Neuro Quiz #5 - Assessing Balance and Coordination in Medicine

True or False: Balance, equilibrium, and postural stability are interchangeable.

TRUE

Balance is ____.

ability to maintain stability in an upright posture against gravity

____ is the maximal distance of intentional displacement of COM in each direction without LOB.

limits of stability (LOS)

____ balance is when they are not moving and ____ balance is when they are reaching out of BOS or during gait.

static; dynamic

The postural control system includes _____, _____, _____, and _____.

biomechanical; sensory; motor; central procession

The biomechanical control system considers _____.

forces applied and mechanical factors that contribute to body and joint/segment stability

COP and COG are (sensory, biomechanical, motor, central procession) postural control.

biomechanical

_____ is all incoming information and used to monitor equilibrium status and adjust upright posture.

sensory

The primary sensory systems involved in balance are ____, _____, and ____.

vision, somatosensory, vestibular

The motor postural control system is ____.

all parts of the neuromuscular system that help carry out postural adjustments and equilibrium reactions

Reflexive postural reactions include ____.

righting reactions (head on body, body on body)

protective reactions

balance strategies (ankle, hip, stepping)

Central processing receives ____ info, _____ it, and _____ a response.

sensory, processes, implements

True or False: Balance is not a critical component of independence.

FALSE

Skilled activities requires ____.

balance

Loss of stability can have a profound impact on daily life of individuals with neurologic pathology due to _____

lack of independence, risk of injury

When asking a patient's history of falls, it is important determine _____ vs _____ factors.

intrinsic; extrinsic

When examining balance, you usually start in ____ and progress to ____.

sitting; standing

When choosing tests and measures to assess balance, we want to make sure the _____ matches the tool used.

degree of impairment

Self reported scales for balance include:

Falls efficacy scale (FES), Activities Specific Balance Confidence Scale (ABC Scale)

Performance based measures of balance include:

TUG

Functional Reach

POMA

Berg

DGI

BESTest

Gait velocity

Balance and Dual-Tasking

Balance Grading Scales are ____.

ordinal

Absent

Patient unable to maintain balance

Patient able to maintain balance with handhold support, may require some minimal assistance, accepts minimal challenge, can maintain balance while turning head/trunk.

Fair

Poor

Patient requires handhold support, moderate to maximal assistance to maintain position, cannot accept challenge or move without loss of balance

Patient able to maintain balance without handhold support, limited postural sway, accepts moderate challenge, can maintain balance while picking object off floor.

Good

Normal

Patient able to maintain steady balance without handhold support, accepts maximal challenge and can weight shift easily within full range of LOS in all directions

Which tests are used to assess steady-state postural control?

Romberg/Sharpened Romberg

Ankle/hip/stepping strategies are used for (anticipatory/steady-state/reactive) postural control.

reactive

Vision gives info about _____.

the environment; dynamic movement

Somatosensation gives info about _____.

cutaneous touch and pressure, proprioception

____gives info about head in relation to gravity/space and helps with VOR.

vestibular

The Clinical Test for Sensory Interaction and Balance (CTSIB) is used to assess ____.

postural control under changing sensory conditions

Conditions 1-3 on CTSIB differ from conditions 4-6 because _____.

1-3 are on ground, 4-6 are on foam

Conditions 2 and 6 both have ____.

eyes closed

The effect of the loss of one sense depends on:

availability of other senses to detect position in space

ability to use orientation cues in the environment

ability to correctly interpret and select sensory information for orientation

Therapy objectives for improving balance include:

educate patient on safety and fall prevention

maximally remediate/correct impairments

teach compensatory strategies when remediation unsuccessful

IMPROVE PATIENT CONFIDENCE

return to PLOF

True or False: There is a progressive decline in balance, increase in falls and injuries from falls as we get older.

