Examination of Balance

Question 1

List the components of postural control (2)

Answer 1

1. Postural stability
2. Postural orientation

Question 2

Define postural stability

Answer 2

Balance

Question 3

Define postural orientation

Answer 3

Ability to maintain appropriate relationship b/t body segments and b/t body and environment

Question 4

List the areas to observe with a posture examination (3)

Answer 4

1. Alignment [vertical, symmetry]
2. Foot position [BOS]
3. Weight scale/Force plates

Question 5

List what should be noted about the initial position during a posture examination (3)

Answer 5

1. Appropriate for functional tasks?
2. Efficient [min mm to maintain position]?
3. Stable [line of gravity with in stability limits]?

Question 6

List reasons to examin a patients balance (3)

Answer 6

1. ID fall risk
2. Determine ability to participate in Pt
3. ID impairment

Question 7

List the 5 types of balance scales and their goal

Answer 7

1. Quiet standing [goal to stand still]
2. Active standing [goal of voluntary weight shift
3. Sensory Manipulation [alt surface/visual condition to assess postural control]
4. Functional scales [whole body movement]
5. Dual task

Question 8

List the quiet standing balance scales (4)

Answer 8

1. Romberg
2. Sharpened Romberg
3. One-legged stance test
4. Postural sway

Question 9

List the active standing balance scales (2)

Answer 9

1. Functional reach test
2. Multi-directional reach test

Question 10

List the sensory manipulation balance scales (2)

Answer 10

1. Sensory organization test
2. Clinical Test of Sensory Interaction and Balance (CTSIB)

Question 11

List the functional scales (5)

Answer 11

1. Berg Balance Scale
2. TUG
3. Tinetti
4. DGI
5. Functional Gait Assessment

Question 12

List the dual task balance scales (2)

Answer 12

1. Walk and Talk
2. Mutliple Tasks Test [8 item]

Question 13

List considerations when selecting an appropriate test (5)

Answer 13

1. Purpose/Population
2. Reliability/Validity/Ease of Use
3. Modifications
4. Norm data available for comparision
5. Which components of posture will be assessed

Question 14

Test:

• Quiet Standing
• Fold arms across chest, picks one leg and holds hip in neutral and knee flexed to 90 [test both sides]
• Normal = 30 sec
• Go intra-rater reliability
• SLS required for gait, steps, ADLs

Answer 14

One leg stance test

Question 15

Test:

• Quiet standning
• Feet together, assess sway EO vs. EC
• Abnormal = excessive sway, LOB, stepping
• Subjective

Answer 15

Romberg

Question 16

Test:

• Quiet standing
• Feet in heel-toe position, arms folded across chest, EC for 60 sec

Answer 16

Sharpened Romberg

Question 17

Test:

• Active standing
• Quick screen for balance
• Norm = > 10” [less = fall risk]
• Reliable and Valid
• Modifications include sitting and multi-directional

Answer 17

Functional Reach Test

Question 18

Test: Examine the limits of stability in forward, backward, and medial/lateral directions

Answer 18

Multi-directional Reach Test

Question 19

Test:

• Measure balance by assessing functional task
• 14 item, total score 56, higher score = better function
• Sitting component
• Reliable and Valid
• Has ceiling effect

Answer 19

Berg Balance Scale

Low fall risk = 41-56

Medium fall risk = 21-40

High fall risk = 0-20

Question 20

Test:

• Gait and Balance sub scores
• Total score = 28
• Reliable and Valid

Answer 20

Tinetti

Low fall risk = 25-28

Moderate fall risk = 19-24

High fall risk = < 19

Question 21

List the test with the best test-retest reliability and predictive ability for fall risk in people > 65 yo

Answer 21

POMA

Question 22

List the items of the Tinietti that are for

1. Steady state balance
2. Proactive balance
3. Reactive balance
4. Sensory component

Answer 22

1. 1 and 5
2. 2, 3, and 9
3. 6
4. 7

Question 23

List the self report measures and what they assess (3)

Answer 23

Activity Specific Balance Confidence Test [fear of falling]

Falls efficacy scale [fear of falling

Dizziness Handicap inventory [self perfeived handicap]

Question 24

Test:

• Assess balance in lying, sitting, standing
• 12 item
• Looks at how they maintain balance and change posture

Answer 24

Postural Assessment Scale for Stroke

Question 25

Test: - Steady state balance - Center of gravity location - Amount of sway - Functional performance - Objective, uses force plates

Answer 25

Balance Master Assessment

Question 26

Test: - USes movable force plate and moveable visual surround to alter the surface and visual environment systematically - Stand on force plate, 3, 20 sec trials under each condition

Answer 26

Sensory Organization Test

Question 27

Test: - Sensory integration test - 3-5 trails of 30 sec - Use stopwatch and visual observation - foam and dome - normal = 30 sec w/o LOB

Answer 27

CTSIB

Question 28

Test: - Assess gait - Change surface, speed, horizontal and vertical head position

Answer 28

DGI

Question 29

Goals of Balance Tx (4)

Answer 29

1. Objectivity for assessment of prorgression 2. ID impairments to be addressed 3. Effective sensory and motor strategies 4. Consider stead state/reactivity/anticipatory control in functional environments

Question 30

A _________ approach should be used to treat balance

Answer 30

Systems

Question 31

Treatment Strategy (4)

Answer 31

1. Postural alignment [efficient, stable, functional] 2. Motor strategies 3. Sensory strategies 4. Gradually increase demand

Question 32

Types of augmented feedback for posture tx (4)

Answer 32

1. Verbal cue 2. Manual cue 3. Visual cue 4. Forceplate

Question 33

Posture Tx (3)

Answer 33

1. Augmented feedback on symmetric/verticla posture 2. EO vs. EC 3. Effect of AD

Question 34

Motor Strategies (5)

Answer 34

1. Ankle strategy = small perturbations, sway A/P 2. Hip strategy = larger perturbations 3. Stepping strategy = largest perturbation 4. Add functional meaning 5. Strength and ROM

Question 35

Control of COG (5)

Answer 35

1. Establish a stable BOS and transfer weight over it 2. Progression: establish \> maintain \> reduce BOS to produce automatic/anticipatory responses to weight shift 3. Sitting [remove UE, move LE] 4. Sit to stand [alter surface and height] 5. Standing [stable \> reach\> narrow BOS \> SLS]

Question 36

Sensory Strategies (4)

Answer 36

1. Goal: learn to coordinate/select appropriate sensory info for postural control 2. Reliance on vision = remove vision to increase somatosensation 3. Reliance on surface = alter surface to increase vision 4. Enhance vestibular by altering surface and removing vision \*\* hard surface rocker bottom = challenges somatosenation \*\* soft surface rocker bottom = takes somatosensation out of the picture

Question 37

Physical Problems to address in elderly with fall risk (5)

Answer 37

1. Mm strength 2. Hearing loss 3. Vision deficit 4. AD 5. Activity level