Posture, Balance, and Gait Changes

Question 1

Reactive postural control

Answer 1

Governs unexpected movements of COM within or outside BOS

Perturbations

Question 2

Anticipatory postural control

Answer 2

Postural adjustments made before a movement

Tossing a ball

Question 3

Adaptive postural control

Answer 3

Modification of a motor response due to a change in environmental conditions or task demands

Incline

Question 4

Younger input from…

Answer 4

Visual input birth-3

Question 5

Adult input

Answer 5

Somatosensory

If impaired, vestibular system kicks in

Question 6

Eye-head stabilization

Answer 6

Eyes and labyrinths (establish difference btwn egocentric and exocentric motion)

Provide orientation of head in space

Question 7

Egocentric motion

Answer 7

Body moves

Question 8

Exocentric motion

Answer 8

Environment moves

Question 9

MSK system

Answer 9

Regulated by viscoelastic properties of mm, GTO, and DESCENDING motor control

Question 10

Motor coordination

Answer 10

Ability to coordinate mm activity to control performance

Requires appropriate mm tone and anti-gravity strength

Question 11

Ankle strategy

Answer 11

Distal to proximal activation for ant/post stability

Question 12

Hip strategy

Answer 12

Proximal to distal activation for ant/post stabilization

Question 13

Step strategy

Answer 13

All planes

If ankle and hip strategy aren’t enough to re-establish COM within BOS

Question 14

Predictive central set

Answer 14

Postural readiness

3 purposes for anticipatory postural adjustments

1. Keep postural disturbance to a minimum
2. Prepare for movement
3. Assist in development of force or velocity

Question 15

Righting rxns

Answer 15

Orienting head with horizon

Question 16

Equilibrium rxns

Answer 16

Balancing over a point

Question 17

Nashner Model of Postural Control and Stance

Answer 17

Less BOS? More use of hip strategy

Question 18

Eyes open v eyes closed balance testing in children

Answer 18

Vision should not be occluded during first three years due to relying on this input

Question 19

Fxl reach test

Answer 19

Self-perturbed balance and fall risk

Question 20

Clinical test of sensory integration and balance

Answer 20

Foam and dome

Question 21

Posture and movement changes with age

Answer 21

Older adults more variable

Floor to stand more asymmetrical

Question 22

Posture and balance decline because…

Answer 22

Change in static posture
Loss of flexibility, mm strength, mm tone
Vestibular impairments
Sensory input and integration
Visual changes
Medications and poly-meds

***Many changes due to inactivity and lack of practice

Question 23

Postural changes with age

Answer 23

Increased kyphosis

Question 24

Loss of flexibility and decreased postural rxn leads to…

Answer 24

Less organized motor patterns

Diminished motor coordination

Question 25

When to use hip strategy

Answer 25

Unstable surface Smaller BOS Fast moving environment

Question 26

Visual changes with age

Answer 26

Less ability to pick up contours and depth cues

Question 27

Vestibular changes with age

Answer 27

Loss of hair cells that sense direction of endolymph in semicircular canals

Question 28

Vestibular nerve (VIII) changes with age

Answer 28

Reduction in number of fibers

Question 29

Vibratory sense changes with age

Answer 29

Declines in LE

Question 30

Tripping over your own feet

Answer 30

While ankle and hip were most important, there are studies showing that stepping strategies are more important in recovering balance Training stepping pattern is more important Older adults tend to cross-over or collide limbs when utilizing stepping strategies

Question 31

Anticipatory postural adjustments stabilize...

Answer 31

PRIOR to voluntary movement

Question 32

Rxn time in adults

Answer 32

Negatively affected

Question 33

Longer onset latencies in postural mm...

Answer 33

LE > UE

Question 34

Torque generating capacity

Answer 34

Decreases with age Example: hip ABD

Question 35

Static postural control

Answer 35

Ensures stability by maintaining COM within BOS

Question 36

Independent ambulation by...

Answer 36

11.5 mos (50% of infants)

Question 37

Critical variable in development of independent ambulation

Answer 37

Extensor mm strength

Question 38

Initial gait pattern

Answer 38

``` Wide BOS Arms in high guard px Short swing phase Lack of heel strike and push-off ER of hips ```

Question 39

2-3 years old and ambulation patterns

Answer 39

Reciprocal arm swing | Heels strike

Question 40

3-4 years of age and ambulation

Answer 40

Narrowing of BOS | Increased time in single limb stance

Question 41

Children ambulation

Answer 41

Mature gait pattern kinematics by 4 years | Consistent heel strike and knee flexion in early stance

Question 42

7 years old and ambulation

Answer 42

COM at L3 Adult kinematic pattern more refined May see further refinement of spatial and temporal aspects of gait up to 15 years of age

Question 43

4-7 years ambulation

Answer 43

You can pick out normal adult gait cycle

Question 44

Key parameters that show change as gait matures to an adult level (4)

Answer 44

1. SLS duration increases with age and maturation 2. Walking velocity increases with age and limb length 3. Cadence decreases with age and limb length 4. Step length increases with age and limb length

Question 45

Normal aging gait changes

Answer 45

``` Decreased gait velocity Decreased stride length Decreased peak knee extension ROM Decreases knee flexion in swing Slightly increases ankle dorsiflexion Decreased ankle PF power ```

Question 46

Decreased strength and ambulation

Answer 46

Increased pelvic tilt (weak abs) Decreased vertical displacement of body during gait Decreased gait velocity Decreased cadence (decreased DF strength)

Question 47

Decreased balance and ambulation

Answer 47

Increased BOS Decreased gait velocity Increased time in double limb support Increased use of visual scanning

Question 48

Fall

Answer 48

Unexpected event in which an individual comes to rest on the ground, floor, or lower level

Question 49

Older adult fallers gait characteristics

Answer 49

Comparison to NON-FALLERS Decreased stride length Decreased walking speed and cadence, especially with dual task Increased double support time, especially with dual task Conservative approach when negotiating an obstacle (smaller steps) Mediolateral instability Greater stride freq across various gait speeds Inability to maintain peak gait speed Increased stride to stride variability

Question 50

Sometimes adults have higher gait speed. Why?

Answer 50

They don't like walking and want to get it over with Decreased time on single limb Use momentum so they don't utilize as much energy

Question 51

Mediolateral instability

Answer 51

More predictive of falls

Question 52

Factors contributing to falls in older adults (9)

Answer 52

Difficulty corralling COM when perturbed Greater mediolateral instability Difficulty modulating step length to avoid obstacles Decreased speed Decreased step length Slower rate of ankle torque development in trip response Increased difficulty in performing another task while walking Decreased hip ABD torque generating capacity Decreased trunk axial rotation

Question 53

Fall Prevention Intervention Strategies (5)

Answer 53

``` Reduce risk factors Multifactorial fall risk assessment PA and balance training Higher risk? Home Hazard Assessment Low heel and resistant-soled shoes should be worn inside and outside the home ```

Question 54

Fall Risk Factors

Answer 54

``` Mm weakness History of falls Gait deficit Balance deficit Use of assistive device Visual deficits Neurological deficits Arthritis Impaired ADL's Depression Cognitive impairment Age > 80 years Medication Cardiovascular deficits ```

Question 55

Therapeutic exercise + balance training =

Answer 55

Increased... ``` Balance LE strength Safety Physical and functional capacity Ability to perform IADL's and ADL's ```