Exam 2 Flashcards
(91 cards)
1
Q
Majority of falls in neurologic pathologies are associated with…
A
- Mobility (Gait)
- Transfers
- Stair Climbing
2
Q
Sensory Weighting Hypothesis
A
When one sensory system is less reliable, the input to the CNS from that system is weighted less heavily, and inputs from other systems will be weighted more heavily.
3
Q
Why postural control?
A
the ability to control our body’s position in space is FUNDAMENTAL to everything we do
4
Q
Alignment
A
relationship of body segments to one another, as well as to the position of the body with reference to gravity and the base of support
5
Q
Center of Mass (CoM)
A
point at center of the total body mass
6
Q
Center of Gravity (CoG)
A
vertical projection of the center of mass
7
Q
Center of pressure (CoP)
A
center of distribution of total force applied to supporting surface
8
Q
Posture
A
biomechanical alignment of the body and the orientation of the body in the environment
9
Q
Postural control
A
control of the body’s position in space for orientation and stability
10
Q
Postural Tone
A
activity increases in antigravity muscle, which keeps the body from collapsing in response to the pull of gravity during quiet stance
11
Q
Postural orientation
A
ability to maintain an appropriate relationship between body segments, and between the body and the environment for a specific task
12
Q
Postural stability or balance
A
ability to control to center of mass in relationship to the base of support
13
Q
Clinical definition of a Fall
A
an event that results in a person coming to rest inadvertently on the ground (unplanned or unexpected contact with a supporting surface)
14
Q
Research definition of a Fall
A
movement of the CoM outside of the base of support (including stepping to recover stability)
15
Q
Clinical Test of Sensory Interaction in Balance (CTSIB)
A
Helps determine which sensory system an individual relies on to maintain balance
16
Q
Factors Contributing to Aging
A
Primary or Genetic Factors - Contribute to loss of neuronal function - LITTLE control
Secondary or Experimental Factors - Environment, nutrition, and lifestyle, affect our nervous system function - MORE control
17
Q
Stats on Falls in the Elderly
A
One out of three elderly fall each year
18
Q
Intrinsic Factors for Falls in Community
A
Age and gender
Physiological and psychosocial
Cognitive impairments
Impaired ADLs
19
Q
Hip Strategy
A
- FORWARD SWAY: to prevent falling on face, use large ANTERIOR muscles
- BACKWARD SWAY: to prevent falling on back, use large POSTERIOR muscles
- TIMING: from proximal to distal
20
Q
Extrinsic Factors for Falls in Community
A
Environmental factors (stairs, rugs, slippery surfaces, poor lighting)
21
Q
Postural Control Problems Vary According to Variabiltity of
A
- Type of neurological injury
- Degree of lesion
- Location
- Age
- Premorbid condition
- Extend of compensation
22
Q
What contributes to Abnormal Postural Control
A
- Problems in Action System
- Problems in Sensory/Perceptual Syatem
- Loss of Anticipatory Postural control
- Problems in Cognitive System
- Impaired Seated Postural control
23
Q
Quiet Stance-Alignment
A
Abnormal alignment due to musculoskeletal impairments
Example: Children with CP
24
Q
Multidirectional Stability
A
- continuum of response patterns that control stability in 360 degrees of possible perturbation directions
- muscles can belong to more than one pattern of movement or synergy
25
Dynamic Systems Model
- emerges from complex interactions of many systems
- musculoskeletal components
- internal representations
- adaptive mechanisms
- anticipatory mechanisms
- sensory strategies
- individual sensory systems
- neuromuscular synergies
26
Spontaneous Sway
- Pt with PD have postural sway in quiet stance
| - Increased sway and velocity
27
Basal ganglia in Control of Postural Set
the ability to quickly change muscle patterns in response to changing tasks and environmental conditions
28
Coactivation in Perturbed Stance
postural coordination strategy in people with neurologic conditions as well as young healthy children
29
movement strategies to maintain balance
- controlling body sway
- feedback control
- feedforward control
- anteriorposterior stability
- lateral stability
- multidirectional stability
30
Intact System for Postural Control
- adaptable postural control system to meet the goals of stability and orientation in any environment
- visual contribution to postural control
31
Visual Inputs
- relationship of our body to objects in the environment
- position and movement of the head with respect to surrounding objects
- direction and speed of head movement
32
Somatosensory inputs
- surface of support
- position and movement about the body with reference to the BOS
- relationship of body segments to one another
33
Vestibular inputs
- gravity
- powerful source of information for postural control
- position and movement of the head with respect to gravity and inertial forces
- angular and linear acceleration/deceleration of the head
34
Synergy
the functional coupling of groups of muscles that are constrained to ACT TOGETHER as a unit
35
Ankle Strategy
- FORWARD SWAY: to prevent falling on face - use POSTERIOR muscles to restore CoM
- BACKWARD SWAY: to prevent falling on back use ANTERIOR muscles
- TIMING: from distal to proximal
