Quiz 4: Balance/Transfers + Bed Mobility

Question 1

Impairments Affect Function

• basic movements are needed for___
• how are transfers defined?
• what can limit mobility and transfers?

Answer 1

• basic movements are needed for mobility
• Transfers-operationally defined as a movement or a series of movements organized to get from one position to another
• difficulty in range, strength, control, sensation etc can limit these

Question 2

Name 4 Transfers:

Answer 2

1. sit stand
2. sit sit
3. supine sit
4. supine sidelying

Question 3

Sit Stand

Things to consider (3)

Answer 3

1. amount of assist needed
2. where assisted (hand placement, amount of force, phase)
3. use of hands (where patient puts his hands)

Question 4

Sit  Stand 
critical components 
1. \_\_ to edge of the mat
2. \_\_\_ flexion
3. Knee flexion past \_\_
4. Ankle dorsiflexion past \_\_  
5. \_\_\_ weight shift
6. extension of \_\_, \_\_\_, \_\_\_,\_\_\_
7. \_\_\_\_ in standing

Answer 4

1. IT to the edge of the mat
2. trunk flexion (or trunk extension with hip flexion)
3. knee flexion past 90 degrees
4. ankle dorsiflexion past 90 degrees
5. forward/diagonal weight shift
6. extension of trunk, hips, knees, ankles, plantarflexion
7. stabilization in standing

Question 5

stand to sit: what to tell patient

eccentric or concentric of ___

Answer 5

reach for floor, forward weight shift as sit back down

unwinding
controlled descent
eccentric control of extensors (lengthen them)

hands free stand to sit even if cannot stand without hands

Question 6

Stand to sit considerations (4)

Answer 6

1. use of hands
2. height of seated surface
3. seating surface stability
4. seated surface angle (sometimes it is tilted back, sometimes it is cushy)

Question 7

30 second sit to stand test:

1. what is it
2. what score correlates with high falls risk? In what patient types (2)?
3. quality vs quantity

Answer 7

do as many sit to stand as possible in 30 seconds

1. hands free
2. less than 8 reps correlates with high falls risk for community dwelling elderly and CVA
3. assess quantity not quality (assess of falls risk is quantity)

Question 8

Rolling/bed mobility (3)

Answer 8

supine sidelying
sideliying prone
sidelying sit

log roll: roll body as one unit vs a segmental roll

supine to sit if abs are strong, rare

Question 9

Berg Question 1

Sit –>Stand

Answer 9

Stand without hands for support

4: stand independently without using hands and stabilize independently

Question 10

Berg Quetion 2

Standing Unsupported

Answer 10

Stand for 2 minutes without holding

4: able to stand safely for two minutes

Question 11

Beg Question 3

Sit with back unsupported but feet supported on floor or stool

Answer 11

4. Able to sit securely for 2 minutes

3. with supervision

Question 12

Berg Question 4

Standing to Sitting

Answer 12

4. Able to go stand –> sit without using hands

Question 13

Berg Question 5

Transfers

Answer 13

Pivot transfer: one way to a seat with armrests and one way to a seat without armrests
4. Able to transfer safely with minor (or without) use of hands

Question 14

Berg Question 6

Stand Unsupported With Eyes Closed

Answer 14

4. able to stand 10 seconds safely

• -if sway more than normal
• someone with a lesion will sway because lack proprioception

3. need supervision
4. not able 3 seconds
5. cannot do with eyes closed
6. needs help to not fall

Question 15

Berg Question 7

Stand Unsupported with Feet Together

Answer 15

4. Able to independently place feet together and stand for one minute safely

Question 16

Berg Question 8

Reaching Forward With Outstretched Arm While Standing

Answer 16

Pt lift arm 90 degrees flexion and stretch out fingers to reach forward as far as he can
examiner places a ruler at the end of fingertips when arm is at 90 degrees. fingers should not touch ruler when reaching forward. measure taken when pt is in most forward leaning position

4. can reach forward confidently >25cm (10 inches)
5. 12
6. 5
7. need supervision
8. lose balance

Question 17

Berg Question 9

Pick up object from the floor from standing position

Answer 17

can be done in anyway as long as do not grab onto something for support
4. able to pick up slipper safely and easily

Question 18

What can Berg Question 9: Pick up object from the floor from standing position
Tell us for treatment

Answer 18

if they can reach down but cannot pick up the slipper we can practice reaching less low

Question 19

Berg Question 10:

