week 9: posture to balance

Question 1

Plumb line view from side:
________ to mastoid process
through ________ acromion process
________ to hip joint
_________ to knee
________ to lateral malleolus

Answer 1

anterior to mastoid
through anterior acromion process
posterior to hip jt
anterior to knee
anterior to lateral malleolus

Question 2

the plumb line goes anterior to the MASTOID not the EAR - exam question

Question 3

what is this? what muscles are weak/stretched?

what patients is this common in?

Answer 3

swayback (PPT!)

abdominals and hip flexors are weak

postpartum

Question 4

what is this? what patients is this posture common in?

Answer 4

right side lean

LBP patients, leaning away from painful side especially if nerve issue

Question 5

parkinsons posture

Answer 5

stooped posture

Question 6

uneven shoulder height

Answer 6

overhead athletes

Question 7

with the uneven shoulder height patients, which shoulder is commonly affected? is it the lower or higher shoulder?

Answer 7

dominant shoulder is commonly depressed (lower)

decreased IR/hand up the back

Question 8

upper quarter cross syndrome:
what is tight?
what is weak?

Answer 8

tight upper traps and levator, tight pectoralis
weak rhomboids, low and mid traps, serratus anterior, deep neck flexors

Question 9

T or F: spine should have some thoracic kyphosis and some lumbar lordosis

Answer 9

T!

Question 10

What is this?

Answer 10

flat back posture

Question 11

what is this?

Answer 11

sway back

notice hips are foward

Question 12

what is this?

Answer 12

kyphotic-lordotic posture

Question 13

increased cervical forward head leads to what?

Answer 13

increased compressive forces on anterior, lower cervical, and posterior facets
levator scapulae shortening
shoulder protraction

Question 14

Shoulder protraction may result from GH or AC instability or post RC tightness. what muscles are prone to getting tight?

Answer 14

teres minor and infraspinatus

Question 15

sway back is _______ kyphosis and _________ lordosis

Answer 15

increased kyphosis and decreased lordosis

Question 16

swayback causes:
_____ hip extensors
_____ hip flexors or lower abdominals

generalized _______ strength

genu ________

________ pelvic tilt

Answer 16

tight hip extensors
weak hip flexors
generalized decreased strength
genu recurvatum
posterior pelvic tilt

Question 17

the posterior pelvic tilt in swayback causes increased stress/elongation of the ____ hip joint

and ____ of the posterior hip ligaments

Answer 17

anterior hip joint and posterior t spine

shortening of posterior hip ligaments and anterior t spine

Question 18

lordosis:
______ hip flexors and/or back extensors
_______ pelvic tilt
increased _____ forces on lumbar vertebrae
increased ______ forces on lumbar facets
________ of anterior spinal ligaments

Answer 18

tight hip flexors/ back extensors
anterior pelvic tilt
increased shear forces lumbar vertebrae
increased compression forces on lumbar facets
elongation of anterior spinal ligaments

Question 19

flatback:
_______ kyphosis and _______ lordosis
______ head, _______ pelvic tilt, knee _____
______ hip extensors
______ hip flexors and back extensors

Answer 19

decreases kyphosis and decreased lordosis
forward head, posterior pelvic tilt, knee flexion
tight hip extensors
weak hip flexors and back extensors

Question 20

at 0 degrees cervical flexion, your head weighs _____

if your neck is flexed to 60 degrees (reading phone), it weighs ______

Answer 20

10-12 lbs

60 lbs!

Question 21

postural sway, AP sway is ___ mm in quiet stance

Answer 21

5-7 mm

Question 22

postural sway, ML sway is ___ mm in quiet stance

Answer 22

3-4 mm

Question 23

what causes postural sway?

Answer 23

high COM and small BOS in standing

Question 24

in sway, what is the body pivoting about?

Answer 24

ankle joint

Question 25

in sitting, proper posture looks like lordosis _______ hips _____ than knees feet on the ground

Answer 25

lordosis preserved hips higher than the knees weight should be distributed between ish tub and posterior thighs

Question 26

what causes a posterior pelvic tilt in sitting?

