Postural Control

postural control, mobility

all functional tasks and skilled movement require some level of _____, associated with _____

participation, instability, confidence, self efficacy, avoidance, restrictions

impaired postural control has direct effect on _____, causes _____ and decreased _____ with higher level tasks (decreased _____) leading to _____ of physical activity and _____ in adls

balance confidence, balance recovery confidence, safe landing confidence, post fall recovery confidence

four factors of postural control and self efficacy

attention, dual task

impaired _____ is a significant factor to instability and falls in _____ conditions for geriatric and neurologic populations

stability, orientation

postural control is controlling body’s position in space for purpose of _____ and _____

postural orientation

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

postural stability

ability to control COM in relationship to BOS

COM

point at center of total body mass, average of all parts

COG

vertical projection of COM

BOS

area of body in contact with support surface

vary, task, environment, prioritized, sacrificed

specific orientation and stability requirements _____ according to _____ and _____, one may be _____/_____ over the other

systems, individual, task, environment

balance uses _____ framework, involvement of _____/_____/_____

interaction, musculoskeletal, neural

ability to control body’s position in space is complex _____ of _____ and _____ systems

adaptive, anticipatory, prior experience, awareness

neural components include _____/_____ mechanisms, _____, and _____

different, variability, injury, experience, personal, age, phmx, compensation, medications

person with same diagnosis can present with very _____ postural control problems due to _____ of _____, _____, _____ factors, _____/_____/degree of _____, and _____

steady state, reactive, anticipatory

balance control for functional mobility requires (3) types

surface, visual, attentional

environmental constraints include change in _____, differences in _____ conditions, or _____ demands

body alignment, muscle tone, postural tone

motor system influence on steady state balance (3)

gravitational, relationship, body segments, strategies, recruited, coordinated

body alignment can minimize effect of _____ forces, involves _____ of _____, determines movement _____, influences how muscles are _____ and _____ for stability recovery

collapsing, gravity, intrinsic stiffness, background

muscle tone keeps body from _____ in response to _____, _____ of muscles, _____ muscle tone

tonic antigravity, somatosensory input, feet, tonic neck reflexes

postural tone is _____ muscles relying on _____ (cutaneous from _____ and _____ via head position)

limits of stability

point at which a person will change the configuration of BOS to achieve stability

fixed, task, COM position, velocity

limits of stability are not _____, change according to _____, affected by _____/_____

sensory, direction, magnitude, perturbation, individual, environmental constraints

balance reactions are motor strategy to recover stability based on _____ information, which strategy is used is based upon _____/_____ of _____ and _____/_____

synergistic response

functional coupling of groups of muscles constrained to act together as unit

ankle, hip, stepping, UE, extend BOS

reactive balance control strategies include _____, _____, and _____, sometimes see _____ involvement to _____

small, firm, gastrocnemius, hamstrings, paraspinals, tibialis anterior, quadriceps, abdominals

ankle strategy is used for _____ perturbations on _____ surface, forward sway muscle activation _____, backward sway muscle activation _____

large, high, compliant, small, quadriceps, abdominals, hamstrings, paraspinals

hip strategy used with _____/_____ perturbations on _____/_____ surfaces, forward sway muscle activation _____, backward sway muscle activation _____

fixed, refined, changing, efficient, perception, instructions, predicting

postural synergies are not _____ reactions, _____ in response to _____ demands, if demands remain same more _____ responses with repeated perturbations, _____ can impact response and _____ that allow _____ size of perturbations

muscular, synergistic patterns, abdominals, trunk extensor, support, positioning

in sitting reactive balance control _____ response initiated more rapidly than volitional, _____ of recruitment (backwards = _____, forwards = _____), _____ and _____ modulates response

sensory information, past experiences, anticipation, voluntary movement, emg

anticipatory processes are based on _____ from _____, causes _____ of _____ and increased _____ occur

single leg stance, curb negotiations, UE

anticipatory balance control is crucial for _____ or _____, _____ movement occurs before to stabilize trunk

orientation, tonic, extensor, weight support, directionally, reflexive, perturbations

spinal contributions include _____ component, _____ activation of _____ muscles for _____ and _____ specific _____ responses to _____

postural tone, automatic, synergies, vestibular, equilibrium, anticipatory

brainstem contributions include regulation of _____ and _____ postural _____, _____ nuclei contribute to restoration of _____, and regulation of _____ postural control

reactive, patterns, changing conditions

basal ganglia contributions include quickly change _____ balance muscle _____ in response to _____

adaptation, amplitudes, changing conditions

cerebellar contributions include _____ of postural response _____ in response to _____

adaptable, any environment, visual

intact system has _____ postural control system to meet goals in _____ and adds _____ contribution

head position, movement, surrounding, vertical

visual contributions for steady state balance include _____/_____ with respect to _____ objects, reference for _____

fastest, steady state, body position, movement, supporting surface, relationship, segments, confirm, head position

somatosensory contributions have _____ processing time, include maintenance of _____ postural control, _____/_____ in reference to _____, _____ of body _____, _____ vestibular and visual inputs, guide _____

