed by HS
- Provided the most mediolateral stability (abd/add)
- Larger disturbance than with ankle strategy

27
Q

What is stepping strategy?

A

-Uses rapid steps or hops in the direction of the displacing force
-Forwards, backwards, lateral steps
-Larger and faster perturbations

28
Q

What dysfunctions are present in balance/postural control following a CVA?

A

-Impaired balance when reacting to destabilizing external force and in self initiated movements
-May be unable to maintain stable balance in sitting or standing to move w/o LOB
-Inability to recruit effective postural strategies and adapt movements to changing tasks and environment
-Demonstrates uneven WB with increased postural sway
-Delay in onset of muscle recruitment, abnormal timing, sequencing, and abnormal co-contraction (results in abnormal postural synergies)
-Corrective responses are inadequate and often results in a fall towards the hemiplegic side

29
Q

How do you assess static standing?

A

Standing unsupported
Document time, sway, assist
Eyes open and eyes closed

30
Q

How do you assess romberg standing?

A

-Feet together with eyes open for 20-30 seconds and if unstable the test is over
-Feet together with eyes closed 20-30 seconds and if unstable the test is over or if unable and considered a positive Romberg sign

31
Q

What does it mean if we have a positive romberg sign?

A

Indicative or proprioceptive loss

32
Q

What are different types of balance assessment?

A

Static standing
Romberg standing
Weight shifts
Reaching across midline to each side

33
Q

What is the retropulsive test?

A

Test for reactive balance

34
Q

How do you test the retropulsive test?

A

Pull backwards and observe response

35
Q

How do you score the retropulsive test?

A

0 = Recovers independently with 1 step of normal
length and width
1 = Two to three small steps backward, but
recovers independently
2 = Four or more steps backward, but recovers
independently
3 = Steps but needs to be assisted to prevent a fall
4 = Falls without attempting a step or unable to stand without assistance

36
Q

What are the 14 components to the BERG test?

A
  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 arms
  9. Retrieveing object from the floor
  10. Turning to look behind
  11. Turning 360˚
  12. Placing alternate foot on stool
  13. Standing with on foot in front
  14. Standing on one foot
37
Q

What is the max score for the BERG balance scale?

A

56

38
Q

A score of less than 45 on the berg balance scale indicates what?

A

Fall risk for older adults and people with a stroke

39
Q

What are the 12 components to the postural assessment scale for stroke patients?

A
  1. Sitting without support
  2. Standing with support
  3. Standing without support
  4. Standing on non-paretic limb
  5. Standing on paretic limb
  6. Supine to affected side
  7. Supine to non affected side
  8. Supine to sitting on edge of mat
  9. Sitting on the edge of mat to supine
  10. Sitting to standing
  11. Standing up to sitting down
  12. Standing picking up pencil from floor
40
Q

What is the max score for the Postural assessment scale?

A

36

41
Q

What does the balance evaluation system test (BESTest) assess?

A

Assess balance across 6 domains

42
Q

What are the 6 categories the BESTest assess?

A
  1. Mechanical constraints
  2. Limits of stability
  3. Anticipatory postural. adjustments
  4. Postural response to induced LOB
  5. Sensory orientation
  6. Gait
43
Q

What is the total score of the BESTest?

A

108 and scored as a percentage

44
Q

A score of less than 82% on the BESTest indicates what?

A

Fall risk

45
Q

What does the activities-specific balance confidence scale assess (ABC scale)?

A

Is a self-reported measure of balance confidence in performing various activities

46
Q

Lower than 50% on the ABC scale indicated what?

A

Low level of physical functioning

47
Q

A score between 50% to 80% on the ABC scale indicates what?

A

Moderate level of physical functioning

48
Q

A score above 80% on the ABC scale indicates what?

A

High level of physical function

49
Q

What 4 conditions are you testing with the modified clinical test of sensory interaction in balance (mCTSIB)?

A
  1. Eyes open, firm surface
  2. Eyes closed, firm surface
  3. Eyes open, foam surface
  4. Eyes closed, foam surface
50
Q

How would you dose the interventions for patients post-stroke?

A

High intensity to achieve neuroplastic and behavioral change

51
Q

How would you write goals for a patient post-stroke?

A

Encourage consistency, symmetry, and maximum use of the affected side

52
Q

What things can you consider during interventions to increase balance challenges and activities

A

-Sensory input
-UE position/support
-LE movement
-UE movement
-Trunk movements
-Destabilizing activities
-Dual tasks
-Modifying environment

Neuromuscular Exam and Rehab Exam 2 (8 decks)

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