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Integrated somatosensory, visual, and vestibular information within the central nervous system

Somatosensory input

Receptors in joints, muscles, ligaments, and skin to provide proprioceptive information regarding length, tension, pressure, pain, and joint position info to cortex & cerebellum
(plays primary role when body not moving, UNLESS standing on uneven terrain...then req. all 3 systems)

Visual input

Receptors allow for perceptual acuity regarding verticality, motion of objects and self, environmental orientation, postural sway, and movements of the head/neck.

Vestibular input

Provides the CNS with feedback regarding the position and movement of the head with relation to gravity via semicircular canals. (makes final decision if diff. info from other 2 systems)

Ankle Strategy

-Elicited by small, slow velocity perturbation
-Distal to proximal
-Fwd sway: gastroc>hams>paraspinals
-Bkwd sway: ant.tib>quads>abs

Hip Strategy

-Elicited by larger, faster perturbatiion
-Proximal to distal
-Fwd sway: abs>quads
-Bkwd sway: paraspinals>hams

Suspensory Strategy

Used to lower the center of gravity during standing or ambulation in order to better control the center of gravity.

Stepping Strategy

Elicited when perturbation produces movement of COG that is beyond BOS.


A sense of movement and rotation of oneself or the surrounding environment caused by inner ear disease.


Abnormal eye movement that entails nonvolitional, rhythmic oscillation of the eyes.

risk of falls increases after age?

65, esp. women

Sharp acceleration of bone loss occurs in women after ?


BMI > or = to 30 in 65+

protective during a fall

BMI < or = in 65+

serious injuries during a fall

Age-related changes in vision:

Reduced: acuity, contrast, depth percep., dark, accomodation

Drug side-effects linked to falls

orthostatic HTN, sedation, < reaction time, < cognitive ability
(highest risk is 3+ meds)

# of falls that may indicate need for eval

> 2 in 6 mos.

This maneuver requires integration of all aspects of balance:



lightheadedness; prior to syncope

6 tests of visual-vestibular system

smooth pursuits, saccadic eye mvmts, vest.occular reflex, head thrusts, rapid head shaking, hallpike

smooth pursuits

track object w/ head stationary

saccadic eye mvmnts

pt. looks back and forth btwn 2 objects

vestib.occ.reflex (VOR)

pt. focuses on object while actively moving head side to side or up and down

head thrusts

therapist does quick passive mvmnt of head to neutral, from starting position of 30 deg.

head shaking

pt. actively shakes head back and forth 10 times


pt. in long sitting....therapist quickly lowers into supine and head in ext.&rotation 45deg. to one side


-time & amt. of sway
-eyes closed, arms folded on chest, ankles touching
-30 sec. normal
-abnormal if eyes open or unfold arms before 30 sec.

Romberg- inability to maintain with eyes open vs. eyes closed

cerebellar prob. vs. somatosensory prob.


asseses balance & gait

Mini-mental state exam

calculation, attention, recall....

Montreal Cognitive Assessment (MOCA)

similar to mini-mental state


timed up and go......10 ft. up and back--most adults= <10 secs.

Func. Reach

reach while maintain bal.

Berg Bal. Measure

similar to Tinettti, but only assesses bal.

6 min. walk test

take pre & post-test HR & BP .....900 ft. in 6 min. is normal

Measure walk test (8ft.)

start timing at 3ft. mark...(11ft-3ft=8ft)....compute gait speed in m/sec (divide 2.4 m by time)
Normal in 70+= .8-1.2 m/sec........<.6 is problem

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