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therex test 2
210: exercise for impaired balance
| Question | Answer |
|---|---|
| Balance or Postural Stability | - A term used to describe the dynamic process by which the body's position is maintained in equilibrium - Center of gravity is maintained over the base of support |
| center of mass | perfect equilibrium |
| center of gravity | vertical projection of COM to the ground |
| base of support | perimeter of contact area between body and it's support surface |
| limits of stability | sway boundary within ability to maintain equilibrium. 8 deg fwd, 4 deg bwd for normal sway. 8 degrees each side/side |
| ground reaction forces and center of pressure | push back from the ground. Newton's law (for every action, there is an equal and opposite reaction) |
| In normal people the ____ is situated over the _____ (feet). In a person with abnormal COG—they must employ a strategy to maintain balance | COG, BOS |
| where is center of mass in human body | S2 |
| systems of the body that maintain balance | vestibular, proprioceptive/somatosensory, visual |
| Visual system provides information about | - position of head relative to environment - Orientation of head to maintain level gaze - Direction and speed of head movements |
| Somatosensory (Proprioceptive) system provides information about | - Position and motion of body and body parts relative to each other and support surface - Information from muscle spindles and GTO, mechanoreceptors |
| when is somatosensory (proprioceptive) system used? | when surface is firm, flat, and fixed. |
| vestibular system provides information about | - position and movement of head with respect to gravity and inertial forces |
| what part of vestibular system detects fast acceleration of the head? (rotational, angular movements - walking or during fall) | semi circular canals |
| what part of vestibular system detects acceleration and head position in relationship to gravity (linear movements)slow, postural sway | otoliths |
| Vestibular system gives no information about ______ by itself—must have information from _____ and ____ system | body position, somatosensory, visual |
| what system is dominant when there is a conflict between proprioceptive and visual cues and for postural stability during ambulation | vestibular |
| sensory organization | vision, vestibular, somatosensory |
| sway referenced vision | when the visual field moves with sway (wall moves—should see small adjustments here, i.e. ankle strategy) |
| swat referenced support | support surface moves with sway |
| tests for sensory integration/balance | - Foam and Dome, Romberg Test - Additional Tests: Reach test, Berg Balance, Tinetti, TUG |
| the ____ suppresses inaccurate information | CNS |
| what system is primary for upright postural control | visual |
| what system contributes mostly to normal quiet stance | somatosensory |
| types of balance control | - static - dynamic - automatic |
| static balance control | Maintain an antigravity position at rest - standing and sitting |
| dynamic balance control | Stabilize the body when a support surface is moving OR when the body is moving on a stable surface (sit to stand, transfers) |
| automatic postural reactions | Maintain balance in response to unexpected perturbations |
| ankle strategy | - Small perturbations, quiet stance |
| weight shift strategy | - Medial/lateral perturbations |
| where does weight shift strategy often occur | - Primarily occurs at hips |
| suspension strategy | - Lowers COM quickly flexing hip and knees - Can be combined with ankle, weight shift |
| hip strategy | - Large perturbations or COG near limits of stability - Rapid hip flexion/extension |
| how would you train hip strategy | incorporate perturbations, stepping over/around objects, stepping off of a moving surface onto a non moving surface, train according to the environment |
| stepping strategy | COM beyond limits of stability a step is taken to enlarge BOS |
| Patient must have adequate ROM and strength to employ ____ , and ____ strategies | hip, stepping |
| 3 things that can cause impaired balance | - deficits with aging - deficits with medications - vision |
| aging balance deficits | - Declines in all three sensory systems - Difficulty when relying solely on vestibular system |
| what medications can cause balance deficits | - Hypnotics - Sedatives - Anti depressants |
| Increased fall risk with decreased ____ strength (below grade 4) | LE |
| what posture increases risk of falls | forward head |
| Increased falls with decreased ankle ___ | DF |
| Increased falls with decreased ____ strength | quad |
| Increased falls with decreased ____ strength, especially reaching tasks | PF |
| reasons for senior falls | pushing something, pulling something, turning, grabbing an object |
| Balance _____ is better than with non-slip socks | barefoot (maybe—but regular socks definitely decreases balance) |
| one study showed ____ can improve balance | OTS (off the shelf orthotics) |
| Fear of ____ may negate gains made through rehab | falling (don't use fear based tactics- sell independence) |
| vit ____ is very important for preventing falls | D - bone integrity |
| balance training to improve static balance control | Sitting, ½ kneeling, Tall kneeling, Standing on firm surfaces, Tandem, single leg stance. Can do each EO or EC |
| be very ____ about how you want patients to their balance exercises at home | specific (do you want them in corner, does someone need to supervise them?) |
| how can we train dynamic balance control | Maintain balance control on moving or unstable surfaces |
| progression for dynamic balance exercises | Progress by shifting bodyweight, moving UEs, LEs, head, excursion of extremities to further away from body, from double leg to single leg |
| is single or bilateral UE moving more disturbing to balance | bilateral |
| Internal Perturbation | Voluntary movement of the body |
| External Perturbation | Forces applied to the body |
| Both internal and external perturbation require activation of _____ but some are anticipatory (internal) or reactive (external) | mm synergies |
| how can we train anticipatory balance control | Reach in all directions, Use different postures for variation and progression i.e., sitting, kneeling, standing, Use different heights of reach, Vary speeds |
| anticipatory balance is a feed ____ system | forward |
| why is marching a good balance exercise for elderly pts | forces them to weight shift and increases single leg stance time |
| what does gait look like when someone is afraid of falling | smaller steps, shuffle, grab onto stuff, decreased arm swing, slower gait speed, decreased foot clearance (everything smaller) |
| how can we train reactive balance control | Emphasize ankle, hip, stepping strategy, etc; Add anticipated and unanticipated external forces |
| reactive balance | ability to respond effectively and prevent a fall following a loss of balance; the loss of balance could be cause by an external source (e.g., hit or bump) or by a failure to control balance during voluntary movement (i.e., an "internal perturbation) |
| Perturbations need to be _____ to be most effective | randomized |
| overall principles for progressing balance training | Move from stable to unstable, Move from wide BOS to narrow BOS |
| Challenge balance by taking vision away (reliance on _____ and ______) | vestibular, somatosensory |
| how can you challenge the vestibular system? | head tilt manuvers |
| Tai Chi for Balance | many studies show it can help improve balance, whole body movements performed in a slow, relaxed manner with an emphasis on awareness of posture alignment and synchronized breathing |
| what does OTIS stand for | oscillating technique for isometric stabilization |
| purpose of OTIS | train peripheral mechanoreceptor input and process signals to efferent responses |
| Without good training, the time it takes to ____ is greater than the time it takes from ____ loading to rupture | react, ligament |
| ____ ms between ligament loading and rupture | 80-90 |
| ____ ms between ligament loading and initiation of ligamento-muscular reflex | 40-80 |
| ____ ms between ligament loading and the initiation of volitional muscle contraction (at cortex level) | 150 |
| motor responses occur at the | spinal cord (joint receptors), brain stem (integrates visual and vestibular information) |
| what is the role of cerebral cortex in balance | process proprioceptive info |
| safety for balance training | gait belt, use parallel bars or near railing, stay away from other equipment, get help with high risk pts, guard pt getting on and off equipment |
| evidence based balance programs | OTAGO, SAIL, Matter of Balance, Tai Ji Quan: Movement for Better Balance, Tai Chi for Arthritis for Fall Prevention |
Created by:
bdavis53102
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