- Functional Reach Test - Multidirectional Reach Test

- How many completed in 30 seconds - 5x Sit to Stand (15sec cutoff to predict recurrent fallers)

>30 seconds = needs assistance 12 seconds = at risk for falls

Week 11 Flashcards by Jennie Maurer

Postural Stability

ability to control center of mass in relationship to base of support

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Postural Orientation

ability to maintain relationship between body segments and between body and environment for a task

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Adaptive Strategies

Changes with demands of task and environment

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Anticipatory Strategies

“Pre-tune” sensory and motor systems based on prior learning

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Cognitive “Override”

Utilizing motivation, intent and attention to perform a task

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Vestibular Ocular Reflex (VOR)

stabilizes gaze during head movement

1:1 head:eye movement

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Vestibulospinal Reflexes (VSR)

Coordinates head and body movements to maintain head in upright position

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Tonic Neck Reflexes

ATNR (rotation) & STNR (extension/flexion)

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Medial Vestibulo-spinal Tract

-Cervical Connections
-Head Righting

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Lateral Vestibulo-spinal Tract

Adjust limb movement for balance (chicken head)

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Postural Control Responses (3)

Ankle
Hip
Stepping

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Steady State Balance (Degrees of Sway)

Anterior 8*
Posterior 4*
Lateral 6-8*

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Reactive Balance

Occurs in response to sensory feedback from an external perturbation, requires feedback control

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Proactive Balance

Postural adjustments are made in anticipation of voluntary movement, requires feedforward control

aka anticipatory balance

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Practical Definition of a Fall

Unintended contact with a supporting surface (walls/counters/ground)

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Activities of Balance Confidence (ABC)

16 items scored 0 to 100% confident in not loosing balance

50-80% = somewhat impaired
<50% = likely homebound

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Fall Efficacy Scale (FES)

10 items scored 1 to 10 confident in completing (reverse, 1 = high)

> 70 indicates person has fear of falling
80 indicates increased risk of falling

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Reach Testing

Functional Reach Test
Multidirectional Reach Test

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Sit to Stand

How many completed in 30 seconds
5x Sit to Stand (15sec cutoff to predict recurrent fallers)

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Timed Up and Go

> 30 seconds = needs assistance
<20 seconds - independently mobile for ADLs
12 seconds = at risk for falls

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Berg Balance Scale

Scoring 0 - 56
Norms:
60-69y/o = 55
70-79y/o = 53-54
80-89y/o = 50-53

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Performance Oriented Mobility Assessment (POMA)

Balance & Gait Assessment
<19 high fall risk
19-24 medium fall risk
25-28 low fall risk

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4 Square Step Test (FSST)

> 15 seconds (older adults) = at risk for multiple falls
24 seconds (stroke) = at risk for falls

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Clinical Test for Sensory Interaction in Balance (CTSIB)

6 sensory conditions
- firm vs foam surface
- eyes open, eyes closed, visual conflict dome

Scored subjectively 1 (minimal sway) to 4 (fall)

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Sensory Organization Test (SOT)

Computerized version of CTSIB

Function in Sitting Test (FIST)

14 items with scale 0-4 (level of assistance)

Dual Task Taxonomy

The concurrent performance of two tasks that can be performed independently and have distinct and separate goals

Novelty

Performer Characteristic

Complexity

Task Characteristic

Mini Mental State Exam (MMSE)

Total score = 30 High is good, low is cognitive impairment Often used with people with demensia

Montreal Cognitive Assessment (MOCA)

Total score = 30 High is good, low is cognitive impairment

Mini-BEST

14 items, scored 0, 1, 2 scoring worst side = max 28 points scoring both sides = max 32 points <22 balance deficits <20 recurrent fallers

Modified Systems Framework for Postural Control: Anticipatory Postural Control

Ability to shift the COM before a voluntary movement

Modified Systems Framework for Postural Control: Cognitive Influences

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

Modified Systems Framework for Postural Control: Dynamic Stability

Ability to exert ongoing control of COM when the BOS is changing

Modified Systems Framework for Postural Control: Limits of Stability

Ability to move the COM as far as possible in the anterior-posterior or medio-lateral directions within the BOS

Modified Systems Framework for Postural Control: Reactive Postural Control

Ability to recover stability after an external perturbation to bring the COM within the BOS through corrective movements

Modified Systems Framework for Postural Control: Sensory Integration

Ability to combine and/or re-weight sensory information for balance

Modified Systems Framework for Postural Control: Static Stability

Ability to maintain position of the COM in unsupported stance when the BOS does not change

Modified Systems Framework for Postural Control: Verticality

Ability to orient appropriately with respect to gravity, support surface and visual surround

3 Meter Backwards Walk Test

<3 sec = 75% did not report fall <4.5 sec = 94% did not report fall >4.5 sec = 81% DID report fall

Cognition

The ability to process, sort, retrieve and manipulate information

7 Domains of Cognition

- Executive Function - Problem Solving - Mental Flexibility - Memory - Processing Speed - Intelligence - Communication & Language

3 Factors affecting Cognition

1 - Arousal / Awareness 2 - Orientation 3 - Attention

Stroop Test

- Word and ink color the same - Word is different than its color

Long Term Memory - Procedural

Stores information about “how to do” specific activities

Long Term Memory - Semantic

Stores our general knowledge about the world based upon experiences

Long Term Memory - Episodic

Stores our knowledge about personally experienced events

Attention

Preparation for and performance of motor skills are influenced by our limited capacity to select and attend to information

Focused Attention

Focus on and respond to a specific stimulus

Sustained Attention

Sustain or keep attention over a period of time

Selective Attention

Focus attention in the presence of distracting stimuli (tune out specific things)

Alternating Focus

Shift focus of attention from one task to another

Divided Attention

Respond simultaneously to multiple tasks

Is the movement end-point location remembered better than movement distance?

Yes, end location is easier set into memory

Internal Focus

Internal sources of FB “How” does it feel to perform the movement?

External Focus

External sources of FB Environmental cues Expected movement outcomes

Does internal focus benefit the novice or skilled performer better?

Novice

Does external focus benefit the novice or skilled performer more?

Skilled Performer

Mental Practice vs. Physical Practice

#1 - Physical + Mental Practice 2 - Physical Practice Only 3 - Mental Practice Only 4 - No Practice

Mental Practice

Cognitive rehearsal of a physical skill in the absence of overt physical movements - EMG recordings show muscle activity during MP - Brain activity during imagery is similar to activity during actual performance - Helps learner answer “what to do” questions (cognitive stage)