Turning to look behind over left and right shoulders while standing

Answer 19

Turn to look directly behind you over towards the left shoulder, then repeat to the right. PT may pick an object to look directly behind at.
4. Looks behind from both sides and weight shifts well

Question 20

Berg Question 11

Turn 360 Degrees

Answer 20

turn completely around in a full circle. pause. then turn the other way
4. able to turn 360 degrees safely in 4 seconds or less [in both directions]

Question 21

Berg Question 12

Placing Alternate Foot on Step Or Stool While Standing Unsupported

Answer 21

Tap the front of the step: alternating right and left (20 seconds to do it)
4. able to stand independently and safely and complete 8 steps in 20 seconds

Question 22

Berg Question 13
STANDING UNSUPPORTED ONE FOOT IN FRONT

weakness of this question and what we tell them to do instead

Answer 22

Place one foot directly in front of the other: heel of one foot touching the toe of the other
4. Be able to get into the heel to toe position hold position 30 seconds without supervision

they put the strong leg behind, we want them to put the weaker leg behind–have them try both sides and look at the worse one

Question 23

Berg Question 14

Standing on One Leg

Answer 23

Stand on one leg as long as you can without holding

4. able to lift leg independently and hold for more than 10 seconds

Question 24

Items on the Berg Balance Scale

Answer 24

TEM DESCRIPTION SCORE (0-4)

1. Sitting to standing _____
2. Standing unsupported _____
3. Sitting unsupported _____
4. Standing to sitting _____
5. Transfers _____
6. Standing with eyes closed _____
7. Standing with feet together _____
8. Reaching forward with outstretched arm _____
9. Retrieving object from floor _____
10. Turning to look behind _____
11. Turning 360 degrees _____
12. Placing alternate foot on stool _____
13. Standing with one foot in front _____
14. Standing on one foot _____

TOTAL (maximum 56) _____
FALLS RISK BELOW 42

0–20, wheelchair bound
21–40, walking with assistance
41–56, independent

Question 25

Dynamic Gait Index | 1. Gait level surface _____

Answer 25

Instructions: Walk at your normal speed from here to the next mark (20’) Grading: Mark the lowest category that applies. (3) Normal: Walks 20’, no assistive devices, good sped, no evidence for imbalance, normal gait pattern

Question 26

Dynamic Gait Index | 2. Change in gait speed _____

Answer 26

Instructions: Begin walking at your normal pace (for 5’), when I tell you “go,” walk as fast as you can (for 5’). When I tell you “slow,” walk as slowly as you can (for 5’). (3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast and slow speeds.

Question 27

Dynamic Gait Index | 3. Gait with horizontal head turns ___

Answer 27

Begin walking at your normal pace. When I tell you to “look right,” keep walking straight, but turn your head to the right. Keep looking to the right until I tell you, “look left,” then keep walking straight and turn your head to the left. Keep your head to the left until I tell you “look straight,“ then keep walking straight, but return your head to the center. (3) Normal: Performs head turns smoothly with no change in gait

Question 28

Dynamic gait Index | 4. Gait with vertical head turns _____

Answer 28

Instructions: Begin walking at your normal pace. When I tell you to “look up,” keep walking straight, but tip your head up. Keep looking up until I tell you, “look down,” then keep walking straight and tip your head down. Keep your head down until I tell you “look straight,“ then keep walking straight, but return your head to the center. (3) Normal: Performs head turns smoothly with no change in gait.

Question 29

DGI | 5. Gait and pivot turn _____

Answer 29

Instructions: Begin walking at your normal pace. When I tell you, “turn and stop,” turn as quickly as you can to face the opposite direction and stop. (3) Normal: Pivot turns safely within 3 seconds and stops quickly with no loss of balance

Question 30

DGI | 6. Step over obstacle ____

Answer 30

Instructions: Begin walking at your normal speed. When you come to the shoebox, step over it, not around it, and keep walking. (3) Normal: Is able to step over the box without changing gait speed, no evidence of imbalance.

Question 31

DGI | 7. Step around obstacles _____

Answer 31

Instructions: Begin walking at normal speed. When you come to the first cone (about 6’ away), walk around the right side of it. When you come to the second cone (6’ past first cone), walk around it to the left. (3) Normal: Is able to walk around cones safely without changing gait speed; no evidence of imbalance.

