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36 terms

Balance & Balance Strategies

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Balance
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.
Vertigo
A sense of movement and rotation of oneself or the surrounding environment caused by inner ear disease.
Nystagmus
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 ?
menopause
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:
sit-to-stand
Dizziness
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
hallpike
pt. in long sitting....therapist quickly lowers into supine and head in ext.&rotation 45deg. to one side
Romberg
-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.
Tinettii
asseses balance & gait
Mini-mental state exam
calculation, attention, recall....
Montreal Cognitive Assessment (MOCA)
similar to mini-mental state
TUG
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