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NeuroPT 1 > Balance: Exam 1 > Flashcards

Balance: Exam 1 Flashcards

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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
Central Sensory Perception ## Footnote **Unresolved sensory conflict**
impaired balance dizziness nausea vomiting
26
Remember the Systems Model !!!
see pics Balance===result of interactions b/w **individual, task, environment that you perform the task in**
27
The Systems model what is the cycle driven by?
* **purposeful choices** of the indiv. and **demands** placed ON the indiv. by the **environment**
28
Systems Model for Balance \*remember the basics-----\> Plan----\> Execution
see pics
29
Motor Planning and Execution Consists of **Reflexes** and 3 diff. types of **postural responses**
1. Automatic 2. Anticipatory 3. Volitional \***ALL dependent on task/goal**
30
VOR and VSR contribute to **orientation of:**
eyes head body
31
VOR what does it do and what is the **input vs. output**
INPUT: vestibular OUTPUT: ocular **aligns head in pos. while the eyes are moving** **\*\*\*remember hockey game ex. Dr. Najeeb**
32
VSR what does it do and what is the **input vs. output**
INPUT: vestibular OUTPUT: spinal maintains **posture (spinal) in resp. to same input (vestibular)**
33
AUTOMATIC Postural Resp's
* Righting rxns * postural/balance strats.
34
"Righting" Rxns aka
straightening things out
35
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**
Orientation of the head and trunk fixing our body to match where our gaze is going!!!
36
3 types of Righting
* 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**
37
Optical & Labyrinthine Righting
* 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
38
Auto. Postural Responses are NOT
quick reflexes
39
Automatic postural resp's are NOT under\_\_\_\_\_\_\_\_
volitional control ## Footnote **they are Reactive**
40
Operate to keep the COG over BOS
auto. postural resp's
41
Auto. Postural Resp's used w/ **perturbations** **how?**
functionally organized to match **amplitude** and **direction** of stimulus
42
Four diff. types of **"Strategies"**
* Ankle * Hip * Suspensory * Stepping
43
Ankle strategy ----\> where is the motion?
body moves as a unit over FEET motion @ ankle
44
W/ the ankle strategy how do the mm's contract? from where to where?
Distally to Proximally
45
Ankle strategy used when?
sway is small, slow, near midline
46
When the **ankle strategy fails....**
Hip Strategy!!! ## Footnote **Proximal response !!!**
47
hip strategy controlled from...
pelvis and trunk
48
W/ the Hip strategy.... the **head and hips** move in\_\_\_\_\_\_\_\_
OPPOSITE directions
49
mm contract. direction Hip Strategy.... from where to where
Prox. to dist.
50
WHEN is hip strategy used?
Sway is lg, fast, nearing LOS
51
Suspensory strategy ex.
surfing \*short-squat or **lowering COG\***
52
Suspensory Strategy lowering COG
lowering COG TOWARDS BOS via **B/L LE** flex or "short-squatting"
53
Suspensory strategy Shortening the dist. b/w COG and BOS allows what?
easier control of COG
54
Suspensory Strategy is most often used during a combo of what and what?
Combo of **stability** and **mobility** **ex. surfing, snowboarding** **ALLOWS FOR MOBILITY**
55
SUSPENSORY STRATEGY
SEE PICS remember lowering COG toward BOS stability + mobility
56
Stepping Strategy \*reestablishing NEW BOS
reestablish BOS when COG **moves OUTSIDE orig. BOS** ## Footnote **stepping to catch yourself**
57
Anticipatory postural responses exactly what it sounds like
* occurs BEFORE disturbance * disturbance is PREDICTED * develop a "**postural set"** * **​you get "set" before disturbance**
58
Volitional means....
under **conscious control**
59
Volitional postural responses
under **conscious control** **ex. wt. shifting during reaching**
60
Volitional postural mvmts are under _________ control
conscious
61
Volitional postural mvmts are ____________ to **accomplish a goal**
self-initiated
62
volitional postural mvmts range from \_\_\_\_to \_\_\_\_\_
simple to complex
63
W/ Volitional postural mvmts.... the more familiar the task...... the \_\_\_\_\_\_\_\_
shorter the response time!!! ## Footnote **well rehearsed====easier to react**
64
Objective Testing of Balance:
* Purpose? * Choosing a test... * functional? * valid/reliable? * time to admin? * static or dynamic balance? * Interpret results: * consider ALL systems!
65
Quiet Standing: Romberg Test
client stands w/ feet parallel and together THEN close eyes 20-30s
66
Sharpened Romberg
Tandem 60s NOTE: documenting Romberg tests==\> **how long they hold, any marked postural sway**
67
Quiet Standing One Legged Standing can be SOLEO, SOLEC
hip==neutral knee==flex 90 Five 30s trials/leg
68
Quiet Standing Postural Sway
use of force plate or other measuring device
69
Quiet Standing: **Nude-Push** \*can vary b/w testers \*NOT reliable \*qualitative
* 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
Quiet Standing: ## Footnote **Motor Control Response Test**
* **perturbs** client thru **surf. displacement** * client stands on **movable footplate, surface rotates toes up or down, translates forward or backward**
71
Quiet Standing ## Footnote **Postural Stress Test** **\*basically a Quantifiable, repeatable nudge/push test\***
* waist belt attached to pulleys w/ wts * wts are dropped from standard hts
72
CTSIB or
Clinical Test of Sensory Integration and Balance
73
CTIS aka
Fome and Dome
74
CTSIB
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
CTSIB can help determine **which sensory system** is responsible for balance dysfunction how?
* reducing impact of sensory systems
76
CTSIB ex's
see pics
77
CTSIB ## Footnote **The conditions**
The conditions and results explained CTSIB
78
CTSIB The conditions
The results/Cond's explained
79
CTSIB
Easy chart
80
Sensory Organization Test \*similar to CTSIB
computerized moveable force plate + movable vis. surrounds alter surf/vis environ.
81
Sensory Integration Test
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
Balance Error Scoring System BESS \*the one where we count the # of errors you make
* 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
Functional Scales for Balance Tests include....
Functional Reach TUG Berg Dynamic Gait Index Tinetti BESTest/Mini-BESTest
84
Functional reach test
* **Functional perform. measure** * **\<10" ====high risk falls** * **reliable/valid** * **​no ceiling** * **mods?** * **​sitting** * **multi-directional**
85
TUG test
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
Berg Balance Test
* 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
Mini-BESTest
SHORT version Balance Equilibrium Systems Test (BEST) 14 items (0-2) that examine **anticipatory and reactive postural control, sensory orientation and dynamic gait**
88
Self Report Scales: Balance ## Footnote **Activities-specific Balance Confidence Scale (ABC)**
* questionnaire about confidence in performing variety of typ. acs----scored out of 100 * total/16 for # out of 0 to 100
89
Clinical Decision Making w/ Balance Examination
ID problems set GOALS ----objective assess. Tx Planning----balance practice use **Motor Learning concepts-----indiv, task, environment**
90
Tx for balance based off of everything we talked about!!!
* 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
Considerations w/ Balance training
* Tx tools * safety edu./environ. mods * rails in shower * lighting * railing * **preventing wall walking----EXACTLY WHAT IT SOUNDS LIKE** * **​throw rugs** * **HEP**
92
Interventions for Balance
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
Interventions for Balance ## Footnote **High tech:**
force plates, balance master, EMG biofeedback, video, TM
94
Interventions: Balance ## Footnote **Low Tech**
rocker board, swiss ball, trampoline, foam, wedges, foarm rollers
95
Interventions for balance training
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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