Balance

Question 1

Balance Definition

Answer 1

Centre of Mass remaining over base of support

Question 2

Balance - Requires

Answer 2

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1. Sensory Reception

• Intact Receptors (mostly joint receptors, golgi tendons, muscle spindles)
• Vestibular system (3 semi-circular canals - movement of fluid stimulates hairs in canals - info to pons + medulla which links with cerebellum - INFO ABOUT POSITION OF HEAD)
• Vision
• Intact pathways (dorsal column/ spinothalamic/ spinocerebellar)

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2. Central Processing

• Sensory cortex
• Motor cortex
• Cerebellum
• Basal ganglia

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3. Motor Output

• Intact pathways
• Muscles (strength/power/tone/endurance)
• Joint range

Question 3

Balance - Assessment

Answer 3

> Sensory input

• Vestibular - rapid movement response
• Vision - visual field testing
• Proprio - mirroring/joint position sense
• Somatosensory - light + deep / sharp + blunt

> Central Processing

• Tone = PROM vs AROM
• Initiation of movement = AROM + function
• Co-ordination = Finger to Nose/ Heel to shin + function
• Smooth movements = F2N/H2S + function
• Reactive - function

> Motor output

• tone = PROM + reflexes
• Strength - Isometric/isotonic
• Joint range - AROM vs PROM

Question 4

Balance Mechanisms

Answer 4

> Aid us to help avoid falling 
> Hip + ankle strategies 
> trunk + head righting reactions 
> protective/saving reactions (arms out to break fall etc.)
> Stepping reactions 

• Reactive = feedback (compensatory)
• Proactive = Feedforward (anticipatory)

Question 5

Challenging Balance

Answer 5

> Reduce Sensory input 
> Reduce Base of Support 
> Raise the Centre of gravity 
> Reactive/Proactive elements
> Dual tasking (remove cognition element of balance)

Question 6

Balance - Outcome Measures

Answer 6

> Rombergs
( 2 feet shoulder width apart with eyes closed)

> Timed unsupported steady stand

> Functional Reach

> 180 degree turn

> Tinetti scale

> Berg Balance scale

> Get up + go

*More challenging
> Star excursion
> Y balance

Question 7

Balance - Preventing Falls

- Definition + risk factors

Answer 7

> Unintentionally coming to rest at ground or other level

> Risk Factors

• Age (otolith degeneration in vestibular system + muscle weakness particularly in hip/knee/ankle)
• Neuromuscular factors (stroke/pd)
• gait/balance disorders
• Dizziness (bp problems, heart problems, vestibular)
• Footwear + feet (barefoot/hard soles = best)