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Neuromuscular (KK) > exam 3: dynamic standing assessment & interventions > Flashcards

exam 3: dynamic standing assessment & interventions Flashcards

1
Q

What are the 3 types of postural control:

A

steady-state, reactive, proactive

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2
Q

Standing unsupported = _________ holds
BOS changes: _________,_______ stance
Compliant vs ________ surfaces
Sensory integration changes:

Which type of postural stability is being described:

A

isometric
Romberg, tandem
firm
EO vs. EC

steady state

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3
Q

Perturbations =
Sensory integration challenges =

Which type of postural stability is being described:

A

nudges or pulls
compliant vs. firm surfaces

reactive

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4
Q

Dynamic reaching or ________
_______ limb movement
Preparing for Transfer or movement =

Which type of postural stability is being described:

A

weight shifts
resisted
SLS, look over shoulder

proactive

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5
Q

Balance grading scale: - patient able to maintain a steady balance without handhold support (static)

A

4- normal

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6
Q

Balance grading scale: - patient unable to maintain balance

A

0- absent

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7
Q

Biomechanics of Standing:
ASIS is _____ with each other
______ pelvis
Head in _______ with “chin in”
______ muscles active maintaining upright posture
Feet flat on floor weight disturbed ______

A

level
neutral
midline
trunk
evenly

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8
Q

Posture changes with age: True or False?

A

True

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9
Q

As a PT you need to assess the patients ________ to inform evaluation and POC

A

limit of stability (LOS)

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10
Q

What is limit of stability:

A

maximum excursion in any direction without losing balance

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11
Q

Where does balance fall in the ICF domain?

A

body function and structure domain

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12
Q

You should likely always be assessed with support on _________ side
-cueing for:

A

affected
hip/knee/truck extension

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13
Q

Physical therapist is testing the patient with a neurological condition and they have an assistive device. What is the highest grade pt. can score

A

2- fair: patient able to maintain balance with handhold support; may require occasional min assistance (static)

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14
Q

Standing is maintained by:

A

postural tone with antigravity muscles throughout trunk and LEs

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15
Q

Task oriented:
Dual cognitive task:
Environmental changes:

A

folding clothes, put shoes on
organizing pills, counting cards
lights on/off

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16
Q

Key elements to observe and document:

A

BOS, COM, use of UE, and LE support

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17
Q

Explain the setup assessment for Sit>Stand:
a. Initial condition-
b. Weight-bearing symmetry-
c. Use bedside table as AD-

A

a. feet are both flat on floor; hips and knee flexed 90º

b. both arms placed in a position of WB, use UEs to
push off, DO NOT use unilat. ADs for standing activities

c. provide stable surface for WB through BL arms

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18
Q

You are a physical therapist performing a push-and-release test on a patient. The patient takes 4 or more steps backward but recovers independently. What would you grade them?

A

2

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19
Q

High score on push-and-release test/ retropulsive pull test =

A

increase risk of fall

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20
Q

The ______ provides the clinician with a means to quantify postural control under various sensory conditions
-conditions include:

A

clinical test of sensory interaction on balance (CTISB) “foam & dome”
normal, eyes closed, dome

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21
Q

If patient is timed for 30 secs. in each condition and unable to maintain the position they can get unlimited attempts. True or False?

A

False; 2 additional attempts

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22
Q

Fill in the blanks: Example of Postural Stability Goals:
Postural adjustments become more _______
________ goals
Independently self-corrects to midline =
Decreased _______ dependence
Improved _________ of posture or limb

A

automatic
timed
orientation
care giver
awareness

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23
Q

What does your assessment of a patient’s dynamic postural stability mean?

fall/safey risk -
support needed -
limits of stability -
DC planning

A

-nursing, SLP needed, OOB safety

-is a caregiver needed for cueing, needs physical assistance for transfers

-upper/lower body dressing standing, balance strategies present

-safety with out of bed independently

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24
Q

Highly recommended measures for Patients with Stroke in Acute Care: (3)

A

Orpington porgnostic scale
Postural assessment Scale for Stroke Patients
Stroke Rehabilitation Assessment of Movement

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25
Q

What are the core measures of gait, balance, and transfers recommended for -

Lists the test: (6)

A

ALL adults with neurologic disorder

6 min walk test
10-meter walk test
Berg Balance Scale
Functional gait assessment
Activities Specific Balance Confidence Scale
5 time Sit to Stand test

26
Q

Standing assessment: Postural stability outcome measure (5)

A

Postural Assessment Scale for Stroke (PASS)
Berg Balance Scale (BBS)
Activities-Specific Balance Confidence (ABC) Scale
Tinetti (POMA)
Mini BESTest

27
Q

What stroke assessment is highly responsive to change in acute patients 14-30 days poststroke

A

postural assessment scale for stroke patients (PASS)

28
Q

A patient score was <45 on BBS what does that indicate:

A

high fall risk

29
Q

The ABC scale is a ______-_______ measure

A

self-report

30
Q

Measures confidence in performing various activities without losing balance or experiencing unsteadiness -

A

ABC scale

31
Q

Biggest disadvantage of the ABC scale:

A

subjective to patient

32
Q

The Tinetti Performace Oriented Mobility Assessment (POMA) is specifically for elderly patients to measure balance and gait function. True or False?

