Week 10 (parts 1 and 2) Flashcards
(25 cards)
part 1
balance, coordination, proprioception
what is postural control
Postural control is the element of motor control that controls our balance and posture
In order to move effectively we need to be able to:
1. Recover from instability
2. Anticipate and move in ways to prevent instability
Postural control includes the mechanisms the body uses to be:
1. Stable
2. Orientated (relationship between body parts and relationship between body, task and environment)
Postural control is also called balance control
Sensory system involvement:
* As with motor control postural control is reliant on sensory (afferent information)
what is useful analogy for the difference between motor and postural control
I think of postural and motor control a bit like a house.
Motor control is the walls and roof – on show and very functional
Postural control is the foundations – no one sees them and doing all the hard work
BUT if you have no foundations the minute the going gets tough the walls will fall down
Similarly postural and motor control – your movement would all go to pot if you did not have underlying postural control
what is balance control
Anticipatory Postural Adjustments
Predictive control of balance
Predictive contraction of muscles to resist whole body movement
Postural Adjustments
Ankle strategy
Hip strategy
Stepping mechanism
NOTE – stretch reflexes have been shown to assist in standing balance – when you sway forwards it stretches calf which by reflex contracts to return you back to upright (& same for lean backwards causing reflex excitation of tib ant!)
People with extremely impaired/no foot & ankle sensation (amputees/diabetics) CAN maintain balance through more proximal muscle/joint proprioception!
Body is v.cool!
“Postural control is defined as the act of maintaining, achieving or restoring a state of balance during any posture or activity. Postural control strategies may be either predictive or reactive, and may involve either a fixed-support or a change-in-support response. Clinical tests of balance assess different components of balance ability. Health professionals should select clinical assessments based on a sound knowledge and understanding of the classification of balance and postural control strategies.”
what are motor and postural control vital for
Balance - when the line of gravity is within the base of support and we have stability
Co-ordination: “The harmonious working together, especially of several muscles or muscle groups in the execution of complicated movements”https://www.medilexicon.com/dictionary/20262
Motor control and postural control require:
Proprioception is defined as “the conscious or unconscious awareness of body position in 3D space”
what is centre of mass
Centre of Mass (CoM) = the point which is the centre of all the particles that make us (our mass).
what is centre of gravity
Centre of Gravity (CoG) = the hypothetical point at which all the weight of the body or object is concentrated, where all linear & angular forces are balanced & gravity passes through.
what is line of gravity
Line of Gravity = vertical line downwards from CoG to ground.
what is base of support
Base of Support (BOS) = the area beneath the body that is encompassed when one continuous line connects all points that are in contact of the ground.
what is balance
BALANCE = when LoG is within BoS = stability
Unstable = When LoG moves outside BoS; a reaction is needed to re-achieve balance /stability
CoM in standing is just in front of the sacrum
If you raise your hands above your head your CoM will pretty much stay the same but CoG will raise.
As you can see here the CoG CAN actually be OUTSIDE the body!!!
A larger BOS increases stability (the line of gravity must move a greater distance to fall outside the BOS)
A lower COG increases stability (it’s unlikely that the line of gravity will fall outside the BOS)
Balance in Action:
Feel what happens to your CoM/CoG/LoG when you stand on one leg
It moves to the weight bearing leg
Now stand next to a wall & try to lift the outer leg!*
What if someone tries to push you over?
What do you do to make yourself more stable?
What worked?
INCREASE BoS
LOWER your CoG
Split stance
The opposite is also true, that reducing BoS and increasing height of CoG will decrease stability
Requirements for balance (or to keep your line of gravity in your base of support)
Available active and passive range (ROM)
Sensory information – vision, vestibular input, somatosensation, proprioception
Neuro-muscular integrity
Changes with:
Age*
Cognition
Environment
Other altered senses (vestibular system or sight)
Disease/injury
what is the control of balance
The control of balance is a complex interaction involving the integration of sensory (afferent) information in order to produce appropriate motor output.
To maintain upright (and be still!) all the forces acting on the body (internal and external) must be opposed/equal – Newton’s first law!
Try closing your eyes and standing still – feel the muscles that kick in to return you to upright
But there are constantly perturbations acting on the body which if not opposed would cause us to lose balance (e.g. coughing, reflexes, volitional movement)
The central nervous system is constantly watching for, predicting and reacting to these perturbations to ensure we do not fall
how can you assess balance
Single leg stand (eyes open/eyes closed)
Star Excursion
Star excursion balance test
Y balance
Y-Balance test
Reaching distance
Berg balance scale – see canvas
Berg balance Scale
Tinetti
Tinetti
Activities specific balance confidence scale (ABC)
ABC
Timed up and go (TUG)
Timed Up and Go
what happens when your balance isnt good
FALLS - Cost the NHS £2.3 billion per year
Cost also includes distress, pain, injury, loss of confidence, loss of independence and mortality
30% of people over 65 and 50% of people over 80 fall at least once a year
Recommends a multi-factorial assessment and interventions
Includes assessment of gait and balance, mobility and muscle strength (e.g. Timed up and go, Tinetti, Berg)
Recommends strength and balance training
NICE Guideline CG161 Falls in older people: assessing risk and prevention (2013)
what factors into coordination as well as balance
A lot of what we have discussed regarding balance applies to co-ordination too
Neuromuscular control
Sensory information
Available range
Motor control
The cerebellum (part of the brain – looking forward to neuro A&P!) is central to the production of co-ordinated movement
It integrates sensory information and information about body position, movement and ongoing activity.
