Impairment: Balance Dysfunction Flashcards
(41 cards)
1
Q
Postural Control: Definition
A
Controlling the body’s position in space for the purpose of STABILITY and ORIENTATION
2
Q
Postural Control: Types
A
- Reactive (compensatory)
- Proactive (anticipatory)
- Adaptive
- Tilting Reactions
3
Q
Reactive (compensatory)
A
Reaction to external force
4
Q
Proactive (anticipatory)
A
Responses that occur in anticipation (feedforward)
5
Q
Adaptive
A
Appropriately modify via sensory and motor
6
Q
Tilting Reactions
A
Reposition COM within BOS for changing surface
7
Q
Postural Orientation (POSTURE) definition
A
Ability to maintain appropriate relationship between:
- Body segments
- Body and environment for a given task
8
Q
Balance (Postural Stability) definition
A
- State of PHYSICAL EQUILIBRIUM involving stabilizing and destabilizing forces
- CONTROLLING COM OVER BOS
9
Q
COM
A
- Located at approximately S2
10
Q
COG
A
- Vertical Projection of the COM
11
Q
BOS
A
Area that is in contact w/ support surface
12
Q
Static POSTURE/BALANCE:
A
- COG falls within BOS
- maintains particular posture agains gravity
13
Q
Postural Fixation Reactions
A
Stabilize the body against thrust force
14
Q
Dynamic POSTURE/BALANCE
A
- COG falls outside BOS
- maintaining stability during movements of body and body segments
- changing surface (walking)
15
Q
Functional Task Analysis (list)
A
- Mobility
- Stability
- Controlled Mobility
- Skill
16
Q
Mobility
A
Ability to move from one position to another safely
17
Q
Stability
A
- (static postural control)
- COM over BOS
18
Q
Controlled Mobility
A
- (dynamic postural control)
- maintain postural stability while moving w/ COM over BOS
- WEIGHT SHIFTING
19
Q
Skill
A
- Ability to consistently perform “coordinated movement” for purposes of INVESTIGATION/INTERACTION w/ environment
20
Q
Line of Gravity (LOG): Definition
A
Ideal posture, where body segment axes should fall
21
Q
LOG “ideal” position:
A
- slightly anterior to ankle and knee joints
- slightly posterior to hip joint
- thru midline of trunk
- anterior to shoulder
- thru external auditory meatus
22
Q
Center of Pressure (COP)
A
- Both VERTICAL and HORIZONTAL shear forces
- within foot unilaterally
- between foot bilaterally - LOG and COP constantly change b/c postural sway
23
Q
Center of Force (COF)
A
Only vertical forces
24
Q
Postural Sway
A
- shifts from SIDE to SIDE and HEEL to TOE
- STEADINESS:
- holding given posture w/ least amount of movement
- increased sway = increased unsteadiness
25
Limits of Stability (LOS)
Maximum angle from vertical that can be tolerated w/o loss of balance
- static standing = 12 degrees of motion in sagittal plane
- static standing = 16 degrees of motion in frontal plane
26
Sensory Processes for Balance Control
- Visual System
- Somatosensory Inputs
- Vestibular System
27
Visual System w/ Balance:
- Helps perceive movements via VISUAL PROPRIOCEPTION
- Exam:
- Focal Vision: central vision
- Ambient Vision: peripheral vision
28
CN Visual Deficits:
- CN II: depth perception, visual acuity
- CN III: lid droop, outward eye, dbl vision, decrease depth perception
- CN IV: head tilt, downward dbl vision, trouble w/ stairs (tripping)
- CN VI: inward eye posture, turns head towards affected eye
29
Somatosensory Inputs:
- Cutaneous and Pressure sensations
| - Muscle and Joint Proprioceptors
30
Sensory Input: Examination
- Romberg Test: assesses DORSAL COLUMN (eyes open/closed)
| - Sensory Testing:
31
Vestibular System:
- vestibulo-ocular reflex (VOR)
- vestibulospinal reflex (VSR) ("no" walking)
- labyrinthine righting reactions (LRR)
32
Vestibular System: Examination
- Ocular Fixation
- Smooth Pursuits
- Saccadic Eye Movements
- Convergence
- VOR
33
Vestibular System: Treatment
- Canalith Repositioning Treatment (CRT)
- rapid repositioning of head to move crystals (periph def)
- Habituation Exercises
- repeated positioning of pt in positions to elicit symptoms
- Gaze Stability Exercises
- Postural Stability
34
Motor Processes: Automatic Postural Synergies
- Ankle (Romberg)
- Hip
- Stepping (reaching/grasp) (nudge)
- Suspension (crouching down)
35
3 movement systems CNS uses to regain balance
- Stretch Reflex (ankle, hip, step strategies)
- Automatic Postural Reactions (righting/equilibrium)
- Voluntary Responses (cortical)
36
Static Tests:
- Single Limb Stance (SLS or OLST)
- Romberg Test
- Tandem Romberg Test
37
Dynamic Tests
- Functional Reach Test (FR)
| - Multidirectional Reach Test
38
Berg Balance Scale (BBS)
- originally for stroke pts
- static and dynamic tests (14 functional tasks)
- 5-point ordinal scale ; 56 total points
- fall predictor
- 54 to 36, each 1 point = 7% increase fall risk
- <45 = high fall risk. <36=100% fall risk
39
Berg Balance Scale: functional tests (14)
1: sitting to stand in
2: standing unsupported
3: sitting unsupported feet on floor
4: standing to sitting
5: transfers
6: standing unsupported w/ EC
7: standing unsupported w/ feet together
8: reaching forward w/ outstretched arm
9: pick up object from floor
10: turning to look behind L and R shoulders
11: turn 360 degrees
12: alternating step stool touches
13: standing unsupported, one foot in front
14: standing on one leg
40
Fullerton Advanced Balance Scale (FAB)
- for higher functioning older adults who pass BBT
| - 10 items, scored 0-40 (0-bad, 40-good)
41
BESTest
- tests multiple aspects of postural control
- 36 items in 6 groups:
Biomechanics constraints
Stability limits
Anticipatory transitions
Postural responses
Sensory orientation
Dynamic gait