slowest, head position, movement, gravity, alone

vestibular contributions are _____ processing time, include _____/_____ with respect to _____, cannot distinguish movements _____

modify, reweighting, varying, visual, proprioception

CNS is able to _____ importance of any sense for postural control through task dependent sensory _____, allows stability in _____ environments, initial heavy reliance on _____ transitions to _____

somatosensory, quicker, vestibular, visual, longer, later, visual, stepping, external stabilization

for reactive balance sensory inputs _____input is critical (processed _____), _____ plays greater role when _____ reduced (_____ processing time, _____ involvement), _____ cues are important during _____ strategy or if reaching for _____

attentional, type, age, abilities, sensory

cognitive contributions include varying _____ demands due to _____ of task, _____/individual _____, and _____ context

automatically, dual task, postural control, older adults, neurologic disorders

steady state postural control occurs _____ but _____ interference is still possible, in younger adults greater prioritization of _____ not in _____/_____

feedback loop

balance control creates large _____ between sensory and motor systems

alignment, COM, BOS, joint, muscle length, weight bearing, lateralized, postural sway, functional stability limits

impaired steady state balance affects _____ (shifts ____/_____ due to _____/_____ changes, may cause _____ asymmetry or _____ control strategies), _____, _____

segmental control, outcomes

impaired steady state balance in sitting has impaired _____ of trunk, indicator of _____ following stroke

inflexible weighting, disrupting, perception

sensory problems include _____ of sensory information, _____ ability to change to task/environment, disruption of development of body _____

alternative senses, body position, orientation cues, interpret, select, orientation

effect of sensory loss depends on availability of _____ to detect _____ in space, availability of accurate _____ in environment, and ability to correctly _____ and _____ sensory information for _____

ankle, sequencing, timing, scaling, coactivation, delayed, modifying, crossover, multiple steps

impaired reactive balance (_____ strategy first), causes _____ problems (____ and _____), _____ of agonist/antagonist, _____ onset, problems _____ to environment, stepping strategy may be _____ or _____

recruitment, activation, segmental control

impaired sitting reactive balance in children see altered _____ patterns and muscle _____, in adults see loss of _____ when unsupported

delay, same, scale, amplitude, velocity, joint position

somatosensory loss with reactive balance causes _____ but _____ muscle activation pattern, impaired ability to _____ response to perturbation _____/_____, _____ sense is impaired with pain/injury

activation, reduced, timing, slower

impaired anticipatory postural control due to altered _____ (_____) or _____ (_____)

adaptation, earlier

somatosensory loss with anticipatory balance results in changes in motor _____, _____ activation as compensation

identification, depth, spatial

visual losses in anticipatory balance impact object _____, _____ perception, and _____ relationship with environment

perception, vertical

impaired _____ of _____ is related to impaired postural control

subjective visual vertical

orient upright to visual cues

subjective postural vertical, impaired, somatosensory, spatial neglect, pusher

_____ is one’s perceived upright, can be _____ even with visual cues, associated with degree of _____ loss and _____, causes _____ syndrome

compounded, lower, exceed, compromise

under dual task conditions attentional capacity limitations are _____, _____ threshold to _____ and _____ stability

STEADI algorithm, self efficacy, perception, functional, environmental, aspects

testing of postural control includes _____ for older adults, assessing _____ is critical (patient _____), outcome measures for _____ activities (limited by _____ conditions and not examining all _____ of postural control)

restrict movement, instability, sensory input, reactions, compensations, gait belt, harnessing

effective guarding does not _____, patient must be allowed to experience _____, important to guard without providing significant _____ which can alter _____ or facilitate _____, _____ or _____ systems may be used

underlying impairments, augment sensory input, functional activities, organize, select sensory information, kinesthetic awareness, adapt, task specific, refine, cognitive, dual task

task oriented approach reduce _____, _____ (improve ability to meet balance demands during _____), help patient learn to effectively _____ and _____ (retraining _____), develop ability to _____ sensory organization strategies, use _____ practice to _____ strategies, add _____ training to improve _____

orientation, alignment, underlying impairments, coordinated, timing, sequencing, force, specific, COM, segmental control

motor strategies include retraining _____ and _____ (first address _____), retraining reactive involves refining _____ multijoint movements (_____/_____/_____ modulation) while training _____ strategies, retraining anticipatory involves controlling _____, training _____ in sitting

kinesthetic, reweighting, augmenting, task specific, changing conditions

treat sensory impairments by improving strategies (_____ retraining or _____ sensory input), _____ sensory inputs, use _____ practice, learn to control during _____

predictable, unpredictable, size, direction, trunk support

training reactive strategies should include _____ and _____ perturbations of varying _____ and _____, optimize _____ in sitting

dual task, motor, cognitive, environmental stimuli, decision making

training attentional demands includes _____ conditions (_____ and _____), changing amount of _____, add _____

fall prevention, participation, self efficacy, functional tasks, specific, reinjury

therapeutic exercise is effective tool in _____ (improves _____ and _____), enhances performance on _____, should target _____ components, lowers _____ rates

slip training, perturbation, proprioception, high

reactive and proactive training includes _____, _____ training (manually, another limb, equipment, alters _____), and _____ level interventions