L1 Balance Exam

Question 1

Postural control standing vs sitting

Answer 1

standing & sitting are the same = static, proactive, reactive

Question 2

Stable trunk for limb motion standing vs sitting

Answer 2

Standing = to allow for gait
Sitting = to allow for standing and gait

Question 3

Direction of control standing vs sitting

Answer 3

standing = A/P
sitting = lateral and A/P

Question 4

BOS standing vs sitting

Answer 4

Standing = feet
Sitting = feet, thighs, buttocks

Question 5

Somatosensory input standing vs sitting

Answer 5

standing = feet
sitting = feet, thighs, buttocks

Question 6

LE contribution standing vs sitting

Answer 6

Standing = multiple degrees of freedom
sitting = less degrees of freedom

Question 7

Verticality

Answer 7

ability to orient appropriately with respect to gravity

Question 8

Dynamic stability/balance

Answer 8

ability to maintain stable upright posture during self-initiated body or body-segment active movement

Question 9

Static stability/balance

Answer 9

ability to maintain stable upright posture without self-initiated movement

Question 10

Anticipatory/Proactive postural control

Answer 10

ability to activate muscles to shift the COM before a discrete voluntary movement
relies on fedforward motor control

Question 11

Reactive postural control/balance

Answer 11

ability to recover a stable position following an unexpected perturbation to bring the COM within the BOS through corrective movements

relies on feedback motor control

Question 12

Perturbation

Answer 12

deviation of an object from its normal state or path by an outside influence

Question 13

Sensory integration

Answer 13

ability to integrate all sensory systems inputs to influence selection of motor output to maintain postural control

Question 14

Sensory reweighting

Answer 14

ability to reweight sensory information when input is altered

individuals will reweight sensory input based on changes to environment. Individuals with impaired sensory systems will have limited ability to re-weight sensory info

Question 15

Cognitive influences

Answer 15

ability to maintain stability while responding to commands during the task or attend to additional tasks

Question 16

Postural constraint

Answer 16

a deficit in one or more balance resources that leads to impaired postural control or balance.

a body structure/function impairment can be the underlying cause of the postural constraint

Question 17

Balance emerges from the interaction of…

Answer 17

individual
task
environment

Question 18

Individual (postural control systems framework)

Answer 18

motor
sensory
cognitive

Question 19

Postural tasks (postural control systems framework)

Answer 19

proactive
reactive
steady state

Question 20

Environment (postural control systems framework)

Answer 20

support surfaces
sensory context
cognitive load

Question 21

Balance Resources

Answer 21

Biomechanical
Movement Strategies
Sensory Strategies
Orientation in Space/Verticality
Control of Dynamics
Cognitive Processing

Question 22

Biomechanical Resources

Answer 22

BOS
LOS
DOF (degrees of freedom)
Strength

Question 23

Movement Strategies

Answer 23

Strategies to maintain balance: Voluntary, Anticipatory, Reactive. Also includes ankle, hip, stepping, protective reactions.

Question 24

Protective Reactions

Answer 24

used to attempt to increase the BOS to either prevent the fall or to lessen injury if a fall occurs

protective extension
grasp for stable object

Question 25

Sensory Strategies

Answer 25

sensory information is integrated in the CNS to interpret complex sensory environment to create a motor plan to maintain equilibrium somatosensory, visual, vestibular

Question 26

Posturography

Answer 26

test and examine sensory conditions with technology

Question 27

Modified Clinical Test of Sensory Interaction in Balance

Answer 27

used for when you don't have technology Record time, including amount of sway or loss of imbalance, and recovery strategy

Question 28

Eyes open and firm surface

Answer 28

baseline observation for sway

Question 29

Eyes closed and firm surface

Answer 29

increased sway indicates balance problem, possible vestibular or somatosensory impairment

Question 30

Eyes open and on foam

Answer 30

increased sway indicates balance problem and visual or vestibular problem, OR over-reliant on somatosensory

Question 31

Eyes closed and on foam

Answer 31

increased sway indicates balance problem and likely vestibular problem OR over reliant on vision and somatosensory systems

Question 32

Orientation in Space/Verticality

Answer 32

-ability to orient the body parts with respect to gravity, the support surface, visual surround and internal references -healthy nervous systems automatically alter how the body is orientated in space depending on the context and the task

Question 33

Control of Dynamics

Answer 33

ability to control balance during gait and while changing from one posture to another. requires complex control of COM. body structure/function impairments in any part of this complex control system can interfere with control of dynamics stability during gait comes from placing the swing limb under the falling COM, essentially a controlled fall

Question 34

Cognitive Processing

Answer 34

control of posture and other processing share cognitive resources balance task difficulty increases or cognitive challenge increase, one will decline to compensate. If you have decreased cognitive processing, you will have decreased balance

Question 35

What is a significant risk factor for falling?

Answer 35

cognitive impairment less able to dual task

Question 36

What is the most dangerous patient subjective impression vs performance?

Answer 36

high confidence, low performance

Question 37

ABC scale

Answer 37

Activities-specific balance confidence scale most commonly used by PTs higher score indicates more confidence score below 67% indicates increased risk of falling

Question 38

Total score of balance exam

Answer 38

use to document severity of balance change over time of balance impairment predict fall risk and safety at home, guiding towards need for AD, helping decide if they need PT

Question 39

Item by Item of Balance Exam

Answer 39

gives you idea of what balance contraints and tasks need to be addressed