36
Hip Strategy
- FORWARD SWAY: to prevent falling on face, use large ANTERIOR muscles
- BACKWARD SWAY: to prevent falling on back, use large POSTERIOR muscles
- TIMING: from proximal to distal
37
Neuromuscular System
Older adults demonstrate:
Slower response onset in key muscles
Increased co-activation to stiffen the joint
38
Perturbation size and velocity increase
Stable older adults show increased amplitude of response as compared to younger adults
Unstable older adults exhibited much more increased amplitude of response
39
Stepping Reaction
Forward or backward stepping with one of more lateral
40
What the effect of a loss of sensory input? Depends on
1-availability of other senses
2-availability of accurate orientation cues
3-ability to accurately interpret and select sensory info for orientation
41
Somatosensory changes with age
Vibratory sensation threshold increases with age and tactile sensitivity increases
42
Visual changes with age
Visual threshold increases with age and visual acuity decreases
43
Problems in cognitive Systems
- Impaired postural stability under dual-task conditions
| - Postural control in demential
44
Anticipatory Postural Ability in Elderly
Elderly have difficult maneuvererring around because of REDUCED ability to INTERGRATE balance adjustments into ongoing voluntary movements
45
Cognitive Issues and Postural Control in Elderly
Older adults show increased time of pressing a button when hearing a sound
46
Dual-Task Intervention
Concentrate on limiting any calculation errors while walking
47
Stepping Strategy
when the ankle and hip strategies are not enough to maintain the balance, a step will restore the CoM
48
Combined strategies
ankle and hip strategies are combined in a continuous way
49
Lateral Stability
- alternative strategy is used to recover stability in mediolateral direction
- mainly muscles at hip and trunk
- muscle patterns organized proximal to distal
50
Multidirectional Stability
- continuum of response patterns that control stability in 360 degrees of possible perturbation directions
- muscles can belong to more than one pattern of movement or synergy
51
Delayed Activation of Postural responses
- onset latencies in paretic muscles were longer and smaller in amplitude (slow and small in amplitude)
- Problems in timing and organization of muscle activity
52
Problems Modifying Postural Strategies
Inability to modify postural strategies in response to changing tasks and environmental demands
53
Normal posture control requires
1-organization from visual, somatosensory, and vestibular systems
2-coordination of sensory info with motor action
54
What the effect of a loss of sensory input? Depends on
1-availability of other senses
2-availability of accurate orientation cues
3-ability to accurately interpret and select sensory info for orientation
55
Dynamic Systems Model
- emerges from complex interactions of many systems
- musculoskeletal components
- internal representations
- adaptive mechanisms
- anticipatory mechanisms
- sensory strategies
- individual sensory systems
- neuromuscular synergies
56
Sensory Selection Problem
Inability to appropriately select sense for postural control in environments in which one or more Orientation cues inaccurately report body's position in space
57
Loss of Anticipatory Postural control
Inability to adapt to changing tasks and environmental demands
-Highly dependent on PRIOR experiences and learning
58
Problems in cognitive Systems
- Impaired postural stability under dual-task conditions
| - Postural control in demential
59
Impaired Seated Postural control
- Sitting Balance is critical part of functional independence in ADLS
- Seated Postural control is impaired in neurologic pts
- Sitting balance is good prognostic indicator
- Trunk muscle helps maintain sitting balance
60
Cerebellum in Control of Adaptation
the ability to modify postural amplitude in response to changing tasks and environmental conditions
61
Basal ganglia in Control of Postural Set
the ability to quickly change muscle patterns in response to changing tasks and environmental conditions
62
Spinal Preparation for Postural Control
- GRF for orientation present though diminished
- tonically active extensor muscle for antigravity support for postural orientation
- no lateral stability
- somatosensory contributions to postural control
63
Brainstem Level for Postural Control
- controls level of postural tone in combination with cerebellum
- circuits for automatic postural synergies
- vestibular contributions to postural control
64
Intact System for Postural Control
- adaptable postural control system to meet the goals of stability and orientation in any environment
- visual contribution to postural control
65
Visual Inputs
- relationship of our body to objects in the environment
66
Somatosensory inputs
surface of support
67
Vestibular inputs
gravity
68
Sensory Strategies
when one sensory system is less reliable, the input to the CNS from that system is weighted less heavily, and inputs from other systems will be weighted more heavily
69
Body Functions [Structures]
- mental functions [structures of the nervous system]
- sensory functions and pain [eye, ear and related structures]
- neuromusculoskeletal and movement-related functions [structures related to movement]
