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Motor Control and Learning > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

What are the components of the balance assessment subjective history?

A

Ask questions about how many falls have occurred
Inquire about how the patient is managing in the home (and what strategies they are using)
What their perception of the risk of falls is

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2
Q

What are the 4 components of a balance assessment?

A

Subjective History
Ongoing Movement Analysis
Objective balance examination
Patient Self-Reporting Questionnaires

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3
Q

Steady State Balance Tests

A

Static timed tests

Single leg balance

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4
Q

Dynamic Balance Tests

A

Any test involving movement

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5
Q

Sensory Organization Tests

A

CTSIB

BESS Test

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6
Q

Reactive Balance Tests

A

Push, Pull, or Release Tests

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7
Q

Anticipatory Balance Tests

A

Functional Reach

Star Excursion Balance

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8
Q

Functional Balance Tests

A

Include a variety of components and incorporate functional tasks (Walking While Talking)

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9
Q

Components of selecting appropriate balance tests

A

Evidence support
What you hope to learn (screening, falls risk, comparison to norms, etc.)
Clinical limitations (time, equipment, stairs/environment)

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10
Q

Romberg/Sharpened Romberg Test

A

Romberg: Feet together, eyes open and eyes closed for up to 30 seconds
Sharpened: tandem stance, arms crossed, eyes closed up to 30 seconds
+ Test: opening eyes, taking a step, or LOB

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11
Q

Romberg Benefits and Challenges

A

Benefits:
quick screen
Limited Equipment

Challenges
Not specific
Not used in isolation => need to perform other tests

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12
Q

Modified Functional Reach

A

Measurement: 1 practice, average 2 next trials in each direction
Cut Off Scores: Not established in the modified version
Stroke Norms:
Forward: 31.7; 37.6
Paretic: 13.8; 17.7
Non-Paretic: 15.5; 18.1

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13
Q

Modified Functional Reach Pros and Cons

A

Pros
Easy
Limited equipment
Patients who can’t stand

Cons
Cognition may limit ability to follow instructions
Need to sit without much assistance

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14
Q

TUG Dual Task

A

Community Dwelling: 15 seconds

PD: TUG manual = 4.5 different than TUG

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15
Q

TUG Pros and Cons

A

Pros
Quantify cognitive impairments
May use Assistive Device
Highly recommended for PD and MS

Cons
Need more research for meaningful changes

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16
Q

Walking While Talking Test

A

Walk 20 feet, turn around, and walk back naming letters out loud

Cut off scores:
20 seconds (simple)
33 seconds (complex)
<70 cm/s = increased risk of frailty and disability
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17
Q

Walking While Talking Pros and Cons

A

Pros
Functional testing for people with cognitive impairments
Adds cognitive component

Cons
Standardization
Limited Evidence

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18
Q

Clinical Test of Sensory Integration and Balance

A

Test balance in 6 conditions (4 on modified: no conflict dome); 3 trials in each condition with max of 30 seconds in each trial

Cut off scores
Community Dwelling: less than 260 of 540 possible seconds (summing all 6 trials) or 48%

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19
Q

CTSIB Pros and Cons

A

Pros
Identify sensory strategies
Limited equipment
Adults and Peds

Cons
Little evidence in cut offs or MDC
Not useful in tracking changes (ceiling/floor effect)
Conflict dome not always available

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20
Q

BESS Test

A

Number of errors during 20 second time frame for 6 conditions on firm and foam surface
Feet together
Single leg stance
Tandem stance

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21
Q

BESS Statistics

A

Max Score: 60 points
Performance worsens after 50 years old
No established cut off for increased fall risk

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22
Q

BESS Pros and Cons

A 
Pros
Recommended for concussion
Evidence for use in younger population
Easy to perform
Identify vestibular processing impairments

