Week 11 Flashcards
Postural Stability
ability to control center of mass in relationship to base of support
Postural Orientation
ability to maintain relationship between body segments and between body and environment for a task
Adaptive Strategies
Changes with demands of task and environment
Anticipatory Strategies
“Pre-tune” sensory and motor systems based on prior learning
Cognitive “Override”
Utilizing motivation, intent and attention to perform a task
Vestibular Ocular Reflex (VOR)
stabilizes gaze during head movement
1:1 head:eye movement
Vestibulospinal Reflexes (VSR)
Coordinates head and body movements to maintain head in upright position
Tonic Neck Reflexes
ATNR (rotation) & STNR (extension/flexion)
Medial Vestibulo-spinal Tract
-Cervical Connections
-Head Righting
Lateral Vestibulo-spinal Tract
Adjust limb movement for balance (chicken head)
Postural Control Responses (3)
Ankle
Hip
Stepping
Steady State Balance (Degrees of Sway)
Anterior 8*
Posterior 4*
Lateral 6-8*
Reactive Balance
Occurs in response to sensory feedback from an external perturbation, requires feedback control
Proactive Balance
Postural adjustments are made in anticipation of voluntary movement, requires feedforward control
aka anticipatory balance
Practical Definition of a Fall
Unintended contact with a supporting surface (walls/counters/ground)
Activities of Balance Confidence (ABC)
16 items scored 0 to 100% confident in not loosing balance
50-80% = somewhat impaired
<50% = likely homebound
Fall Efficacy Scale (FES)
10 items scored 1 to 10 confident in completing (reverse, 1 = high)
> 70 indicates person has fear of falling
80 indicates increased risk of falling
Reach Testing
- Functional Reach Test
- Multidirectional Reach Test
Sit to Stand
- How many completed in 30 seconds
- 5x Sit to Stand (15sec cutoff to predict recurrent fallers)
Timed Up and Go
> 30 seconds = needs assistance
<20 seconds - independently mobile for ADLs
12 seconds = at risk for falls
Berg Balance Scale
Scoring 0 - 56
Norms:
60-69y/o = 55
70-79y/o = 53-54
80-89y/o = 50-53
Performance Oriented Mobility Assessment (POMA)
Balance & Gait Assessment
<19 high fall risk
19-24 medium fall risk
25-28 low fall risk
4 Square Step Test (FSST)
> 15 seconds (older adults) = at risk for multiple falls
24 seconds (stroke) = at risk for falls
Clinical Test for Sensory Interaction in Balance (CTSIB)
6 sensory conditions
- firm vs foam surface
- eyes open, eyes closed, visual conflict dome
Scored subjectively 1 (minimal sway) to 4 (fall)
Sensory Organization Test (SOT)
Computerized version of CTSIB
Function in Sitting Test (FIST)
14 items with scale 0-4 (level of assistance)
Dual Task Taxonomy
The concurrent performance of two tasks that can be performed independently and have distinct and separate goals
Novelty
Performer Characteristic
Complexity
Task Characteristic
Mini Mental State Exam (MMSE)
Total score = 30
High is good, low is cognitive impairment
Often used with people with demensia
Montreal Cognitive Assessment (MOCA)
Total score = 30
High is good, low is cognitive impairment
Mini-BEST
14 items, scored 0, 1, 2
scoring worst side = max 28 points
scoring both sides = max 32 points
<22 balance deficits
<20 recurrent fallers
Modified Systems Framework for Postural Control: Anticipatory Postural Control
Ability to shift the COM before a voluntary movement
Modified Systems Framework for Postural Control: Cognitive Influences
Ability to maintain stability while responding to commands during the task or attend to additional tasks
Modified Systems Framework for Postural Control: Dynamic Stability
Ability to exert ongoing control of COM when the BOS is changing
Modified Systems Framework for Postural Control: Limits of Stability
Ability to move the COM as far as possible in the anterior-posterior or medio-lateral directions within the BOS
Modified Systems Framework for Postural Control: Reactive Postural Control
Ability to recover stability after an external perturbation to bring the COM within the BOS through corrective movements
Modified Systems Framework for Postural Control: Sensory Integration
Ability to combine and/or re-weight sensory information for balance
Modified Systems Framework for Postural Control: Static Stability
Ability to maintain position of the COM in unsupported stance when the BOS does not change
Modified Systems Framework for Postural Control: Verticality
Ability to orient appropriately with respect to gravity, support surface and visual surround
3 Meter Backwards Walk Test
<3 sec = 75% did not report fall
<4.5 sec = 94% did not report fall
>4.5 sec = 81% DID report fall
Cognition
The ability to process, sort, retrieve and manipulate information
7 Domains of Cognition
- Executive Function
- Problem Solving
- Mental Flexibility
- Memory
- Processing Speed
- Intelligence
- Communication & Language
3 Factors affecting Cognition
1 - Arousal / Awareness
2 - Orientation
3 - Attention
Stroop Test
- Word and ink color the same
- Word is different than its color
Long Term Memory - Procedural
Stores information about “how to do” specific activities
Long Term Memory - Semantic
Stores our general knowledge about the world based upon experiences
Long Term Memory - Episodic
Stores our knowledge about personally experienced events
Attention
Preparation for and performance of motor skills are influenced by our limited capacity to select and attend to information
Focused Attention
Focus on and respond to a specific stimulus
Sustained Attention
Sustain or keep attention over a period of time
Selective Attention
Focus attention in the presence of distracting stimuli (tune out specific things)
Alternating Focus
Shift focus of attention from one task to another
Divided Attention
Respond simultaneously to multiple tasks
Is the movement end-point location remembered better than movement distance?
Yes, end location is easier set into memory
Internal Focus
Internal sources of FB
“How” does it feel to perform the movement?
External Focus
External sources of FB
Environmental cues
Expected movement outcomes
Does internal focus benefit the novice or skilled performer better?
Novice
Does external focus benefit the novice or skilled performer more?
Skilled Performer
Mental Practice vs. Physical Practice
1 - Physical + Mental Practice
2 - Physical Practice Only
3 - Mental Practice Only
4 - No Practice
Mental Practice
Cognitive rehearsal of a physical skill in the absence of overt physical movements
- EMG recordings show muscle activity during MP
- Brain activity during imagery is similar to activity during actual performance
- Helps learner answer “what to do” questions (cognitive stage)
