Balance Measures and Postural Control Flashcards

(55 cards)

1
Q

Postural Control

A

Stability and orientation of the body in space

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2
Q

Postural Orientation

A

Maintain the body in alignment and in relationship to the environment for a task

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3
Q

Postural Stability or Balance

A

Ability to maintain state of equilibrium/stability

Control the COM in relationship to the base of support –> static, synamic

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4
Q

Postural control, orientation, stability require

A

integration of sensory information and generation of forces to control the body position

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5
Q

Reflex Hierarchical Theory - Attitudinal Reflexes

A

Produce persisting changes in body posture due to change in the head position
Assymetric Tonic Neck Reflex - baby head and arm reach
STNR - head flex and then extend - weight shift
TLR

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6
Q

Reflex Hierarchical Theory - Righting Reactions

A

Orient head in space and orient the body in relationship to the head and the ground
Ability to keep eyes on the horizon
Optical righting, Labyrinthine (even if you blindfold will still get head righting cuz of this reflex), NOB, BOB

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7
Q

Reflex Hierarchical Theory - Equilibrium Reactions

A

Tilting, postural fixation to perturbations, and protective extension

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8
Q

Dynamic Systems Theory

A

Interaction of multiple systems
Individual = neural (somatosensory, vision, vestibular), musculoskeletal, cognitive
Task
Environment (surface, windy..)

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9
Q

Development of postural control - Head control

A

Cephalo-Caudal

Orient first to visual stimuli and improves as strength inc and vestibular system develops and matures

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10
Q

Development of postural control - Sitting

A

Coordinate head control with trunk
Develop synergistic patterns of control
Once ind sitting, then feed forward in trunk is seen prior to UE movement

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11
Q

Development of Postural Control

A

Rely on visual input for balance initially and later somatosensory inputs (4-8 years old)

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12
Q

Development of Postural Control - Stance

A

Need to control additional DOF and COM within base of support

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13
Q

Development of stance postural control

A

LE force production greater than body weight at 6 months
Progression distal to proximal with ankle strategy first
Development constrained by neural maturation
All strategies by 7-10 y/o
Amplitude and velocity of sway reaches adult levels at 12-15 y/o

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14
Q

Postural control with aging - older adults

A

sensory changes –> dec vision, dec vestibular responses, inc threshold for cutaneous and proprioceptive receptors

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15
Q

Postural control with aging - older adult sensory changes result in

A

Dec reaction time due to timing and force production changes
Slowed righting and equilibrium reactions
Increase in postural sway

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16
Q

Methods to maintain postural control

A
  1. Maintain static balance/posture against perturbation (steady state)
  2. Feed forward in preparation for movement (anticipatory)
  3. Recovery from perturbation (reactive)
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17
Q

Move the BOS under a moving COM

A

Stepping strategy (LE)

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18
Q

Widen the BOS and lower the COM

A

protective extension (UE)

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19
Q

Lowering the COM toward the BOS

A

suspensory strategy

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20
Q

Body Structure Impairments of girl with ankle sprain

A

Dec ROM, proprioception, force production, balance

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21
Q

Activity impairments for girl with ankle sprain

A

Difficulty with advanced gait and running, driving, assuming stance from chair or toilet
standing in line in cafeteria

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22
Q

Participation limitations: Disability for girl with ankle sprain

A

Participate as team member for volleyball
Dec ability to meet friends for social activities
Impact as a student in PE class and getting to classes on time in high school

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23
Q

Exam and Assessment

A

Safety first - HEP need to be careful of them being alone - back them into a wall or something, educate on getting up in case

24
Q

Examination

A
History
Musculoskeletal - ROM, MMT
Sensory - vision, proprioception, vestibular
Gait
Balance
Function
25
Categories of Balance Tests
1. Quiet standing 2. Active Standing - dynamic with voluntary weight shifts 3. Sensory manipulation - altered sensory cues to test adaptation 4. Functinal Scales with whole body and functional tasks 5. Vestibular - if complain of vertigo 6. COmprehensive test - BESTest
26
Quiet Standing - with or without perturbations - movement goal is to hold still
Romberg (sharpened) - feet together or tandum Single leg stance Perturbations (postural stress test)
27
Active Standing, dynamic with vol weight shifts
FUnctional reach | Limits of stability - stand and only let ankle joint move - cone of movement
28
Sensory manipualtion - alter sensory cues
Clinical Test of Sensory Interaction and Balance or Sensory Organization Test
29
Functional Scales of whole body movements
Berg TUG Four square step test Dynamic Gait Index or Functional Gait Assessment
30
Vestibular
Hallpike Oculomotor tests Fukufa Stepping test Dizziness Handicap Inventory
31
Comprehensive test BESTest
a lot of tests looking at anticipatory and reactive control, gait, standing
32
Fregly and Graybiel Quantitative Ataxia Test Battery
Sharpened Romberg: EO 60 sec ( >48 sec no fall risk, less than 38 sec fall risk) Balance beam for 5 steps Stance on BB in tendem, EO and EC for 60 sec Single leg stance EC for 30 sec Tandem gait EC for 10 steps
33
Functional Reach Test - Norm for 20-40 y/o
typically do three times and avg. 16. 73 men 14. 64 women
34
Functional Reach Test - Norm for 41-69 y/o
14. 98 men | 13. 81 women
35
Functional Reach Test - Norm for 70-87 y/o
13. 16 men | 10. 47 women
36
Clinical Tests for sensory integration and balance (CTSIB)
Eyes open Eyes closed Floor and Foam
37
Berg Test
Predictor of falls
38
TUG
>14 sec fall risk Manual TUG > 14.5 sec fall risk Cognitive TUG > 15 sec fall risk
39
Tinetti Tests
less than 19/23 = fall risk
40
Fukuda Stepping Test
Dynamic
41
Postural Stress Test
Static with perturbation
42
Dynamic Gait index includes
balance and gait
43
Intervention - Individual (impairment level)
Musculoskeletal - flexibility, ROM, force production (speed/timing/accuracy) Somatosensory (proprioception, vision, vestibular) Cognitive
44
Intervention - Task and Environment
Multiple tasking, adaptability, endurance, function, adaptive equipment
45
Documentation/Goals
Objective - trials correct, normal to poor scale, scores of assessments, strategy used, support needed Functional
46
Grading
Absent Fair Poor Good
47
Absent
Cannot maintain position and makes no attempt to assist or self correct
48
Poor
Cannot maintain position and makes ineffective attempts to self correct
49
Poor +
Cannot maintain position but occasionally makes effective attempts to self correct
50
Fair -
Maintains position a limited period of time and makes effective attempts to self correct at least 25% of the time
51
Fair
Maintains or corrects balance at least 50% of the time
52
Fair +
Maintains or corrects balance at least 75% of the time
53
Good -
Maintains position a functional period of time and is effective in self correcting at least 90% of the time: may experience momentary balance losses not normally seen with the task
54
Good
Maintains position with appropriate self correction of 100% of the time: momentary balance losses are appropriate to task level
55
What to include with documentation
Type of structure (stable vs dynamic) Type of activity (static vs dynamic: with or without activity) Supported/unsupported by UEs Time factors involved relating to performance/fatigue