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Balance
| Question | Answer |
|---|---|
| defined as the point within a body where all of the mass can be concentrated; the center point from which the mass is evenly dispersed on all sides | Center of Mass |
| Center of Mass is also referred to as | Center of gravity |
| defined as the area between all of the contact points between a body and the supporting surface | Base of support |
| what type of compensations in Base of support might you see in a person with impairments in balance? | Wider Base of support Lateral force application Stance to increase stability anteriorly Base of support increases with crutches/ walker |
| the condition in which all of the forces acting on the body are equalized such that the center of mass (COM) is being maintained within the boundaries of the base of support (BOS). | Balance |
| defined as the maximum distance an individual is able or willing to lean in any direction without loss of balance or changing the BOS. | Limits of stability |
| The goal of posture is to.... | align the body segments to maintain the COM within the base of support |
| Ideal alignment is.... | the COM directly over the center of the BOS |
| The closer the COM gets to the limit of stability (or further from the center of BOS), the harder the body has to work to | Maintain Balance |
| When the COM moves outside the BOS, we respond by... | Moving our body or falling |
| A person’s limits of stability are influenced by multiple factors Name some: | Height, weight size of feet distance between feet |
| Humans rely on 3 major systems to help monitor and maintain balance. Name them: | Visual system Vestibular system Somatosensory system |
| This system provides very important information related to the orientation of our body segments to each other and our body position in space | Visual system |
| What things that affect eye sight will have an impact on our ability to balance correctly | Environmental conditions that limit visibility or diseases |
| This method in the visual system allows us to maintain our direction of eye focus (gaze) during activities when the head/body are moving | Gaze Stabilization system |
| This is a fast acting system that reflexively allows the eyes to move in a manner equal and opposite to those of the head | VOR = vestibulo-ocular reflex |
| Allows the direction of gaze to smoothly follow a desired visual target during active movement: | Smooth pursuit eye movement |
| This are quick catch-up eye movements when a visual target is moving faster than the smooth pursuit system can follow: | Saccadic eye movement |
| The vestibular system is located in... | the inner ear |
| Information generated in the vestibular system is communicated to the ??? through Cranial Nerve # | communicated to the CNS through CN VIII (8) |
| There are two components in the vestibular system that assist with posture and balance: Name them | Semicircular canals Otolith Organs |
| They detect angular acceleration and deceleration forces acting on the head | Semicircular canals |
| They are located in the utricle and saccule and they detect linear acceleration and orientation of the head relative to gravity | Otolith Organs |
| Semicircular canals are filled with _______________________ which circulates in response to __________________ of the head They are more sensitive to (slow/fast) movements of the head | 1. Endolymph fluid 2. Acceleration 3. Fast |
| Otolith Organs are more sensitive to (slow/fast) movements of the head and positional change relative to gravity | Slow |
| Somatosensory input includes | -cutaneous and pressure sensations from the body segments -muscle and joint proprioception throughout the body that provide information on position |
| Adjustments may be made when _________________ changes or _________________, _____________________ changes in posture and movement | -Conscious -Automatic -Unconscious |
| Why is diabetes a good example as an impairment that causes a risk for falling? | -peripheral neuropathy (impaired ability to feel things in the legs) -impaired vision (due to compromised microcirculation in the small blood vessels of the retina) |
| In PT we assess balance in multiple ways: Name some: | Static sitting Perturbed sitting Dynamic balance – sitting Static standing Perturbed standing Dynamic balance – standing |
| During ALL balance testing, What is a primary concern? | Saftey |
| When assessing static sitting we look for: | - Postural alignment (COG over BOS) - Can they sit unsupported or do they need UE assistance? -Is there an unusual amount of postural sway? (Normal, mild – moderate increase) |
| We can challenge each of the 3 sensory systems to make sure they are not relying too heavily on any one system: Name some methods. | Eyes closed, head turns, combination |
| Once we have determined the patient is stable in static sitting, we can challenge the body to respond to unexpected stimuli. What type of test is this called? | Perturbed Sitting |
| What is given to the patient during Peturbed Sitting? | The patient is given light perturbations (nudges) in different directions |
| What do we observe in Peturbed Sitting? | We observe for an appropriate and proportional response to the perturbation |
| What is Dynamic Balance in Sitting | the ability of the patient to move and maintain balance simultaneously this usually involves reaching for something outside the base of support |
| When our COG moves near or outside the edge of our BOS, our body will use 3 typical strategies to avoid falling. Name them. | Ankle strategy Hip strategy Stepping strategy |
| Which strategy to avoid falling: small movements of the body within the BOS are met by contraction of the ankle muscles to provide a correcting force | ankle strategy |
| In the ankle strategy how are muscles recruted? | Muscles are recruited distal to proximal |
| In the ankle strategy activation of the plantarflexors is which lean? | Foreward lean |
| In the ankle strategy activation of everters on one side and inverters on the other is which lean? | Sideways lean |
| In the ankle strategy activation of the tib anterior is which lean? | Backward lean |
| If movement becomes too large to be corrected with activation of the ankle muscles, the body will respond with a motion of the trunk on the hip. This describes which strategy? | Hip Strategy |
| How are muscles recruited in the Hip Strategy? | Muscles are recruited from proximal to distal |
| The hip and stepping strategy may involve the ________ to assist with recovery of balance | Upper Extremities |
| These happen in response to large and fast postural perturbations when ankle and hip strategies cannot maintain balance | Stepping strategy |
| Balance should be observed in.... | Normal standing |
| Observations regarding postural sway should be noted along with comments regarding __________________ & __________________ | alignment and symmetry |
| Another useful tool is to test the ability to balance on a single leg | Single leg Balance |
| For single leg balance the goal is __ seconds on each leg without a loss of balance | 30 sec |
| We can check the individual components involved in balance by isolating either the visual, vestibular, or somatosensory portion of balance A quick method used in PT is the Clinical Test of _______________ ______________ ___ ________________ | Sensory Interaction in Balance |
| This is a basic test to help determine if one of the systems involved with balance demonstrates some impairment | Modified Clinical Test of Sensory Interaction in Balance (mCTSIB) |
| When standing, the patient is nudged from different directions and their response to the perturbation is observed and documented | Perturbed Standing |
| This incorporates reaching activities attempted in standing The patient can be given a variety of targets to reach for to see if they can maintain balance | Dynamic Standing |
| List the advantages of using standardized tools : | -provides a common and consistent method to assess balance -allows standardized tools to assess fall risk and to identify individuals in need of intervention prior to an injury -They can help guide intervention |
| Examples for Balance Include: | The Romberg and Sharpened Romberg The Berg Balance Scale The Performance Oriented Mobility Assessment Functional Reach Test Multidirectional Reach Test Function in Sitting Test |
Created by:
Cainta
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