It shares this information with other sensorimotor systems in order to produce smooth co-ordinated movement
E.g. biceps (agonists) working, triceps (the opposite muscle and therefore antagonist) relaxed
how do you assess coordination
Co-ordination assessments
Finger-nose
Finger Nose
Heel-shin
Heel Shin
SARA (for ataxic patients)
Subjective assessments of dexterity e.g. tying shoe laces, undoing and doing up buttons, ability to manipulate a smart phone
what is proprioception
Proprioception is defined as “the conscious or unconscious awareness of body position in 3D space”
It requires integrity of peripheral joint position sense and motion sense and the transmission of this information through nervous system to brain (feedback) for interpretation
mechanoreceptors in muscle (spindles) = info about muscle length
In tendons (golgi-tendon organs) = info about muscle tension
Cutaneous receptors (in skin)
In other words; if you close your eyes and I ask you to lift a cup up – you can do it because you know where your arm is and how much the cup weighs. That is because your proprioception is intact. This is reliant on feedback that comes from receptors in your joints/muscles/tendons
In order to have normal balance and co-ordination we talked about needing to have sensory information.
Proprioception is one (big!) element of the sensory information that we need in order to balance and have co-ordinated movement
Proprioception is integrated along with somatosensation, vision and vestibular information to inform us how to move smoothly
If your proprioception is poor you are at greater risk of injury – for instance in terms of the ankle – if you have poor awareness of what position your ankle is in then when you roll your ankle you are less likely to respond to the fact that your ligaments are on a stretch and therefore more likely to be injured. Equally if you roll your ankle and sprain it then your proprioception may be further reduced – a vicious circle!
It is worth noting that if the patient has an ankle injury then there may be damage to the receptors around the ankle but over time this can lead to altered proprioception throughout the limb due to adaptations in the brain
how do you assess proprioception
No quantifiable assessments of proprioception have been developed. So assessment is done functionally:
Is the joint up or down
Proprioception Testing
Hold the body part in question
Patient closes their eyes
Place the limb in a specific position
Let go & ask patient to reproduce same position either ipsilaterally (on the same side) or contralaterally (on the opposite side)
Assess their accuracy
Assist patient to a posture - come out of it - can they find it again
Ask functional questions – can they stand on a bus or do they have to hold on?
why are balance, coordination and proprioception important
All the above (balance, co-ordination and proprioception) influence how we move & function
MANY pathologies/diseases/injuries result in loss in one or more of these areas and have either direct or subsequent negative impact on balance/co-ordination/proprioception
BUT
Many can be changed or altered through the use of appropriate therapeutic exercise – or rehabilitation or physiotherapy!
Its relevant to all of us!*
part 2
health promotion and self-management
what is self-management
■ ‘Any form of formal education or training for people with long-term conditions that focuses on helping people to develop the knowledge, skills and confidence to manage their own health and care effectively’ (NHS England, 2016)
– Strong self-efficacy is vital to self-management – it leads to better health outcomes
– What is self-efficacy?
– What does this mean to you?
– How do we promote it in our patients?
what are the key components of self-management
setting goals, reflection, self discovery, problem solving, taking action, decision making, taking risks, collaboration
why is health promotion vital
■ Promoting health is vital to neurological rehabilitation
– Preventing onset of diseases
– Slow or stopping diseases that have been diagnosed, prevention of secondary complications or diseases
– Reducing impairments and activity restrictions
– Can you think of any examples of how health promotion might have a role in these three scenarios – think about stroke, MS and PD?
– What does health promotion actually involve?
what are the self-management principles and examples
■ It is more than just education
■ Listening
■ Goal-setting
■ Break down tasks into smaller achievable components
■ Reflection
■ Problem solving
■ Knowledge
■ Action plans
■ Self-discovery
■ Resources
■ People with lack of sensation learning to check their skin for marks or injuries
■ People at risk of chest infections ensuring they have warm homes and take early action if they feel unwell
■ Taking regular exercise to prevent deterioration of their condition
what are some health promotion examples
■ Regular exercise
– ACSM for adults with chronic health conditions and disabilities:
■ 150 mins to 300 mins moderate intensity or 75 mins vigorous intensity aerobic activity per week
■ Strength training twice a week
■ If unable to meet this guidance avoid inactivity
■ Smoking cessation
■ Dietary advice
■ Compliance with medications
■ Rehabilitation
