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NeuroPT 1 > Balance: Exam 1 > Flashcards

Balance: Exam 1 Flashcards

1
Q

Balance is controlling ______ OVER ________ in ANY GIVEN SENSORY ENVIRONMENT

A

COG over BOS

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2
Q

Motor plans are ___________

A

Goal driven!!!

“where do I want to be?”

“What do I want to do?”

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3
Q

NORMAL execution req’s these things

A
  • ROM
  • strength/endurance
    • feet
    • ankles
    • hips
    • trunk
    • neck
    • eyes
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4
Q

Balance is common among MANY dx’s

Is knowing the dx important?

ex’s

A
  • MS
    • progressive
  • TBI
    • one time thing
  • cerebellar strokes vs. peripheral vestib dysf.
    • these can be similar dysf’s
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5
Q

Balance and the ICF model

A
  • body structure/function
    • balance contributes to a LARGER scale!!!
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6
Q

Terms involved w/ Balance

A

COG

BOS

Limits of Stability—how far can they go w/out feeling unstable?

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7
Q

COG

*where avg mass is loc’d*

A

pt @ which ALL wt of object can be considered concentrated

normal or avg loc?

see pics

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8
Q

When COG is IN BOS====>

A

Stability

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9
Q

BOS

*think surface

A

Surface that experiences pressure as the result of weight and gravity, and the area contained therein

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10
Q

Limit of Stability or

LOS

farthest dist a person can what?

A
  • Farthest dist. in any direction a person can lean (away from midline) w/out altering original BOS by stepping, reaching or falling

Pt @ which you cannot catch balance w/out moving feet or re-positioning

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11
Q

What direction is usually the furthest LOS?

A

FRONT

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12
Q

3 VARIABLES that affect balance

A
  1. surface cond’s
  2. visual envir’s
  3. Intentions/task choice
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13
Q

Demands of the system

NOTE: fluctuate continuously, producing CHANGING DEMANDS on the systems that control balance

A
  • Loc. of COG, BOS, LOS
  • surf cond’s
  • visual envir’s
  • intentions/task choices
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14
Q

Sensory Systems:

Peripheral (3 components)

A
  1. Somatosensory
  2. Visual
  3. Vestibular
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15
Q

Sensory Systems

Central (3 components)

A
  • compares sides body + diff sensory modalities
  • integrates sensory info
    • compares 3 sensory comps
  • resolution of sensory conflict
    • NOTE: motion sickness is an INABILITY to resolve this conflict
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16
Q

Somatosensation is made up of….

A

proprio

kinesthesia

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17
Q

Somatosensation comes from your what?

A

joints

ligs

mm’s

skin

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18
Q

Somatosensation provides info about mm _________ and joint__________

A

mm length, stretch,

joint pos. and pressure

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19
Q

2 roles of vision:

A

Central (focal)

Peripheral (ambient) or perception of mvmt

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20
Q

2 components of Central vision (Focal)

A
  • environment orientation and perception of verticality
  • obstacle motion and avoidance
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21
Q

Peripheral vision of ambient

PERCEPTION OF MVMT

detects what?

A
  • detects motion of SELF in relation to the environment
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22
Q

Vestibular

provides info regarding what and during what?

A
  • regarding:
    • head pos. in relation to gravity
  • during:
    • linear and rotary mvmt
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23
Q

This type of perception compares input w/ 3 systems:

*NOTE: brain performs BEST w/ input from ALL systems

A

Central Sensory perception

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24
Q

Central Sensory perception

Conflict

A
  • brain recognizes these “discrepancies” and selects the BEST input
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25
Q

Central Sensory Perception

Unresolved sensory conflict

A

impaired balance

dizziness

nausea

vomiting

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26
Q

Remember the Systems Model !!!

A

see pics

Balance===result of interactions b/w individual, task, environment that you perform the task in

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27
Q

The Systems model

what is the cycle driven by?

A
  • purposeful choices of the indiv. and demands placed ON the indiv. by the environment
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28
Q

Systems Model for Balance

*remember the basics—–>

Plan—-> Execution

A

see pics

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29
Q

Motor Planning and Execution

Consists of Reflexes and 3 diff. types of postural responses

A
  1. Automatic
  2. Anticipatory
  3. Volitional

*ALL dependent on task/goal

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30
Q

VOR and VSR contribute to orientation of:

A

eyes

head

body

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31
Q

VOR

what does it do and what is the input vs. output

A

INPUT: vestibular

OUTPUT: ocular

aligns head in pos. while the eyes are moving

***remember hockey game ex. Dr. Najeeb

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32
Q

VSR

what does it do and what is the input vs. output

A

INPUT: vestibular

OUTPUT: spinal

maintains posture (spinal) in resp. to same input (vestibular)

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33
Q

AUTOMATIC Postural Resp’s

A
  • Righting rxns
  • postural/balance strats.
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34
Q

“Righting” Rxns aka

A

straightening things out

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35
Q

Righting rxns

*remember…..this is like when someone is talking to you so you turn your head to see them and the body stays facing one way….but then eventually we turn our whole body that way as a righting rxn

A

Orientation of the head and trunk

fixing our body to match where our gaze is going!!!