Question 32

DGI | 8. Steps _____

Answer 32

Instructions: Walk up these stairs as you would at home, i.e., using the railing if necessary. At the top, turn around and walk down. (3) Normal: Alternating feet, no rail. (2) Mild Impairment: Alternating feet, must use rail. (1) Moderate Impairment: Two feet to a stair, must use rail. (0) Severe Impairment: Cannot do safely

Question 33

Total Score DGI

Answer 33

24

Question 34

Spastic Diplegia Gait

Answer 34

2 extremities affected, lowers more than uppers - Flex hip/flex knees/PF toes - IR hip - high guard arms - no weight shift, pure sagittal plane movement video: foot slaps, no weight shift, wide BOS< lack of knee flexion??, no arm swing, quadricep spasticity lacking knee flexion, pelvic retraction, using momentum

Question 35

Spastic Hemiplegia Gait

Answer 35

one side affected -arms flexed/adducted/IR in high guard -drag affected leg with circumduction due to footdrop and lack of hip extension wide BOS

Question 36

How is balance is an Emergent Property?

Answer 36

--different motor skill emerge due to the constraints of the task, the individual, and the environment All movement is therefore emergent The CNS organizes movement to meet the constraints

Question 37

what does balance achieve?

Answer 37

keep center of mass over base of support

Question 38

What is the Motor Control Model? (3)

Answer 38

Balance is an interaction between: 1. the balance task 2. the environment the task is occuring in 3. the individual performing the task each of these factors constrains the act of balance in a certain manner

Question 39

The Balance Task: what are its constraints? (3)

Answer 39

1. Spatial Constraints- space where the task is occurring in: how far do i have to move my body 2. Kinetic Constraints - how much force do i have to generate to accomplish the task (relax/contract muscles) 3. Temporal Constraints- at what speed do i need to move to accomplish the task

Question 40

The Balance Environment: what are its constraints? (4)

Answer 40

1. Surface the individual is standing, sitting, balancing or rolling on (height, firmness) 2. Temperature (MS affected by heat, PD affected by cold) 3. Light (if poor sensation so rely on vision) 4. Medium (air, water, snow...)

Question 41

The Balance Individual Factors: what are its constraints? (10)

Answer 41

1. Spinothalamic: sensation 2. Dorsal Column/medial lemniscus: sensation [proprioception and kinesthetic] 3. Force Production (strength: central and peripheral components) 4. Motor Control: correct force, correct time, initiating and terminating appropriately [correct grading] 5. ROM 6. Endurance 7. Attention (ie stroop test) 8. Mood 9. Vestibular [where PNS meetscerebellum, pons, vestibular cortex] 10. Vision (least important for balance)

Question 42

Balance Testing | --what limits balance and how must we therefore practice

Answer 42

- balance is a task and therefore we must examine the task - the task differs depending on the environment, therefore we must practice in different environments - individual impairments limit the individuals ability to complete the task

Question 43

How can we use balance test in treatment?

Answer 43

- look at specific balance task that the individual is having difficulty with - what impairments are preventing effective completion of the task - tx then becomes remediation of the underlying impairments with graded practice of the task

Question 44

How may pathology affect balance test?

Answer 44

depending on pathology (CVA, MS, TBI) the individual impairments may differ MS: poor endurance will result in poorer balance when fatigued than otherwise PD: initiation of balance strategies will be delayed

Question 45

Task Specific Balance Scales

Answer 45

1. Berg Balance Scale 2. Dynamic Gait Index 3. Time Up and Go Test 4. Mini Best Test

Question 46

ankle balance strategy

Answer 46

ankle (push back and toes come up, push forward and heels come up) hip (flexion/extension) step (if neither ankle or hip work, then use step strategy)

Question 47

Berg Balance Scale 1. what does it test 2. how many items 3. what kind of scale, how is it graded 4. how it acts/what is the purpose 5. what is it based on

Answer 47

1. Tests standing balance 2. 14 items on an ordinal scale 3. items are graded 0-4 4. Acts as a screen: 56 is perfect score, 42 or less is correlated with 100% falls risk 5. based on functional movements: the movements that the patient has difficulty with can therefore become interventions screen above or below 42 lets you know what functional issues are limitations weakness: only loos at stand/sit not at balance during gait

Question 48

Dynamic Gait Index 1. what does it test 2. how many items 3. what kind of scale 4. how is it graded 5. what is the purpose 6. what is it based on

Answer 48

1. Tests balance during gait 2. 8 items on an ordinal scale 3. Items are graded 0-3 (0-normal /1: mild impair/ 2: moderate impair / 3: severe impair) 4. Acts as a screen: score below 19 is a high falls risk 5. based on functional gait movements: the movements that the patient have difficulty with become interventions -more provocative and solves the problem of the 25 ft walk test that only looks at speed