Cons
Less evidence across populations
Not useful in lower level or older adults

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23
Q

Dynamic Gait Index

A

Focus on activity level on ICF model

8 items testing vestibular input on 0-3 points scale

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24
Q

DGI Statistics

A 
Max Score: 24 points
MDC: 3 points (community dwelling, vestibular, and PD)
Cut offs
19: older adults, vestibular, and PD
12: MS
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25
DGI Pros and Cons
``` Pros Short amount of time Dynamic balance focus Moderate level of equipment With or without AD ``` Cons Need 20 ft space Subjective rating Not super sensitive
26
Functional Gait Assessment
7 from DGI and 3 additional (Narrow BOS walking, backwards, eyes closed walk)
27
FGA Statistics
Max Score: 30 points Cut offs: 22/30: older adults 15:30: PD
28
FGA Pros and Cons
Pros Short test Focus on dynamic balance with integration of systems involvement More objective than DGI Highly recommended for PD and Vestibular EDGE groups With or without AD Cons 20 foot space Not appropriate for lower level (higher balance level)
29
Mini Best
14 items | Foam, ramp, chair w/ and w/o arms, shoe box
30
Mini Best Statistics
``` Max Score: 28 points MCID: 4 points (balance disorders) Cut off scores: 20: PD 17: Chronic stroke ```
31
Mini Best Pros and Cons
``` Pros Different systems Functionally based Highly recommended for PD More time efficient than BEST ``` Cons More equipment Can take longer if patients are slower
32
HiMAT
13 items for 54 points
33
HiMAT Statistics
Max score: 54 points Norms: 50-54 (males); 44-54 (females) Cut offs: none established
34
HiMAT Pros and Cons
Pros Good objective test for higher level balance deficits Integrates functional tasks for younger populations Highly recommended for TBI/concussion Cons Must be independent with ambulation Consider contraindications Limited research in other populations
35
Activity Balance Confidence Scale
16 item self-report measure rating patient's confidence in various tasks 0 = no confidence 100 = very confident Score is average of all items
36
ABC Scale Statistics
``` Max Score: 100% Cut offs: Older adults: 67% PD: 69% Stroke: 81% indicates multiple faller ```
37
ABC Pros and Cons
Pros Identify self-perception of balance Objective measure of fear of falling MS, PD, and acute vestibular Cons Confusing for cognitively impaired Time intensive Requires reading skills
38
Falls Efficacy Scale
16 items self-reported measure rating patient's confidence in various tasks 10 = very confident 100 = not confident Score based on sum of all items
39
Falls Efficacy Statistics
Cut offs: 80: increased risk of fall 70: increased fear of fall
40
Falls Efficacy Pros and cons
Pros Identify patient's perception of balance Objective measure of fear of falling Cons Confusing for cognitively impaired Requires reading skills Less researched than ABC
41
Tests for identifying fall risk
``` Berg Balance DGI FGA Tinetti (POMA) 10 meter walk ABC Scale TUG ```
42
Tests for Dual Tasks
Walking While Talking TUG Dual DGI FGA
43
Tests for younger patients after concussion
HiMAT Mini BEST TUG
44
Tests for older community dwelling adult with history of falls
``` Mini Best CTSIB Berg DGI FGA ABC Scale TUG ```
45
Tests for complaints of dizziness
DGI FGA Mini Best
46
10 Meter Walk Test
Average 3 trials Can use AD Space to accelerate/decelerate
47
10 Meter Walk Statistics
MCID: 0.05 m/s (geriatrics)
48
Walking speed Table
0-0.6 m/s: Dependent and likely to be hospitalized 0-0.9 m/s: need intervention to reduce fall risk 0-0.1 m/s: Discharge to SNF 0.1+ m/s: discharge home more likely 1.0 m/s: independent in ADLs, less chance of hospitalization, less likely for adverse event Household Walker: 0-0.4 m/s Limited Community Ambulation: 0.4-0.8 m/s Community Ambulator: 0.8-1.2 m/s Cross street and normal walking speed: 1.2+ m/s
49
Berg Balance
14 items testing static and dynamic activities (non-vestibular)
50
Berg Balance Statistics
``` Max Score: 56 points MDC: 6 points (older adults) Cut offs: 45: elderly population and stroke increased risk 40: 100% risk of falls in elderly ```
51
Pediatric Balance Scale
Peds version of Berg Scored as best of 3 trials Ages 4-15
52
Berg Pros and Cons
Pros Highly recommended for incomplete SCI, MS, stroke, PD, TBI Good evidence use for mild-moderately impaired patients Cons Not useful in those requiring AD Not recommended for low level patients not anticipated to ambulate (floor effect)
53
Tinetti (POMA)
16 items (9 balance, 7 gait)
54
Tinetti Statistics
Max Score: 28 points | Cut offs: 19 (older adults)
55
Tinetti Pros and Cons
Pros Recommended for PD (not for other edge groups) Can use AD Strong evidence older adult population that has been hospitalized Gait analysis component Cons Less generalizable for younger or healthy older adults Can't track changes in higher functioning (Ceiling effect)