A

False: non-diagnosis specific

33
Q

A patient scores a 21 on the POMA what is this indicating

A

patient is a medium fall risk

34
Q

MiniBESTest 4 subcategories:

A
  1. Anticipatory postural response
  2. Reactive postural response
  3. Sensory orientation
  4. Stability in dynamic gait
35
Q

What is the highest score a pt. can achieve on the Mini-BESTest

A

28 points per test directions

36
Q

UE support devices and ADs are used to _______ shoulder subluxation during long periods of standing or gait

A

prevent

37
Q

What are the pros of ADs

A

expands BOS
reduce WBing through LEs

38
Q

What are the cons of ADs

A

-Learned nonuse
-If stability is maximized too much they will become reliant upon AD
-Compensation>Restorstaion

39
Q

DO NOT have wheels, must pick up and place

A

Standard walker (SW)

40
Q

has 2 large/small wheels anteriorly, can be pushed (glide) opposed to lifting

A

Rolling walker (RW)

41
Q

Essentially a robust cane, very supportive, but cumbersome

A

hemi- walker

42
Q

Four feet at the end of the cane, providing a wider base and greater stability

A

Large base vs Small Base Quad Cane

43
Q

Order walker/cane from most stable to least:

A

Standard walker
Rolling Walker
Hemi Walker
Large/Small base quad cane

44
Q

When fitting a patient to an AD make should elbows are in ______º of flexion in standing

A

20-25º.

45
Q

Beside table, AD is utilized for bilateral arm support. Use dycem material and/or hand-over-hand supports to steady hemi side. True or False?

A

True

46
Q

Roller walker (4WW or RW): if grip strength is an issue a _________ may be necessary.

A

arm trough

47
Q

Pros/Cons of Unilateral devices (cane and hemi walker)

Pro: unilateral device may offer _______ to the patient.
Cons: Encourage _________ gait pattern with minimal weight-bearing. Usually ________ gait pattern is used.

A

independence
compensatory
step-to

48
Q

Intervention goals of pt. handling:
-focused on improving _______ skills and motor learning
-interventions need to be ________ enough to promote behavioral change an neural reorganization
-final goal will be the __________ of the learned skill

A

functional - ADL improvement, gait. mobility
intense - challenges LOS
adaptability- transfer and retention test

49
Q

Weight-bearing- increases ________ awareness through compression of the joint
-____% of balance is somatosensory input

Visual feedback - promotes awareness of _______ or ______
-_____% of balance is visual input

A

proprioceptive; 70%
posture/limb: 20%

50
Q

Static stabilization exercises are ______ exercises for functional movements (transfers) and ADLs. Consider performing strengthening exercises in ________ positions. Challenge ______ integration and ________ postural strategies.

A

“lead up”; functional; sensory; reactive

51
Q

Sit <> Stand interventions:
Eccentric control the descent from ______
______ hold for static strengthening
______control for dynamic strengthening
-facilitate anterior trunk positioning over _____ from pt. to maintain COG over BOS.

A

standing
isometric
eccentric
toes

52
Q

Challenge all 3 aspects of balance by _________ the accuracy of one or two inputs. What are the inputs?

A

reducing; vision, somatosensory, vestibular

53
Q

Reactive postural strategy interventions:
ankle strategy: small shifts in ______ alignment using ankle DF and PF.
-manual therapy or ________ by PT

hip strategy: larger, faster shifts in COM alignment when ankle strategy is _________

stepping strategy: inventions include (2)

A

COM; perturbations
not sufficient
push and release, push/pull testing

54
Q

Adding resistance to limb movements strengthens and enhances control of limbs- proximal stability while creating _____ strength and mobility.
Increases automaticity of _____ control and postural awareness

A

distal
trunk

55
Q

Your assessment ______ intervention. refer to slide 63*

A

drives

56
Q

Pouring water from a pitcher into a glass, solving math problems, and playing naming games are examples of ________ tasks with cognitive load. Be sure to incorporate _____ patients.

A

dual; salience

57
Q

Task-oriented standing interventions to increase the challenge of activities:
increase _______ to reach
vary _____ of target
vary weight or size of an ______
add ____constraint
involve multiple ____

A

distance
location
object
time
extremities

58
Q

Visual biofeedback has been shown to improve _______.
all for ______cues to self correct. What is an example of visual biofeedback?

A

balance; internal; Wii/VR

59
Q

Push against me forward, pull against me backward -
Hold don’t let me move you -

A

stabiliziang reversals
rhythmic stabilization

60
Q

Pre-gait training is initiated for _____ level patients to emphasize ______ phase stability.
-stage of recovery?
-______% of gait cycle in stance phase
-introduce weight shifting toward ______ limb

A

low; stance
acute
60%
affected

61
Q

Standing intervention leads to ______. Before advancing to gait perform ______ assessment.

A

gait; standing

Neuromuscular (KK) (21 decks)

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