Task-Oriented Approach to Balance Rehabilitation Flashcards
According to the book what is the best approach to balance rehabilitation?
Task-oriented approach
The ICF framework examines the effects of impaired balance on what 2 things?
- activities and participation
- the underlying impairments of body structure and function that contribute to impaired balance
What is the number one concern when examining postural control?
SAFETY
During a postural control examination the “what” portion represents balance on a _______ level
functional
During a postural control examination the “how” portion represents balance on a _______ level
strategy
During a postural control examination the “why” portion represents balance on a _______ level
impairment
What does the examination of balance on the functional level require? Why?
The use of multiple tests as there is no single test that covers all aspects of balance.
List a few balance tests
- Self Efficacy Scales
- Timed Up & Go (TUG)
- Functional Reach Test (FRT)
- Performance-Oriented Mobility Assessment (POMA)
- Berg Balance Scale (BBS)
- Short Physical Performance Battery (SPPB)
- Balance Evaluation Systems Test (BESTest)
What are 2 examples of self efficacy scales?
- Activity-specific Balance Confidence (ABC) Scale
- Falls Efficacy Scale
What are self efficacy scales?
Questionnaires in which the patient answers questions pertaining to their confidence in reference to certain ADLs
Describe the timed up and go test
Stand up from chair, walk 3 m (10 ft), turn around, and return to sit back on chair
If a patient can perform the TUG test in less than __ seconds they are considered freely independent
10
If a patient can perform the TUG test in less than __ seconds they are considered independent in basic transfers
20
If a patient can perform the TUG test between __-__ seconds they are considered to have variable mobility (gray area)
20-29
If it takes a patient longer than __ seconds to perform the TUG test they are considered impaired and usually need help with chair or toilet transfers, help in and out of tub, assistance with stairs, and are unable to go out alone.
30
In community dwelling older adults a TUG score greater than __ seconds indicates a fall status
15
If a patient scores less than a __ on the Performance-Oriented Mobility Assessment they are considered to be a high risk for falls
19
If a patient scores anywhere from __-__ on the Performance-Oriented Mobility Assessment they are considered to be a moderate risk for falls
19-24
If a patient scores anywhere from __-__ on the Performance-Oriented Mobility Assessment they are considered to be a low risk for falls
24-28
If a patient scores anywhere from __-__ on the Berg balance scale they are considered a high fall risk and the patient should be wheel chair bound
0-20
If a patient scores anywhere from __-__ on the Berg balance scale they are considered a medium fall risk and the patient can walk with the use of an AD
21-40
If a patient scores anywhere from __-__ on the Berg balance scale they are considered a low fall risk and the patient can ambulate independently
41-56
What is the Short Physical Performance Battery (SPPB) test used to measure?
lower extremity performance such as strength, balance and mobility in older adults
What is the Balance Evaluation Systems Test (BESTest) used to examine?
6 things
Multiple aspects of postural control
- Biomechanical constraints - Stability limits - Anticipatory-transitions - Postural responses - Sensory organization - Dynamic gait
What are 3 strategies used to examine balance?
- Postural alignment
- Movement strategies
- Sensory strategies
What are 4 things to assess when examining alignment?
- Posture
- Weight bearing
- Width of base of support
- Location of the CoP
Why are automatic postural responses needed?
To keep the center of gravity over the BOS in response to a stimulus or unexpected perturbation
Describe automatic postural responses
They are rapid movements that are not under voluntary control
What are 3 automatic postural responses?
- ankle
- hip
- stepping
Postural responses can either be _____ or ______.
adaptive or reactive
What are 4 movement strategies?
- Steady state (sitting and standing)
- Reactive (sitting and standing)
- Anticipatory postural control
- Adaptive control
What test is used to test reactive movement strategies?
The Nudge Test
Describe the nudge test
The subject stands with their feet as close together as possible and then the examiner pushes lightly on subject’s sternum with palm of their hand 3 times
What is the grading criteria for the nudge test?
0: Begins to fall
1: Staggers, grabs, catches self
2: Steady
What is a proactive postural response?
A response that occurs before the prime mover in preparation for a perturbation
Give an example of a proactive postural response
Preparing to lift a heavy bag of groceries. This is the body’s way to prepare for a ‘predicted’ perturbation
What is adaptive control?
The body’s way of adapting to movement strategies to changes in the BOS
What is the normal response to a small backward displacement?
Dorsiflexion in both feet
What is an abnormal response that is often seen in hemiparetic patients to a small backward displacement?
The loss of dorsiflexion on the hemiparetic side
What test is used to examine sensory strategies to maintaining balance?
Clinical Test for Sensory Interaction in Balance (CTSIB)
*This test is the one with the 6 various surface and visual conditions
When examining on the impairment level what 3 systems must be examined?
- motor
- sensory/perceptual
- cognitive
What approach seems to work the best when retraining balance?
Task-Oriented Approach
The goals of a task-oriented approach to treating a patient with postural control problems include therapeutic strategies on what 3 levels?
1) Impairment
2) Strategy
3) Functional
What is the goal on the impairment level?
Resolve, reduce, or prevent impairments in systems that are important to balance
What is the goal on the strategy level?
Develop effective task-specific sensory, motor, and cognitive strategies
What is the goal on the functional level?
Retrain functional tasks with varying postural control demands (e.g., steady-state, reactive, and anticipatory control) under changing environmental contexts
All 3 levels should be worked on in _____
PARALLEL
What is the ULTIMATE goal of task-oriented balance rehabilitation?
To improve participation outcomes, reflected in the ability (increased frequency, independency, and reduced falls) to participate in social roles, tasks, and activities important in ADLs.
What are 4 ways to progress exercises to improve the control of a patient’s center of gravity in sitting?
- Removing UE support
- Making the surface less stable
- Add UE activities
- Increase limits of stability through reaching and throwing activities
What are 4 ways to progress exercises to improve the control of a patient’s center of gravity in standing?
- Slow weight shifts on a stable platform
- Elastic band LE exercise
- Standing sway
- Sit to stand
- Tai Chi
- Add UE activities and functional activities
What are 3 exercises to help promote the ankle strategy?
- Standing sway exercises
- Slow small perturbations either self generated or external
- Computerized limits of stability training (Balance Master)
What are 3 ways to progress exercises to help promote ankle strategy?
- Increase difficulty with UE, head, or eye movements
- Functional activities (reaching to take objects off shelves, leaning backwards to rinse hair in shower)
- Add resistance (TheraBand)
What are 7 exercises to help promote the hip strategy?
- Standing sway using a table and a wall, patient instructed to bow to move nose towards the table
- Standing on a rail, add UE activities as able
- Use moderate rapid perturbations either self generated or external
- Tandem standing (sharpened Romberg) or walking
- Single limb support
- Large anterior/posterior weight shifts on a variety of surfaces
- Functional activities (reaching into trunk of a car, laundry dryer)
What are 5 exercises to help promote the stepping strategy?
- Standing sway with large sways, consciously taking step forward and backward
- Ambulate in tandem, promote balance steps
- Stepping over obstacles
- Walking on uneven surfaces
- Large rapid perturbations such that the hip strategy would be inadequate and stepping or reaching is required; progress from predictable to unpredictable disturbances
How can you retrain vertical alignment?
Using a mirror
What are 4 helpful cues to teaching balance activities?
- Do one thing at a time
- Avoid carrying objects when walking or going up and down steps
- Stop and stand still if talking to people
- Use an assistive device to decrease risk of falling
Why must balance intervention be assessed at the functional level?
To develop the interaction between perception-cognition-action
