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Theory & Practice II > Balance/Postural Control > Flashcards

Balance/Postural Control Flashcards

1
Q

Define postural control

A
  • the act of maintaining, achieving, or restoring a state of balance on a support surface during any functional task that involves movement
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2
Q

Stages of motor control

A
  • movement
  • stability
  • controlled mobility
  • skilled movement
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3
Q

Where is the center of mass

A
  • at 2nd sacral vertebra in anatomical standing
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4
Q

Line of gravity through the body in standing

A
  • anterior to ankle
  • anterior to knee
  • posterior to hips
  • anterior to thoracic vertebrae
  • anterior to shoulders
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5
Q

Describe limits of stability/ cone of stability

A
  • max distance one can lean/reach without changing base of support & without loss of balance
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6
Q

Steady state balance

A
  • quite sitting/standing
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7
Q

Reactive balance

A
  • balance reactions in response to brief perturbations/movement in COG
  • mostly use feedback mechanisms in response to sensory inputs
  • use some automated motor control strategies here
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8
Q

Proactive balance

A
  • postural adjustments in anticipation of voluntary movements that will move COG
  • use feedforward mechanisms
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9
Q

Postural alignment

A
  • perfect alignment when line of gravity passes through structures as expected
  • minimal muscle activity required
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10
Q

Steadiness/postural sway

A
  • ability to maintain COM/LOG at place with minimal movements
  • can be measured by center of pressure movements on force plates
  • normally exhibit small postural sway during standing
  • sway envelope = path of excursion of the center of pressure during quite standing
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11
Q

Fixed support strategies

A
  • used to control center of mass over fixed base of support, center of mass remains within limits of stability
  • ankle, hip, and suspension strategies
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12
Q

Ankle strategy

A
  • move COM of body as a block about ankle joints
  • used when sways are small/slow
  • muscles are activated distal to proximal
  • during forward sway -> gastroc, hamstrings, & paraspinals
  • during backward sway -> tib ant., quads, & abdominals
  • used on firm support surface
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13
Q

Hip strategy

A
  • moves COM by flexing/extending/ABD/ADD hips
  • used with larger/faster sway
  • muscles activated proximal to distal
  • forward sway -> abdominals & quads
  • backward sway -> paraspinals & hamstrings
  • used when support surface is small/narrow/compliant
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14
Q

Suspension strategy

A
  • moves COM down by flexing hips/knees & flexing trunk
  • may progress to squating
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15
Q

Change in support strategies

A
  • used to control COM over moving base of support when COM moves out of loss of stability
  • stepping & reaching/grasping strategies
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16
Q

Stepping strategy

A
  • brings COM back within loss of stability by taking a rapid step in the direction of the destabilizing force
  • recruited in response to fast large perturbations when ankle/hip strategies are not adequate to recover postural control
  • not a strategy of last resort it is recruited quickly ahead of ankle/hip strategies if CNS perceives a big perturbation
17
Q

Reaching/grasping strategy

A
  • bring COM within loss of stability by extending base os support by reaching/grasping using UE
18
Q

What sensory systems are involved in balance

A
  • visual
  • somatosensory
  • vestibular
19
Q

Visual system

A
  • has roles in both feedforward and feedback balance mechanisms
  • Feedforward: focal vision (central vision, to see obstacle ahead of you & react beforehand & needed for proactive/anticipatory postural control
  • Feedback: ambient vision (focal & peripheral vision), to regain postural control after perturbations & needed for reactive postural control
20
Q

Somatosensory system

A
  • information from touch receptors and proprioceptive sensations from muscles, tendons, and joints
  • has roles in both feedforward and feedback mechanisms
  • provide info about orientation & movement of body in relation to support surface
21
Q

Vestibular system

A
  • provides CNS with info about position.movement of head with respect to gravity/inertial forces
  • info about linear/angular acceleration
  • functions to stabilize gaze during head movements, regulates tone in postural/antigravity muscles
22
Q

Sensory Organization Test (SOT) scoring

A
  • 1 = minimal sway
  • 2 = mild sway
  • 3 = moderate sway
  • 4 = loss of balance
23
Q

Modified Clinical Test for Sensory Integration of Balance (mCTSIB)

A
  • performs standing on stable surface eyes open then closed
  • performs standing on unstable surface eyes open then closed
  • does not test/perform inaccurate visual input
24
Q

Balance tests for steady state balance

A
  • single limb stance time (30s)
  • Romberg test (feet together 30s)
  • CTSIB/mCTSIB
25
Q

Balance tests for anticipatory balance

A
  • functional reach test
  • multi-directional reach test
  • star excursion balance test/Y-balance test
26
Q

Balance tests for reactive balance

A
  • retropulsive pull test (pull pt backwards)
  • push and release test (0 = recovers with 1 step, 1 = 2-3 small steps, 2 = 4 or more steps, 3 = multiple steps & needs assistance to prevent fall, 4 = falls w/o attempting steps)
27
Q

Balance tests for sitting balance

A
  • Static sitting balance: postural symmetry, pelvic tilt, base of support, biomechanical constraints, & sensory orientation
  • Dynamic sitting balance: stability limits & verticality, anticipatory postural control, and reactive postural control
28
Q

Assessment of balance at impairment level

A
  • Motor systems: ankle, hip, and step strategies
  • Sensory systems: stable to unstable surface
  • Cognitive systems: dual task testing
29
Q

Seated balance tests

A
  • sitting balance assessment
  • FIST (function in sitting test)
  • SATCo
30
Q

Standing balance tests

A
  • FRT/MDRT (functional reach test)
  • Romberg/Sharpened Romberg (feet together/tandem)
  • SLST (single limb stance time)
31
Q

Combined sitting & standing activities to assess balance

A
  • TUG (time up & go; more than 13s is cut off for fall risk)
  • 5TSTS (5x sit to stand)
  • 30SCST (30s sit to stand)
  • PASS (postural assessment seated/standing)
  • BESTest (cut off for fall risk is <69%)/miniBESTtest (cut off <23/28)
  • DGI (dynamic gait index)
  • FGA (functional gait assessment)
32
Q

How do you improve balance

A
  • appropriate intensity and volumes
  • need to work at the levels where patients experience some loss of balance
33
Q

Interventions for static/steady state balance control

A
  • having patient maintain progressively difficult static postures: sitting, quadruped, half kneeling, tall kneeling, standing, lunge, squat positions
34
Q

How to train reactive balance control

A
  • requires external perturbations
35
Q

How to train anticipatory balance control

A
  • requires change of posture during functional activities
  • example: reach in all directions to touch or grasp objects, pick objects from floor, catch ball, tap balloon, or kick ball
36
Q

Combined reactive and anticipatory balance control activities

A
  • seated reaching with perturbations
  • gait with head turns and perturbations
  • sit to stands with perturbations

Theory & Practice II (19 decks)

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