Test 3: Standing Balance Assessment and Interventions Flashcards
3 types posture control
steady state- normal; unsupported
reactive - perturbations/sensory integration challenges
proactive- dynamic reaching/resisted limb/prepare for movement
balance grading scale
4 = normal
3= good; maintain without support; minimal sway; low fall risk
2= fair; maintain with handheld support; may require min A; moderate fall risk
1 = poor; requires hand support and mod to max A; high fall risk
0 = absent; unable to maintain
aspects of normal standing biomechanics
ASIS’s level
neutral pelvis
head in midline
active trunk muscles
feet flat on floor/weight even distributed
what is limit of stability
max excursion in any direction without losing balance
need to assess to inform eval and POC
components when testing postural stability with neuro pts and things to keep in mind
check standing unsupported - always have support on affected side and cue for hip/knee/trunk ext
if using assistive device highest grade is fair
weight shifting- start toward less affected side
trunk RT- reach across midline, look over shoulder
limb advancement - pregait stepping with sound limb
assessment techniques for dynamic posture stability
active weight shift
active weight shift against resistance
reaching outside of BOS
task oriented practice (i.e. folding clothes, reaching for tray, etc)
dual cognitive task
resisted limb movement
environmental changes
key observations to make when evaluating dynamic posture
BOS/COM
use of UE/LE
degree of stability maintained by WBing segments
range/degree of control of moving segments
level/type of assistance
environmental constraints that influenced performance
how to set up STS for assessment
initial conditions - feet on floor with hips/knees flexed to 90
WBing symmetry- arms should be in position to WB at first; if they have enough strength they can push up with both arms then use one to grab AD; dont want unilateral AD b/c it encourages learned nonuse
bedside table can be used as AD - Wbing through BUEs; can start lower and raise up later on
what is a push and release test/retropulsive pull test
quick assessment for reactive postural instability
high score = increased risk of fall
0 = independent recovery w/ 1 normal step
1 = 2-3 small steps bwd but recovers still
2 = 4+ steps bwd but recovers
3 = steps but needs to be assisted to prevent fall
4 = falls w/o attempting to step/unable to stand independently
examples of goals for postural stability
more automatic posture control (i.e. less static sway/better ankle or hip strategy)
timed goals (i.e. hold 10s or reach for 30s)
orientation goals (i.e. self correct midline)
decreased dependence (i.e. weight shift w/o assist, stand by assist, etc)
improved awareness of posture/limb
examples of important things to document with posture stability assessment
fall risk or safety/out of bed safety
support needed (physical assistance, cueing)
limits of stability (balance strategies, UE/LE body dressing while standing)
DC planning (safety with out of bed; need home assist?)
describe Postural Assessment Scale for Stroke Patients (PASS)
10 min to administer
total score from 0-36
each item scored 0-3 (i.e. from cant perform to perform w/o help)
higher score = higher function
high responsive to acute pts (14-30 days); high sensitivity
least responsive to chronic pts
describe Berg Balance Scale
14 items
measure of balance for geriatric pt or neuro pt to determine FALL RISK
15-20 min
score 0-4; 0 lowest functional level, 4 highest level
total score = 56
45-56 = independent
<45 = fall risk
ceiling effect possible
describe the Activiries Specific Balance Confidence (ABC) scale
confidence in performing various acivities w/o losing balance
self report measure
16 item questionnaire
subjective to pt
describe tinetti test
measures balance and gait function in elderly
16 items; 2 parts (balance and gait)
each item scores 0-2
28 possible points
higher score = more independent
<19 high fall risk
19-24 = medium fall risk
25-28 = low fall risk
stroke cutoff score <20 = fall risk