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36
Q

3 types of Righting

A
  • Optical and Labyrinthine righting
    • labyrinthine==inner ear
  • Body-on-head righting
    • head/body alignment
  • Body-on-body righting
    • upper/lower body alignment

**ALL keep head/neck UPRIGHT relative to ground

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37
Q

Optical & Labyrinthine Righting

A
  • Vestib tells us which way gravity pulling
  • VIS + VESTIB===checks body tilt, keeps eyes in line w/ horizon
    • so if we are tilted or leaning over, it keeps our eyes in line w/ horizon
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38
Q

Auto. Postural Responses are NOT

A

quick reflexes

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39
Q

Automatic postural resp’s are NOT under________

A

volitional control

they are Reactive

40
Q

Operate to keep the COG over BOS

A

auto. postural resp’s

41
Q

Auto. Postural Resp’s

used w/ perturbations

how?

A

functionally organized to match amplitude and direction of stimulus

42
Q

Four diff. types of “Strategies”

A
  • Ankle
  • Hip
  • Suspensory
  • Stepping
43
Q

Ankle strategy —->

where is the motion?

A

body moves as a unit over FEET

motion @ ankle

44
Q

W/ the ankle strategy

how do the mm’s contract? from where to where?

A

Distally to Proximally

45
Q

Ankle strategy used when?

A

sway is small, slow, near midline

46
Q

When the ankle strategy fails….

A

Hip Strategy!!!

Proximal response !!!

47
Q

hip strategy controlled from…

A

pelvis and trunk

48
Q

W/ the Hip strategy….

the head and hips move in________

A

OPPOSITE directions

49
Q

mm contract. direction Hip Strategy….

from where to where

A

Prox. to dist.

50
Q

WHEN is hip strategy used?

A

Sway is lg, fast, nearing LOS

51
Q

Suspensory strategy ex.

A

surfing

*short-squat or lowering COG*

52
Q

Suspensory Strategy

lowering COG

A

lowering COG TOWARDS BOS via B/L LE flex or “short-squatting”

53
Q

Suspensory strategy

Shortening the dist. b/w COG and BOS allows what?

A

easier control of COG

54
Q

Suspensory Strategy is most often used during a combo of what and what?

A

Combo of stability and mobility

ex. surfing, snowboarding

ALLOWS FOR MOBILITY

55
Q

SUSPENSORY STRATEGY

A

SEE PICS

remember lowering COG toward BOS

stability + mobility

56
Q

Stepping Strategy

*reestablishing NEW BOS

A

reestablish BOS when COG moves OUTSIDE orig. BOS

stepping to catch yourself

57
Q

Anticipatory postural responses

exactly what it sounds like

A
  • occurs BEFORE disturbance
  • disturbance is PREDICTED
  • develop a “postural set”
    • ​you get “set” before disturbance
58
Q

Volitional means….

A

under conscious control

59
Q

Volitional postural responses

A

under conscious control

ex. wt. shifting during reaching

60
Q

Volitional postural mvmts are under _________ control

A

conscious

61
Q

Volitional postural mvmts are ____________ to accomplish a goal

A

self-initiated

62
Q

volitional postural mvmts range from ____to _____

A

simple to complex

63
Q

W/ Volitional postural mvmts….

the more familiar the task…… the ________

A

shorter the response time!!!

well rehearsed====easier to react

64
Q

Objective Testing of Balance:

A
  • Purpose?
  • Choosing a test…
    • functional?
    • valid/reliable?
    • time to admin?
    • static or dynamic balance?
  • Interpret results:
    • consider ALL systems!
65
Q

Quiet Standing:

Romberg Test

A

client stands w/ feet parallel and together

THEN close eyes 20-30s

66
Q

Sharpened Romberg

A

Tandem 60s

NOTE: documenting Romberg tests==> how long they hold, any marked postural sway

67
Q

Quiet Standing

One Legged Standing

can be SOLEO, SOLEC

A

hip==neutral

knee==flex 90

Five 30s trials/leg

68
Q

Quiet Standing

Postural Sway

A

use of force plate or other measuring device

69
Q

Quiet Standing:

Nude-Push

*can vary b/w testers

*NOT reliable

*qualitative

A
  • automatic resp. to unpredictable perturbations
  • Backwards @ sternum/pelvis
  • forwads b/w shoulder blades/pelvis

“don’t let me push you” ======> judging of anticipatory postural control

70
Q

Quiet Standing:

Motor Control Response Test

A
  • perturbs client thru surf. displacement
  • client stands on movable footplate, surface rotates toes up or down, translates forward or backward
71
Q

Quiet Standing

Postural Stress Test

*basically a Quantifiable, repeatable nudge/push test*

A
  • waist belt attached to pulleys w/ wts
  • wts are dropped from standard hts
72
Q

CTSIB or

A

Clinical Test of Sensory Integration and Balance

73
Q

CTIS aka

A

Fome and Dome

74
Q

CTSIB

A

Tests balance under a number of cond’s

  • firm vs. soft surface
  • eyes open vs. eyes closed vs. conflicting vis. info (remember the lined paper)
  • 5 reps 30s for ea. cond.
75
Q

CTSIB can help determine which sensory system is responsible for balance dysfunction how?

A
  • reducing impact of sensory systems
76
Q

CTSIB ex’s

A

see pics

77
Q

CTSIB

The conditions

A

The conditions and results explained

CTSIB

78
Q

CTSIB

The conditions

A

The results/Cond’s explained

79
Q

CTSIB

A

Easy chart

80
Q

Sensory Organization Test

*similar to CTSIB

A

computerized moveable force plate + movable vis. surrounds alter surf/vis environ.

81
Q

Sensory Integration Test

A

Three 20s trials under 6 cond’s

Cond’s 1,2,3—FIXED surf.

Cond’s 4, 5, 6—SWAY REF’D 1:1 (moves when you sway)

82
Q

Balance Error Scoring System

BESS

*the one where we count the # of errors you make

A
  • closed, single, tandem stance
  • firm or soft surf
  • EYES CLOSED FOR ALL TESTS
  • count errors during 20s test pd
    • hands lifted off illiac C.
    • opening eyes
    • step, stumble, fall
    • moving hip into >30deg ABD
    • lifting forefoot/heal
    • remaining out of test pos. >5s
83
Q

Functional Scales for Balance Tests include….

A

Functional Reach

TUG

Berg

Dynamic Gait Index

Tinetti

BESTest/Mini-BESTest

84
Q

Functional reach test

A
  • Functional perform. measure
  • <10” ====high risk falls
  • reliable/valid
    • ​no ceiling
  • mods?
    • ​sitting
    • multi-directional
85
Q

TUG test

A

PT times pt up from chair, walk 10’ turn sit

4x—-avg them out

<13.5s===elevated fall risk

TUG-cognitive===serial 7’s

TUG-manual====hold cup w/ water (dual tasking)

reliable/valid==no ceiling

86
Q

Berg Balance Test

A
  • 14 items
  • 56=normal
  • <42===very high fall risk
  • reliable/valid
    • ceiling effect

*NOTE: score of = 49/56 w/ + hx falls was found to be MOST SENSITIVE measure of falls prediction in community-dwelling older adults

87
Q

Mini-BESTest

A

SHORT version Balance Equilibrium Systems Test (BEST)

14 items (0-2) that examine anticipatory and reactive postural control, sensory orientation and dynamic gait

88
Q

Self Report Scales: Balance

Activities-specific Balance Confidence Scale (ABC)

A
  • questionnaire about confidence in performing variety of typ. acs—-scored out of 100
  • total/16 for # out of 0 to 100
89
Q

Clinical Decision Making w/ Balance Examination

A

ID problems

set GOALS —-objective assess.

Tx Planning—-balance practice

use Motor Learning concepts—–indiv, task, environment

90
Q

Tx for balance

based off of everything we talked about!!!

A
  • sitting balance
    • static
    • dynamic
  • sit-stand transfers
    • transitional balance
  • standing
    • static
    • dynamic
  • strategy training
    • ankle, hip, standing, suspensory
  • gait training
    • CLOSE prox. w/ balance training
91
Q

Considerations w/ Balance training

A
  • Tx tools
  • safety edu./environ. mods
    • rails in shower
    • lighting
    • railing
    • preventing wall walking—-EXACTLY WHAT IT SOUNDS LIKE
    • ​throw rugs
  • HEP
92
Q

Interventions for Balance

A

manip envir.

task specific

adjust to stage of learning

manip amt of sensory info

work for control of COG in all planes

train specific strategies

93
Q

Interventions for Balance

High tech:

A

force plates, balance master, EMG biofeedback, video, TM

94
Q

Interventions: Balance

Low Tech

A

rocker board, swiss ball, trampoline, foam, wedges, foarm rollers

95
Q

Interventions for balance training

A

PUSH THEM TO LIMITS OF ABILITY!!!

This is the ONLY WAY TO IMPROVE!!!

YOU NEED TO REMEMBER THIS TOO!!!

YOU FUCKING GOT THIS!!!!

NeuroPT 1 (7 decks)

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