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S3 - Clinical Practice 2 > Week 12- Balance > Flashcards

Week 12- Balance Flashcards

1
Q

PART 1

A

PART 1

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2
Q

What are 3 important terms when talking about Balance?

A
  • Center of Mass (CoM)
  • Center of Gravity (CoG)
  • Base of Support (BoS)
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3
Q

What is the point at which distribution of mass is equal in all directions and changes with body position? It is independent of gravity.

A

CoM (center of mass)

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4
Q

Where is the CoM generally located?

A

2/3 of body height above BoS, slightly anterior to sacrum (6in above belly button)

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5
Q

What is the vertical projection of CoM and is gravity dependent?

A

CoG (center of gravity)

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6
Q
  • The CoG is located _______ to the ankle and knee joints.
  • The CoG is located ___ or ________ to the hip joint, trunk midline.
  • The CoG is located ________ to the GH joint.
  • The CoG goes ________ the external auditory meatus.
A
  • anterior
  • at or posterior
  • anterior
  • through
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7
Q

What is the area beneath a person that includes every point of contact that the person makes with the supporting surface?

A

BoS (base of support)

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8
Q

What exactly is balance?

A

Control of the CoM over the BoS.

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9
Q

Balance is divided into postural _______, ________, and ___________.

A
  • control
  • stability
  • orientation
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10
Q

What is postural control?

A

Ability to control body position in space within and outside our BoS. (balance)

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11
Q

What is postural stability?

A

Ability to control CoM and CoG over BoS in varying sensory environments.

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12
Q

What is postural orientation?

A

Ability to maintain position with respect to gravity.

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13
Q

What 6 things keep us balanced?

A
  • Limits of Stability
  • Anticipatory Control
  • Reactive Responses
  • Sensory Organization/Integration
  • Stability During Gait
  • Biomechanical
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14
Q

PART 2 AND 3

A

PART 2 AND 3

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15
Q

What are the 3 main systems involved in the CNS processing for balance?

A
  • Somatosensory
  • Vestibular
  • Visual
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16
Q

How is our semsorimotor integration of the 3 systems split based on whether we are standing on a firm/stable surface or a compliant surface?

A 
Firm/Stable
-70% Somatosensory
-20% Vestibular
-10% Visual
Compliant
-60% Vestibular
-30% Visual
-10% Somatosensory
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17
Q

Firm/Stable Surface:

  • __% Somatosensory
  • __% Vestibular
  • __% Visual
A
  • 70% Somatosensory
  • 20% Vestibular
  • 10% Visual
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18
Q

Compliant Surface:

  • __% Vestibular
  • __% Visual
  • __% Somatosensory
A
  • 60% Vestibular
  • 30% Visual
  • 10% Somatosensory
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19
Q

As we age, we become _______ reliant for balance.

A

visually

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20
Q

__________ input is the dominant sense for upright postural control and is most active in triggering automatic postural responses in almost all cases.

A

Somatosensory

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21
Q

Visual input is split into ______ (_______) vision and __________ (__________) vision.

A
  • Central (foveal)

- Peripheral (ambient)

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22
Q

_______ vision is largely conscious while ________ vision is largely subconscious.

A
  • Central (foveal)

- Peripheral (ambient)

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23
Q

_________ input provides information to the CNS about position and motion of the head.

A

Vestibular

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24
Q

Vestibular input is unique in its ability to distinguish _____ motion from _________ motion.

A
  • self

- environmental

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25
Q

Somatosensory, Visual, and Vestibular Input act on a __________.

A

continuum

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26
Q

When changes in the environment occur, what happens to the 2 systems of balance? What is this called? Give an example.

A
  • Available, accurate, and useful information is “upweighted,” whereas unavailable, inaccurate, or less-useful information is “downweighted”.
  • Multisensory Reweighting
  • Walking at night, vision is downweighted while somatosensory is upweighted.
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27
Q

We will also see multisensory reweighting after _________ injury.

A

neurological

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28
Q

When reweighting occurs, ________ is inevitably impacted.

A

balance

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29
Q

CNS processes this weighted sensory input to allow for descending commands to motor and neuromuscular systems to allow for our body to be in one of what 3 states?

A
  • Steady State (quiet balance)
  • Anticipatory Postural Control (activate in advance)
  • Reactive Postural Responses (perturbation recovery)
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30
Q

Anticipatory Postural Control:

  • Motor planning based on prior ____________ to avoid losses of balance.
  • Involves the _________ system and _______ control.
  • Voluntary _____-__________ movements in preperation for movement.
A
  • experiences
  • feedforward, cerebellar
  • goal-directed
31
Q

Do Anticipatory Postural Control or Reactive Postural Responses act faster?

A

Anticipatory Postural Control

32
Q

What muscles act the quickest in regards to anticipatory control in the UE and LE?

A
  • UE =Biceps

- LE = Gastrocnemius

33
Q

Limits of Stability:

  • Postural sway is _______, gentle, automatic and involuntary A and P oscillations.
  • Normal = __ degrees in all directions.
A
  • normal

- 8 degrees (cone of stability)

34
Q

What happens if our CoM gets outside of the Limits of Stability?