- voice and speech functions [related to voice and speech]
- functions and [structures] of the cardiovascular, hematological, immunological and respiratory systems
70
Environmental Factors to Clinical Management
- natural environment
- human-made changes to the environment
- support and relationships
- attitudes
- services, systems, and policies
- products and technology
71
Balance Assessments of Functional Activities
- Self Efficacy Scales (ABC, Falls Scale)
- Timed Up & Go (TUG)
- Functional Reach Test (FRT)
- Performance-Oriented Mobility Assessment (POMA)
- Berg
- Short Physical Performance Battery (SPPB)
- Balance Evaluation Systems Test (BESTest)
72
Self Efficacy Scales
- Questionnaires
- Confidence in doing ADLs
- Activity-specific Balance Confidence (ABC) scale
- Falls Efficacy Scale (FES)
73
Timed Up & Go (TUG)
- stand up from chair, walk 3m, turn around, and return to sit back on chair
- 10 s freely independent
- 20 s independent in basic transfers
- 20-29 s gray zone
- 30s usually need help with chair or toilet transfers, help in and out of tub, assistance with stairs, unable to go out alone
- sensitive and specific indicator of fall status in community dwelling older adults (>15s)
74
Functional Reach Test (FRT)
- FRT is a single-item test developed as a quick screen for balance problems and risk for falls in older adults
75
Performance-Oriented Mobility Assessment
- frail elderly
- balance subscale
9 items - 16pts
- gait subscale
7 items - 12pts
- maximum score - 28 pts
19-24: at moderate risk for falls
24-28: at low risk for falls
76
Berg Balance Scale
- community dwelling older adults
- there are 14 items, scaled 0-4
- stability (steady state)
- anticipatory
- no reactive postural control
77
Short Physical Performance Battery (SPPB)
- used to measure LE performance such as strength, balance and mobility in older adults
78
BESTest
- developed by Horak et.al and used to examine multiple aspects of postural control
- biomechanical constraints, stability limits, anticipatory transitions, postural responses, sensory organization, dynamic gait
79
Examination Strategies used for Balance
- postural alignment
- movement strategies
- steady state (sitting/standing)
- reactive (sitting/standing)
- anticipatory postural control
- adaptive control
- Sensory strategies
- CTSIB
80
Alignment
- posture
- weight bearing
- width of base of support
- location of the CoP
81
Automatic Postural Responses
- to keep the COG over the BOS in response to a stimulus or unexpected perturbation
- rapid; not under voluntary control
- ankle, hip and stepping strategies
- adaptive postural responses
- reactive postural responses
82
Reactive Control
- Nudge test
- unexpected external perurbation at the level of the sternum
- subject at maximum position with feet as close together as possible; examiner pushes lightly on subject's sternum with palm of hand 3 times
0: begins to fall
1: staggers, grabs, catches self
2: steady
83
Proactive Postural Responses
- responses occur before prime mover and in preparation for the perturbation
- body's way to prepare for a 'predicted' perturbation, e.g, lifting a heavy bag of groceries
84
Examination at Impairment Level
- Motor problems: motor coordination, muscle strength, involuntary movements
- Sensory/Perceptual Status: somatosensory problem, visual problem, vestibular problem, impaired body image and spatial relationship
- cognitive status: alertness, memory, orientation, attention, learning
85
Task-Oriented Approach to Intervention
- work on these goals in PARALLEL
- impairment level: to optimize the components of postural control
- Strategy Level: to develop or refine task specific sensory and motor strategies used for postural control
- Functional Level: to learn to preserve postural control during changing tasks and environmental conditions
86
Ultimate Goal for Task Oriented Balance Rehab
- improve participation outcomes, reflected in ability (increased frequency, independency, and reduced falls) to participate in social roles, and ADLs
87
Exercises to Improve Control of CoG - SITTING
- encourage balance with progressively less surface contact
- progress by: removing UE support, making the surface less stable, add UE activities, increase limits of stability through reaching and throwing activities
88
Exercises to Improve Control of CoG - STANDING
- begin with slow weight shifts on a stable platform
- elastic band LE exercise
- standing sway
- sit to stand
- Tai Chi
- add UE activities/functional activities
89
Exercises to Promote Ankle Strategy
- standing sway exercise
- slow small perturbations either self generated or external
- computerized stability training
- increase difficulty with UE, head or eye movements
- functional activities
- resistance
90
Exercises to Promote Hip Strategy
- standing sway using a table and a wall, pt instructed to bow to move nose towards table
- standing on rail
- mod. to rapid perturbations
- tandem standing
- single limb support
- large ant./post. weight shifts on a variety of surfaces
- functional activities
91
Exercises to Promote Stepping Strategy
- standing sway with large sways, consciously taking step forward and backward
- ambulate in tandem, promote balance steps
- stepping over obstacle
- walking on uneven surfaces
- large rapid perturbations
