Balance And Fall Risk

Question 1

When people fall, 20% to 30% sustain what kind of injuries?

Answer 1

moderate to severe injuries such as hip fractures or head trauma

Question 2

What do injuries caused by falls cause?

Answer 2

reduce their mobility & independence & increase their risk for premature death

Question 3

What is balance?

Answer 3

the ability to locate & maintain one’s center of gravity (COG) within or over one’s base of support (BOS)

Question 4

What can a lack or dysfunction of any type or component of postural control do?

Answer 4

A lack or dysfunction of any type or component of
postural control can hinder a person’s ability to
meet particular task demands & increase the risk
of falling

Question 5

What are causes of balance dysfunction?

Answer 5

Muscle weakness, skeletal asymmetry or joint
dysfunction can impair balance & increase the risk
of falling

Question 6

What is the dynamic equilibrium theory?

Answer 6

sensory & motor

systems interact to control equilibrium

Question 7

What are some peripheral sensory impairments?

Answer 7

– Visual pathologies such as glaucoma, macular
degeneration or diplopia can increase risk of falls
& impair balance
– Problems with oculomotor functions can interfere
with orientation to the environment

Question 8

What is conjugate?

Answer 8

eyes move at the same time to follow object moving across visual field

Question 9

What is smooth pursuit?

Answer 9

eyes move to follow image whether head or image is moving, or both

Question 10

What are saccades?

Answer 10

quick recovery phase to resume smooth pursuit after eyes slip off an image during head or image movement, or both; function of the VOR

Question 11

What is nystagmus?

Answer 11

multiple slow movements of eyes interspersed rhythmically by quick recovery phases; normal if noted at ends of ranges of eye movements and after spinning (for a few seconds)

Question 12

What are the roles of the vestibular system?

Answer 12

• Sensing & perceiving self-motion
• Orienting to vertical
• Controlling the center of mass
• Stabilizing the head

Question 13

What do central components of the vestibular system do?

Answer 13

receive information from the peripheral
components & send information to the reticular
formation, which facilitates arousal & motor
responses

Question 14

What does the vestibular system do?

Answer 14

• Orient the head & body to vertical
• Activate antigravity muscles & automatic postural
responses to control the stability of the head & the
body’s center of mass

Question 15

What can disease or trauma do to sensory?

Answer 15

impair peripheral sensory

receptor & sensory nerve function

Question 16

What are central sensory impairments?

Answer 16

CNS disease, such as stroke, multiple sclerosis,
cerebral palsy or brain tumors, as well as trauma,
can adversely affect central sensory processing

Question 17

Why is the CNS needed?

Answer 17

because
information from a single system does not
distinguish specific movements & positions

Question 18

When is central processing important?

Answer 18

when there are
sensory conflicts within or between sensory
systems

Question 19

When can sensory conflict be triggered?

Answer 19

by walking on
stairs, escalators, uneven ground, dimly lit, or
overly bright areas

Question 20

What does ankle strategy do?

Answer 20

Ankle strategy to prevent falls primarily controls

body sway during stance

Question 21

What does hip strategy do?

Answer 21

Hip strategy to prevent falls is used when COG

shifts quickly/unexpectedly over BOS

Question 22

What does stepping strategy do?

Answer 22

Stepping strategy initiates establishment of a new
BOS when the boundaries of stability are
exceeded or even approached

Question 23

What does the peripheral motor system do?

Answer 23

executes all of the

movements required for postural control

Question 24

What are central motor impairments?

Answer 24

– Disorders that affect areas of the CNS that control
motor output can cause difficulties with motor
control
– Static, anticipatory, adaptive, & reactive postural
control & balance are affected

Question 25

What are cognitive impairments?

Answer 25

Individuals who have had a stroke, head injury, multifocal cerebral infarcts, tumors, or dementia may have significant changes in cognition that can increase their risk of falling

Question 26

What is the impact of poor balance and limited postural control on gait?

Answer 26

Many older adults use hip strategies rather than ankle strategies & walk more slowly to improve accuracy during gait

Question 27

What are some neurological disorders that affect balance?

Answer 27

Parkinson's disease, cerebellar degeneration, stroke or head trauma, multiple sclerosis, and multisensory disequilibrium

Question 28

What is Parkinson's disease?