A

We begin to lose balance and need to react.

35
Q

Reactive Postural Responses:

  • Reaction to unplanned ___________ to balance resulting in displacement of CoG or moving the BoS.
  • Feedback system (dependent on fast _______ and ______ responses)
A
  • perturbations

- fast sensory and motor responses

36
Q
  • Reactive Postural Responses = __________

- Anticipatory Postural Control = __________

A
  • feedback

- feedforward

37
Q

What are the 3 main reactive strategies?

A
  • Ankle Strategy
  • Hip Strategy
  • Stepping Strategy
38
Q
  • What reactive strategy is used to counteract large perturbations?
  • What reactive strategy is used to counteract small perturbations?
  • What reactive strategy is used when ankle and hip strategies fail?
A
  • Hip
  • Ankle
  • Stepping
39
Q
  • Ankle Strategy = _____ to ______ muscle recruitment

- Hip Strategy = ______ to ______ muscle recruitment

A
  • distal to proximal

- proximal to distal

40
Q

Biomechanical Considerations:

  • A direct relationship between _______/______/_____ and balance has been well documented in literature.
  • Ankle _____ and _______ strength are independent predictors of functional performance.
  • PF strength of ______ affected balance and function in older adults.
  • Weakness of hip and knee _________ was associated with increased likelihood of employing a multi-step strategy to recover from balance perturbations.
  • Exercise has shown to have a __________ effect on fall risk in older adults.
A
  • strength/power/endurance
  • PF and DF
  • big toe
  • extensors
  • proactive
41
Q

Stability During Gait:

  • Goal is controlled forward transference of _____.
  • __% of our BoS during gait is in DLS.
  • __% of our BoS during gait is in SLS.
A
  • CoM
  • 40%
  • 60%
42
Q

Adding a __________ load to a balance test is a great progression for patients.

A

cognitive

43
Q

What happens when our strategies fail?

A

FALLS

44
Q

PART 4

A

PART 4

45
Q

Why are we so concerned with falls?

A

Falls are DANGEROUS

  • Can lead to severe orthopedic injuries (back and hip fractures)
  • Neurological injuries, TBI, Spinal Cord
46
Q

What is the most common cause of TBI (traumatic brain injuries)?

A

Falls

47
Q

Fall risk factors can be _______ or _________. List examples of each.

A

Intrinsic

  • AGE
  • impaired balance
  • prior Hx of falls
  • fear of falling
  • Comorbidities/Diseased state
  • Medications side effects

Extrinsic

  • type of surface
  • slippery surface
  • obstacles, stairs, curbs
  • poor lighting
  • footwear
  • poorly fitted AD and/or orthotics
  • recreational drugs, alcohol
48
Q

Why is balance such a huge issue for aging patients?

  • __ in __ Americans falls each year
  • Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions in ____________.
  • Community dwelling incidence __-__% with injury rate of __-__%.
  • Fall-related injuries lead to 15% re-hospitilization in ____ month post-discharge.
A
  • 1 in 4
  • older adults
  • 30-40%, 10-15%
  • first
49
Q

Does aging directly cause bad balance?

A

NO, rather aging negatively impacts crucial systems involved in our balance, which leads to higher risk for falls.

50
Q

Balance Strategies and Aging:

  • _______ __ _________ tend to decrease.
  • With age, tend to see larger and more delayed ___________ postural adjustments.
  • Higher levels of _______ _______ were correlated with better anticipatory responses.
  • Fear of falling found to increase anticipatory postural adjustment durations.
  • Direct correlation between muscle fatigue and slowed reactive postural responses in older adults.
  • Increased dominance of _____ strategy, even with smaller CoM displacements.
A
  • Limits of Stability
  • anticipatory
  • physical fitness
  • hip
51
Q

Visual Changes and Aging:

  • Presbyopia
  • ______ senstivity
  • _________ dark adaptation
  • Difficulty shifting ______ (far/near)
  • Slower visual ________ time
  • Difficulty distinguishing ______
  • Loss of ____________ vision
A
  • glare
  • reduced
  • focus
  • reaction
  • color
  • peripheral
52
Q

What are some common vision pathologies seen with aging?

A

Cataracts, glaucoma, macular degeneration, diabetic retinopathy

53
Q

What are the functional implications of visual changes with balance?

A
  • Higher risk for falls at night or in reduced lighting.
  • At risk to trip due to peripheral vision loss.
  • Slower reaction time = reduced reactionary strategies for balance.
54
Q

Does aging break down our somatosensory system?

A

No

55
Q

Vestibular Changes and Aging:

  • Loss of ____ cells in SCC and otoliths
  • ___________ of otolithic membranes
  • Microvascular ________
  • Reduction of vestibular and cerebellar neurons and nuclei
  • Reduced effectiveness of _____
A
  • hair
  • calcification
  • ischemia
  • VOR
56
Q

What are the functional implications of vestibular changes with balance?