Answer 26

short hamstrings = sacral sitting = pressure ulcers

Question 27

in sitting, if the chair is too high it leads to

Answer 27

pressure on posterior thighs

Question 28

in sitting, if the chair is too low it leads to

Answer 28

increases posterior tilt

Question 29

percentage pressure on discs when laying supine

Answer 29

25

Question 30

percentage pressure on discs when laying side lying

Answer 30

75

Question 31

percentage pressure on discs when standing

Answer 31

100

Question 32

percentage pressure on discs when standing leaning over

Answer 32

150

Question 33

percentage pressure on discs when standing leaning over holding weight

Answer 33

220

Question 34

percentage pressure on discs when sitting upright

Answer 34

140

Question 35

percentage pressure on discs when sitting and leaning back

Answer 35

105

Question 36

percentage pressure on discs when sitting leaning forward

Answer 36

185

Question 37

percentage pressure on discs when sitting, leaning forward with weight

Answer 37

275

Question 38

for the computer: head should be tilted __ degrees into flexion or less elbows should be ____ wrists in _____ keyboard slope no greater than __

Answer 38

head should be tilted 15 degrees into flexion or less elbows should be close wrists in neutral keyboard slope no greater than 15

Question 39

a hip flexion contracture will present how in supine?

Answer 39

shortened, adducted, internally rotated

Question 40

strengths of HHD

Answer 40

document force in a number more reliability able to demonstrate a more subtle improvement of strength - more sensitive to change!

Question 41

HHD limitation

Answer 41

forces may not be linear across the entire spectrum difficulty with patients understanding specific instructions cost inadequate resistive force STRENGTH OF EXAMINER CNA MAKE A DIFFERENCE

Question 42

HHD: the force must be

Answer 42

Isometric

Question 43

clinical pearls for HHD

Answer 43

consistent test position same joint max stabilization same therapist flat learning curve

Question 44

HHD: resistance must be applied in what direction?

Answer 44

prependicular

Question 45

how can you compare results of HHD between patients?

Answer 45

have to convert to torque! Torque = force x perpendicular distance of the force to the joint center (axis of joint to where you applied force)

Question 46

what may make a pt a high fall risk? exam question!

Answer 46

DECREASED HAND GRIP STRENGTH AND LOWER SCORE ON THE TIMED CHAIR STANDS TEST history of falls medication use impaired cognition recent hospitalization fear of falling increased sway in near tandem with eyes open cardiovascualr conditions > 65

Question 47

of all hip fracture over 65, __% are related to a fall

Answer 47

90

Question 48

falls account for __% of hospital admissions and __% of nursing home admissiond

Answer 48

25% 40%

Question 49

multifactors of balance and fall prevention

Answer 49

physical activity education environment modifications fall risk assessment review of other systems

Question 50

3 subsystems for balance

Answer 50

visual, somatosensory, vestibular

Question 51

if there is a conflict in sensorimotor integration, what happens?

Answer 51

loss of balance/ fall/ faulty motor response

Question 52

for ankle corrective forces, if the COM is shifted anterior what activates?

Answer 52

gastroc and Hamstrings

Question 53

for ankle corrective forces, iF the COM is shifted posterior what activates?

Answer 53

tib anterior and quads

Question 54

if the COG moves too quickly or too far outside the BOS, what strategy is used?

Answer 54

stepping

Question 55

outcome measures for balance/ confidence these address a patients self-perception

Answer 55

ABC Scale- activities-specific balance confidence (score of less than 67% predict fall 84% of the time Falls Efficacy Scale fear of falling avoidance questionare

Question 56

static balance: 2 types

Answer 56

quiet stance or active standing

Question 57

reactive versus proactive standing

Answer 57

reactive to perturbations proactive- ex: sit to stand/functional reach

Question 58

2 types of dynamic balance

Answer 58

step initiation and ambulation

Question 59

T or F: good dynamic balance means good static balance

Answer 59

False

Question 60

5 categories of balance tests

Answer 60

clinical laboratory functional specific population- concussion combination

Question 61

FICSIT-4

Answer 61

CLINICAL BALANCE TEST

Question 62

balance test for athletes after concussion

Answer 62

BESS