Answer 28

Parkinson's disease characterized by tremors, rigidity, flexed or forward posture, slowing of movements, or bradykinesia

Question 29

What is cerebellar degeneration?

Answer 29

Cerebellar degeneration lead to ataxia & dysmetria decrease the effectiveness of balance strategies & impair oculomotor control

Question 30

What does stroke or head trauma affect?

Answer 30

Stroke or head trauma leads to falls & loss of balance due to paresis, sensory loss, visual field defects, or impaired spatial perception

Question 31

What does multiple sclerosis affect?

Answer 31

Multiple sclerosis affects balance by impairing function in multiple locations of the brain & spinal cord

Question 32

What is multisensory disequilibrium?

Answer 32

Multisensory disequilibrium refers to combined dysfunction of the vestibular, visual, & somatosensory systems

Question 33

What kind of history would the PT ask for?

Answer 33

– Fall history: including number, time & circumstances of any falls – Type & overall number of medications – A number of targeted standardized self-report questionnaires concerning balance & fall history – Complaints of imbalance, dizziness, vertigo, oscillopsia, nausea &/or vomiting, diminished strength, sensation changes, hearing loss, tinnitus, or vision changes

Question 34

What kind of musculoskeletal tests and measures would be done for balance?

Answer 34

* Standing posture * Joint range of motion * Muscle strength

Question 35

What kind of neuromuscular tests and measures would be done for balance?

Answer 35

* Arousal & cognition * Cranial nerve function, particularly as it relates to the vestibular nerve (Hallpike-Dix & head thrust tests) * Cerebellar screening & equilibrium testing * Specific tests of sensory integration or sensory organization * Peripheral nerve integrity * Motor function - control & learning

Question 36

What are some flexibility exercises?

Answer 36

Increase ROM in patients with limited ROM & | consequent poor balance

Question 37

What kind of strength training would be done?

Answer 37

Usually focus on the lower extremities, | particularly the ankle & hip muscles

Question 38

What kind of sensory training or retraining would be done?

Answer 38

Intended to optimize the function of the visual, vestibular, & proprioceptive sensory systems to enhance delivery of information to the CNS where it can be integrated & processed, & then used to control balance

Question 39

What kind of perceptual training would be done?

Answer 39

Focuses on integrating all sensory information relevant to certain environmental conditions, particularly vertical orientation relative to gravity & surface orientation relative to the BOS

Question 40

What kind of postural awareness training would be done?

Answer 40

Includes COG training & postural strategy training, which focus on attaining & regaining an upright posture

Question 41

What kind of task-specific locomotion training would be done?

Answer 41

Balance during gait can be made more challenging by increasing its speed, number of stops & starts, variation of surfaces, & closing the eyes

Question 42

What is vestibular rehabilitation?

Answer 42

Widely used in the management of patients with disequilibrium, dizziness, a history of loss of balance or falls, & gait instability caused by peripheral or central vestibular dysfunction

Question 43

What is the progression of gaze stabilization exercises?

Answer 43

– Start with a simple target, patient moves head in direction that is easiest to focus – Using two targets patient focuses on one with eyes & head aligned then moves eyes to other without moving head – Habituation exercises involve repeated exposure to a symptom-causing stimulus or movement to reduce the pathological response to that movement

Question 44

What would be included in multidimensional or multifactorial training?

Answer 44

– Normally include gait training, strengthening programs, balance training, training in appropriate assistive device use, review of health management – Normally include environmental assessment or modification, including a home safety evaluation & patient &/or caregiver education regarding fall risk

Question 45

What would the PTA teach the patient about safety?

Answer 45

– Teach patients to stop, hold onto a stable surface, & refocus if they feel dizzy or unbalanced – When turning, they should move their eyes first, focus, & then turn their head & body to help minimize dizziness

Question 46

What are the most important considerations when making home modifications?

Answer 46

Most important considerations in making home modifications to reduce falls are modifications of surfaces, lighting, obstacles, & activity in the home

Question 47

What are some ongoing assessment tools?

Answer 47

``` – Tinetti's Performance - Oriented Mobility Assessment (POMA) – The Dynamic Gait Index (DGI) – The Timed Up & Go (TUG) test – The Berg Balance Scale (BBS) – The Functional Reach Test (FRT) – The Physical Performance Test (PPT) ```

Question 48

what is convergence?

Answer 48

eyes move toward each other to follow object approaching face head-on