A
  • Less capacity for detection of rotation and gravity-related positions
  • Reduced gaze stabilization with head movements
  • Increased postural sway
  • Sensory substitutions can mask deficit more effectively than with other impaired systems
57
Q

NMS/MSK Changes and Aging:

  • Decrease in # of type I and II fibers (__>__)
  • Decrease in # of ___s as well as maximal voluntary muscle activation
  • Muscle performance (strength, power, endurance) decreases __% every year after age 60
  • Decrease in peak _______ muscle power
  • Increase in agonist/antagonist __-________ during volitional movement
  • Increased muscle connective tissue leads to decreased _________
  • Increased risks of __________
A
  • II>I
  • MUs
  • 3%
  • anaerobic
  • co-activation
  • flexibility
  • osteoporosis
58
Q

What are the functional implications of NMS/MSK changes with balance?

A
  • Reductions in strength, power and muscle endurance have all been tied to balance deficits
  • High prevalence of OP results in more risk of fracture when falls occurs
  • Postural changes lead to changes in COM/COG/BOS
  • Greater axial stiffness and reduced flexibility
59
Q

Cognitive Changes and Aging:

  • Conceptual reasoning, memory, and processing speed __________ with time
  • Decreased use of strategies to improve learning and memory
  • Reduced selective and divided __________
  • Gradual reduction in visual constructional skills
  • Research has shown that concept formation, abstraction, and mental flexibility decline with age, especially after age 70
A
  • decrease

- attention

60
Q

What are the functional implications of cognitive changes with balance?

A
  • Dual Task

- Carry over

61
Q

How do we determine if a patient is “off-balance”?

A
  • Observation (postural alignment, weight distribution, functional task analysis)
  • Clinical History Taking
  • Subjective Outcome Measures
  • Objective Outcome Measures (cut-off scores, MDC, MCID)
62
Q
  • What is a cut-off score?
  • What is MDC?
  • What is MCID?
A
  • Score in which we can say they are at risk if scored below.
  • When met, you can determine it was met not by chance.
  • Amount of change where you will see improvement in function.
63
Q

What is the most common subjective outcome measure for falls?

A

Activity-Specific Balance Confidence Scale (ABC)

64
Q

Describe the Activity-Specific Balance Confidence Scale (ABC).

A
  • 16-item questionnaire (0-100 score)
  • Measure of balance confidence in performing various activities without losing balance or experiencing a sense of unsteadiness
  • Evaluates vestibular and non-vestibular balance tasks as well as functional mobility
65
Q

What is a 2nd subjective outcome measure for falls?

A

Tinetti Falls Efficacy Scale

66
Q

Describe the Tinetti Falls Efficacy Scale.

A
  • 10-item questionnaire with each item is rated from 1 (very confident) to 10 (not confident at all)
  • Assesses perception of balance and stability during activities of daily living as well as non-vestibular balance tasks, functional mobility, life participation, and self-efficacy
  • Cut-Off Scores: >80 increased risk of falling, >70 indicates fear of falling
67
Q

What are some domains of balance?

A
  • Limits of Stability
  • Anticipatory Postural Control
  • Reactive Postural Responses
68
Q
  • Limits of Stability involves ________ tasks.

- What are some outcome measures for limits of stability?

A
  • reaching

- Functional Reach Test, Multidirectional Reach Test

69
Q
  • Anticipatory Postural Control involves activities that require ______ rotation such as what?
  • What are some outcome measures for anticipatory postural control?
A
  • trunk rotation such as reaching, twisting, stepping, kicking, punching
  • 5TSTS, BBS, Mini BESTest, 4 Square Step Test
70
Q
  • Reactive Postural Responses are activities that require a patient to respond ________ such as what?
  • -What are some outcome measures for reactive postural responses?
A
  • respond such as start/stop activities

- Push/Pull Test, Mini BESTest, DGI/FGA, Tinetti

71
Q

What are some outcome measures we can use to assess sensorimotor integration?

A
  • Romberg Test
  • Sensory Organization Test (SOT)
  • Clinical Test for Sensory Interaction in Balance (CTSIB) (foam and dome test)
72
Q

What are the APTA EDGE 6 Core Outcome Measures?

A
  1. ) Berg Balance Scale
  2. ) Functional Gait Assessment
  3. ) Activities-Specific Balance Confidence Scale (ABC)
  4. ) 10MWT
  5. ) 6MWT
  6. ) 5TSTS
73
Q

What is the point of the 6 Core Outcome Measures?

A
  • All encompassing look at someones balance, postural control, and functional mobility after a neurological event.
  • All 6 can be tied to balance.
74
Q
  • Anticipatory Postural Control is a ____________ system that closely coincides with motor control and accurate muscle grading.
  • Principles of __________ are crucial with traning this aspect of balance. (repitition, specificity, transferance)
A
  • feedforward

- Neuroplasticity

S3 - Clinical Practice 2 (13 decks)

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