05-06: Balance Flashcards Preview

05 - Tests and Measurements > 05-06: Balance > Flashcards

Flashcards in 05-06: Balance Deck (32):
1

Definition of balance

- A state of physical equilibrium
- Maintenance and control of COG within BOS
- Achieving and maintaining upright posture

2

Systems that contribute to balance (3)

- Vestibular
- Somatosensory
- Visual

3

Vestibular Input

- Provides CNS with info about position and movement of head with relation to gravity

- CNS: Cerebellum
- PNS: Labyrinth of inner ear
- Semicircular canals: Respond to movement of fluid with acceleration and deceleration of head
- Otolith: measures acceleration and orientation of head with reference to gravity

- Stabilizes gaze during head movement (VOR) and regulates postural tone/control via VSR

4

Perturbations

- Applications of external force acting on the body to displace COM
- Used to assess vestibular

5

Somatosensory Input

- Proprioceptive and tactile info
- Receptors provide proprioceptive info about length, tension, pressure, pain, joint position
- Receptors located in joints, muscles, ligaments, skin

6

Challenges

- Change surface area (standing or sitting) to test balance
- Stationary surface vs moving surface, solid vs foam
- Used to assess somatosensory

7

Visual Input

Receptors provide perceptual acuity info about
- vertical
- motion of objects
- motion of self
- environmental orientation
- postural sway
- movements of the head and neck

8

Assessing visual input

- Eyes open
- Eyes closed
- Dim lighting
- Dark

If visual input is taken away and balance gets worse, visual system is compensating for impairment elsewhere

9

Vestibuloocular reflex (VOR)

- Allows for head-eye movement coordination
- Supports gaze stabilization: Eyes can move while head is fixed, Visual tracking can occur when both eyes and head are moving

10

Vestibulospinal reflex (VSR)

- Stabilizes the body and controls movement
- Stability of trunk while head is moving
- Coordination of trunk during upright postures

11

Automatic postural strategies (4)

- Maintain COG over BOS

- Ankle: Elicited by small range and slow velocity force, challenge or perturbation when feet on ground; muscles contract distal to proximal
- Hip: Elicited by greater force, challenge or perturbation through pelvis and hips; hips move in opposite direction of head; muscles contract proximal to distal
- Suspensory: Lowering COG during standing and ambulation in order to control COG; Used when both stability and mobility required (surfing)
- Stepping: LE or UE reaches out when challenge/perturbation moves COG outside BOS; UE = sitting balance, LE = standing balance

12

Vertigo

Affects sense of movement and rotation
- Of self
- Of environment

13

Nystagmus

- Nonvolitional, rhythmic oscillation of eyes
- Abnormal eye movements
- Normal end range

14

Vestibular rehabilitation

- Addresses central or peripheral balance disorders
- Exercises address: compensation, adaptation, plasticity
- Intervention goals: Increase brain sensitivity, restore symmetry, improve VOR control, increase motor control and movement

15

Static Standing Tests

- Romberg Test
- One legged stance (cross arms, stand on one leg)
- Timed standing test
- Clinical Test for Sensory Interaction on Balance (CTSIB): Foam and Dome Test
- SOT: Computerized posturography of CTSIB

16

Active Standing Tests

- Functional Reach
- Sensory Organization Test (SOT)
- Gait observation

17

Dynamic Balance Tests

- Tinetti Performance Oriented Mobility Assessment (POMA)
- Berg Balance Scale
- Timed Up and Go Test (TUG)

18

Nystagmus Tests

- Head-shaking test
- Head-thrust test
- Hallpike-Dix test
- Electrooculography
- Saccadic Test
- Gaze Test

19

Functional Balance Grades

4 = Normal: Pt able to maintain balance without handheld support (static); pt accepts max challenge and can shift weight easily within full range in all directions (dynamic)
3 = Good: Pt able to maintain balance without handheld support, limited postural sway (static); pt accepts mod challenges; able to maintain balance while picking object off floor (dynamic)
2 = Fair: Pt able to maintain balance with handheld support, may require min assistance (static); pt accepts min challenge, able to maintain balance while turning head/trunk (dynamic)
1 = Poor: Pt requires handheld support and mod to max assistance to maintain position (static); pt unable to accept challenge or move without loss of balance (dynamic)
0 = Absent: Pt unable to maintain balance

20

Berg Balance Scale

- Assesses fall risk
- Categories: static, transitional, dynamic activities in sitting/standing
- 14 tasks on an 0-4 ordinal scale, Max 56
- Less than 45 = higher risk of fall

21

BBS Scoring (Risk of fall)

> 45 = normal
41-45 = mild
34-41 = moderate
< 35 = severe

22

Functional Reach Test

- Assesses standing balance, risk of falling
- Yard stick measures reach without moving feet
- Average of 3 trials assessed in standing or sitting

23

Function Reach Standards

20-40 yo: men 16.7" (+1.9); women 14.6 (+2.2)
41-69 yo: men 14.9" (+2.2); women 13.8 (+2.2)
70-87 yo: men 13.2" (+1.6); women 10.5 (+3.5)

24

TUG Test

- Assesses level of mobility and balance
- Scores based on: amount of postural sway, excessive movements, reaching for support, side stepping, other signs of LOB
- Requiring more than 20 seconds indicates increase in falls

25

TUG Scoring

Normal: < 10 sec
Mild Impairment: 11-15 sec
Mod Impairment: 15-20 sec
Severe: > 20 sec

26

Romberg Test

- Assesses proprioceptive contribution
- Unsupported standing > Feet together > UE folded > EO > EC
- Normal = able to maintain position for 30 sec

27

Romberg Scoring

- Negative: No LOB when standing with feet together, arms crossed (EO or EC)
- Positive: LOB when standing with feet together, arms crossed (EO or EC)

28

Tinetti (POMA) Test

- Assesses risk of falling during gait
- Two tests: Balance, Gait

29

Tinetti Scoring

- Max score: 28
- Normal: > 24
- Mild: 21-24
- Mod: 17-20
- Severe: < 17

30

CTSIB Test

- Determines effectiveness of different balance input system
- 1st: determines baseline (all 3 systems)
- 2nd: Visual is removed
- 3rd: Visual reference is removed by use of dome (tests vestibular)
- 4-6: Perform on foam for unstable somatosensory input
- Monitor sway for 30 seconds on each position

31

Activity Balance Confidence Scale

- Self-report (16 point scale)
- 0% = no confidence
- 100% = completely confident

32

Falls Efficacy Scale

- Self-report
- Low score = Less fear of falling
- 70 = Fear of Falling