Balance

Question 1

Balance requires input from 3 systems

Answer 1

Relies on somatosensory, visual, and vestibular input.

Question 2

Vestibuloocular reflex (VOR)

Answer 2

Allows for head-eye movement coordination. Supports gaze stabilization through eye movement that counters movement of the head, allowing a stable image on retina during movement.

Question 3

Vestibulospinal reflex (VSR)

Answer 3

Attempts to stabilize body when head is moving and coordinate the trunk during upright postures.

Question 4

Ankle Strategy

Answer 4

Elicited by small range and slow velocity perturbations. Muscles contract in a distal to proximal fashion.

Question 5

Hip Strategy

Answer 5

Elicited by greater force, challenge, or perturbation. Hips will move in opposite direction from the head to maintain balance. Muscles contract in proximal to distal fashion.

Question 6

Stepping Strategy

Answer 6

Elicited through unexpected challenges or perturbations that causes COG to move beyond BOS. Lower extremity steps or upper extremity reaches to regain new BOS.

Question 7

Suspensory Strategy

Answer 7

Lowers center of gravity during standing or ambulation to better control center of gravity. Bending knees, squatting, crouching.

Question 8

Peripheral Vertigo Characteristics

Answer 8

Episodic/short duration (a few seconds)
Autonomic symptoms
Precipitating factor (changes in head position)
Pallor, sweating
Nausea and vomiting
Auditory fullness
Tinnitis

Question 9

Central Vertigo Characteristics

Answer 9

Autonomic symptoms less severe
Loss of consciousness can occur
Neurological symptoms: diplopia, hemianopsia, weakness, numbness, ataxia, dysarthria

Question 10

Benign paroxysmal positional vertigo (BPPV) leads to peripheral or central vertigo?

Answer 10

Peripheral

Question 11

Meniere’s disease leads to peripheral or central vertigo?

Answer 11

Peripheral

Question 12

Ear infection leads to peripheral or central vertigo?

Answer 12

Both

Question 13

Trauma/tumor leads to peripheral or central vertigo?

Answer 13

Both

Question 14

Metabolic disorders (diabetes) leads to peripheral or central vertigo?

Answer 14

Peripheral

Question 15

Acute alcohol intoxication leads to peripheral or central vertigo?

Answer 15

Peripheral

Question 16

Meningitis leads to peripheral or central vertigo?

Answer 16

Central

Question 17

Migraine headaches leads to peripheral or central vertigo?

Answer 17

Central

Question 18

Cerebellar degeneration disorders (alcoholism) leads to peripheral or central vertigo?

Answer 18

Central

Question 19

Multiple sclerosis leads to peripheral or central vertigo?

Answer 19

Central

Question 20

Congenital nystagmus

Answer 20

Typically mild and does not change in severity over lifetime

Question 21

Spontaneous nystagmus (acquired)

Answer 21

Caused by imbalance of vestibular signals to oculomotor neurons that causes a constant drift in one direction that is countered by a quick movement in opposite direction. Usually occurs after acute vestibular lesion and will last approximately 24 hours.

Question 22

Peripheral nystagmus (acquired)

Answer 22

Occurs with peripheral vestibular lesion and is inhibited when pt fixates vision on an object.

Question 23

Central nystagmus (acquired)

Answer 23

Occurs with a central lesion of the brainstem/cerebellum and not inhibited when pt fixates vision on object

Question 24

Positional nystagmus (acquired)

Answer 24

Induced by change in head position, usually stimulated by semicircular canals.

Question 25

Gaze-evoked nystagmus (acquired)

Answer 25

Occurs when eyes shift from one position to another. Caused by inability to maintain stable gaze position. Usually indicates CNS pathology and associated with brain injury and MS.

Question 26

Peripheral nystagmus direction

Answer 26

Unidirectional with fast segment of movement indicating the opposite direction of lesion

Question 27

Central nystagmus direction

Answer 27

Unidirectional or bidirectional

Question 28

Peripheral nystagmus with visual fixation

Answer 28

Inhibition of nystagmus and vertigo

Question 29

Central nystagmus with visual fixation

Answer 29

No inhibition with fixation

Question 30

Peripheral nystagmus length of symptoms

Answer 30

Minutes, days, or weeks but recurrent

Question 31

Central nystagmus length of symptoms

Answer 31

May be chronic

Question 32

Berg Balance Scale

Answer 32

Assesses fall risk using 14 tasks. Score of 45/56 indicates increased fall risk.

Question 33

Fregly-Graybiel Ataxia Test Battery

Answer 33

Consists of 8 test conditions focused on balance. Each condition graded as pass/fail with normative data for comparison. Suited for patients with high level motor skills.

Question 34

Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery

Answer 34

Assesses balance for patients with hemiplegia. Each of 7 items scored from 0-2, with 2 being a better score.

Question 35

Functional Reach Test

Answer 35

Assesses standing balance and fall risk. 3 trials are performed and averaged.

Question 36

Romberg Test

Answer 36

Assesses balance and ataxia. Balancing with feet together and eyes opened followed by eyes closed for 30 seconds each. Somatosensory or vestibular system may be affected when visual system is taken out for balance. If pt demonstrates ataxia and has a positive Romberg Test, this indicates sensory ataxia and not cerebellar ataxia.

Question 37

Timed Up and Go Test

Answer 37

Assesses person’s level of mobility and balance. 10 seconds indicates independence, 20 seconds indicates limited functional independence and increased fall risk, 30 seconds indicates high fall risk.

Question 38

Tinetti Performance Oriented Mobility Assessment

Answer 38

Assesses balance and gait. Score of 19/28 indicates high fall risk.