56
Postural Control
Controlling the body's position in space which includes STABILITY and ORIENTATION
57
Environment factor of balance
Layout of home
58
Task factor of balance
Tasks performed (walking: dynamic; standing: static)
59
Individual factor of balance
PMH
60
Center of Mass
Center of total body mass (point) | Assumed
61
Center of Gravity
VERTICAL projection of the COM
62
Base of Support
Area of the body in contact with the support surface
63
Postural Orientation
Maintain an appropriate relationship between body segments and between the body and the environment
64
Postural Stability
Ability to control the COM within the BOS
65
Posture vs Postural Systems
Posture: Task, individual, and environment Postural Systems: Musculoskeletal, cognition, muscle synergies, sensory systems, sensory organization
66
Task Constraints of postural control
Balance control: steady-state, reactive, proactive balance Feedback control: occurs in response to sensory feedback from external perturbation Feedforward control: anticipatory postural adjustments made in anticipation of voluntary movement
67
Environmental Constraints of postural control
Changes in support surfaces Differences in visual and surface conditions Multiple tasks
68
Steady-State Balance
Body Alignment can minimize effect of gravitational forces Muscle tone keeps body from collapsing in response to the pull of gravity (intrinsic stiffness, background muscle tone, postural tone)
69
Stability Limits
Point at which a person will change configuration of his/her BOS to achieve stability Change based on task, individual's biomechanics, and environment
70
Not fixed boundaries
Not set | Depend on the tasks you are performing
71
Factors affecting Movement Strategy
Stability limit | Perceptual and cognitive factors
72
Reactive Balance Control
Motor Patterns: ankle, hip, step, reach-to-grasp Fixed-support vs. change-in-support Synergy: functional coupling of muscle groups to act as a unit
73
Fixed-support vs Change-in-support
Ankle: slowed perturbation Hip: Faster perturbation or narrow BOS Stepping: Fastest perturbation or very narrow BOS Reach-and-Grasp: reach and grasp while stepping after perturbation
74
Ankle Strategy
Distal to proximal activation | Useful with small balance disturbances, on a firm surface, intact ankle ROM and strength
75
Hip Strategy
Proximal to Distal activation Longer length of time to regain balance Useful with larger and faster disturbances, small support surface, and compliant support surface
76
Refining and Tuning Muscle Synergies
Postural synergies are not fixed, stereotypical reactions Synergies are refined and tuned in response to changing demands in task and environment Adaptation: movements in response to demands
77
Proactive Postural Control
Preselect muscles required to complete the task prior to the movement Based on previous experiences Benefits: prevent disturbances to the system
78
Sensory Inputs for steady-state balance
Visual inputs Somatosensory Contributions Vestibular Contributions
79
Components of visual inputs
Position and motion of head with respect to surrounding objects Reference for verticality
80
Somatosensory contributions
Provides CNS with position and motion information about body with reference to supporting surfaces Report information about relationship of body segments to one another
81
Vestibular Contributions
Provides CNS info about position and movement of head with respect to gravity and inertial forces
82
Sensory integration of balance
Tend to rely on visual input when learning a new task Transition to reliance on somatosensory system once in associative phases of learning Increased tactile feedback changes postural muscle activation Utilize sensory info to prevent loss of balance in different ways Moving room example
83
Neurocom Results
``` Nothing: Vestibular, Vision, and Somato Blindfold: Vestibular and Somato Head Box: Vestibular and Somato Foam Surface: Vestibular and Vision Blindfold and Foam: Vestibular Foam and Head Box: vestibular ```
84
CTSIB Results
Vision: 2, 3, 5, and 6 Somatosensory: 4-6 Vestibular: 5-6 Sensory Selection: 3-6
85
Strategies for Steady State Stability
Passive skeletal alignment and muscle tone Postural tone Hip and Ankle strategies
86
Strategies for Perturbation Stability
Ankle, hip, and stepping strategies
87
Attentional Resources
Info processing resources required to complete a task
88
Dual-Task Interference
Two tasks performed simultaneously | Attentional resources may decrease in performance on one or more tasks (motor and cognitive)
89
Cognitive Systems in Postural Control
Attentional demands vary as function of sensory context Performance of secondary task not always detrimental effect on postural control Important to assess balance under single and dual-task conditions

Motor Control and Learning (2 decks)

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