Balance Evaluation and Treatment Flashcards
(27 cards)
postural control
control body position in space to maintain COM over BOS
sensory system aware over relationship between body segments and environment
systems making up postural control
sensory systems/strategies
neuromuscular synergies
musculoskeletal
eye head coordination
adaptive mechanisms - safety response to perturbations
anticipatory mechanisms
MSK attributes affecting posture control
ROM, esp ankles for ankle strategy
muscle tone/strength
postural tone
postural alignment for body’s equilibrium/energy efficient
ankle strategy
used in normal stance or slight uneven surfaces
gastroc, hamstring
forward push or backwards surface movement turns on gastroc (+ hamstrings and paraspinals)
backwards push or forward surface movement turns on ant tib (+quads and abdominals)
hip strategy
used on narrow/unstable surface, incline, larger perturbations
backwards sway: hamstrings and paraspinals bring hips into extension/forward to counteract
forward sway: abdominals and quads flex to bring hips back
how are neuromuscular synergies used in postural control?
used in ankle and hip strategies to activate a group of muscles all at once in response to a perturbation to correct COM
stepping strategy
used when COM outside BOS with large perturbation
abnormal eye movements effect on postural control
poor vision affects balance by lack of depth perception, not focusing on objects in environment, etc
nystagmus
eyes move to side with rapid movement to midline to correct
abnormal saccade
inability of eyes to maintain focus with the head moving
diploplia
double vision
sensory inputs on postural control
visual: head position, motion, verticality
somatosensory: body position/movement
vestibular: position, movement w respect to gravity
attention’s affect on balance and postural control
pt not understanding task or not focusing on objects in environment can create fall risk
maintaining balance is no longer automatic, taking up some of their attention
normal anticipatory control
pt’s ability to anticipate displacements based on exp, practice, knowledge of body constraints
postural muscles should prepare ms before movement and reoccur after movement to make adjustments
treatment to address impaired ankle strategy
balance board
AP to touch toes/heels to ground
hold in middle
med/lat w stepping motion
What should be included in balance assessment?
functional measure of skills eg BERG, tinetti, TUG
sensory assessment
assess balance strategies through observation
test for sensory/motor/cognitive impairments ww ROM, strength, sensory, cognitive testing
CTSIB
functional reach
purpose: screen balance problems
pt is able to move COM in BOS
test: arms flexed to 90, subjects reaches forward as far as possible without moving feet or losing balance, measure from middle finger
functional reach norms
20-40: M 17, W 15
41-69: M 15, W 14
70-87: M 13, W 10
15-25 cm 2x fall risk
below 15 cm 4x fall risk
no reach 8x fall risk
tinetti/POMA
purpose: screen balance/mobility in ADLs, older adults, determine fall risk
2 part test, 9 balance items 7 gait items scores 0-2
AD ok but reduce grade
fall predictive validity of tinetti
max score=28
mod fall risk - 19-24
high fall tisk - <19 or <14 balance
better sensitivity than BERG/TUG
BERG
purpose: screen fall risk
test: 14 items, AD not allowed
BERG predictive validity
<48 - benefit from PTT
<45 - risk of multiple falls
<36 - 100% risk of falls
correlated with functional reach
best predictor of falls in elderly, for PD, acute stroke
TUG
purpose: quick screen of functional mobility
test: rise from chair, walk 3m, turn 180 degrees, return to sitting
timed and rated 1-5
1 practice and 2 timed, take average
can also add cognitive load or manual task
predictive validity TUG
<10-12s normal
> 14s indicates falls
>20s frail, lacks functional independence
>30s, dependence