TRUE

Specific changes in ____, ____, and ____ contribute to balance decline.

visual, vestibular, musculoskeletal

Safety first! So we need to:

guard, put gait belt on, challenge impaired systems

Impairments that can be corrected in relation to balance are ____.

strength, ROM, alignment

_____, _____, and ____ strategies can help improve postural control.

movement, sensory, and cognitive

True or False: We should work on balance before having the patient properly align themselves.

FALSE; we want to patient to be symmetrically vertical and then perform balance interventions

With movement strategies, we want to work on strategies that ____.

are not intact

Ways to challenge the system that is impaired are by ____.

decreasing visual input

using unstable surface

walk on uneven surface

implement head turns with activities

Additional considerations for balance training are _____.

cardiopulmonary conditioning, mental practice, gradually withdrawing assistance

____ is the ability to execute smooth, accurate controlled movement.

coordination

Coordinated movements are characterized by _____.

speed, distance, direction, timing, and muscular activation

With coordination, you need to consider ____ and ____.

dexterity and agility

Changes in coordination with age include:

impaired balance

decreased strength (sarcopenia)

slowed reaction time

loss of flexibility

faulty posture

We need to assess ____, ____, ___, and ___ before assessing coordination.

lack of strength, ROM, sensation, and muscular imbalance

What conditions can cause ataxia?

MS, sarcoidosis, celiac disease

infections (chicken pox) -- will resolve over time

paraneoplastic syndrome

tumor on cerebellum

side effects of medications

Vitamin E deficiency

With cerebellar dysfunction, balance testing will be hard under which conditions?

ALL, eyes open and closed

With somatosensory issues, patients might have problems with ____.

their eyes closed because relying on purely somatosensation.

True or False: you should test bilaterally even if a patient has a hemi side.

TRUE

Examples of cerebellar pathology are _____.

dysdiadochokinesia, dysarthria, dysmetria, dyssynergia

Examples of basal ganglia pathology are ____.

akinesia, athetosis, bradykinesia, chorea, dystonia, rigidity

Intention and postural tremors are ____ pathology, whereas resting tremors are ____ pathology.

cerebellar; basal ganglia

Standardized coordination tests include ____ for pediatric populations, and ____, ____, and ____ for others.

BOT-2; 9 hole peg test, bocks and blocks, Minnesota Manual Dexterity test

Sample tests for dysdiadochokinesia:

finger-to-nose

alternate nose-to-finger

pronation/supination

knee flex/ext

Pointing and past pointing, drawing a circle or figure 8, heel on shin are examples of tests for ____.

dysmetria

Hypotonia is tested by _____.

passive motion, deep tendon reflexes

Asthenia can be tested by ____.

fixation or position holding, applying manual resistance

Intervention strategies for coordination include:

addressing impairments

using sensorimotor systems to enhance motor performance

train motor coordination - accuracy and speed

compensate with other systems or equipment

Interventions for cerebellar disorders include:

core/proximal stability for distal mobility

increase body awareness

train VOR

Stability is developed in ____ postures, including _____.

weight bearing; prone on elbows, quadruped, sitting, kneeling, standing, modified plantargrade

True or False: if possible, add limb movements in weight bearing positions to improve ataxia and building stability.

TRUE

In sitting, you can work on _____.

holding with alternating isometrics or rhythmic stabilization

Slow reversals with stepping movements can be completed in ____.

modified plantargrade

Using the pool or a gait training _____ a patient.

unweights

After strengthening proximally, we can work on ____, ____, and ____.

gait, fine motor, higher level coordination

We can increase body awareness through _____, ____, and ____.

tactile input; approximation to increase proprioception; visual input

Tactile input can be through _____.

hinged AFOs, manual contact

Approximation to increase proprioception can be increased with ____.

weighted vests/belts

You can use mirrors to increase _____.

visual input

With chorea, athetosis, or dystonia, patients will have most success when the UE and LE are ____ to control ____.

weightbearing; involuntary movements

The restorative approach for improving coordination includes _____.

aerobic activity, core, balance, gait

True or False: you should train aerobic activity in isolation for those with coordination impairments.

FALSE in conjunction with other exercises

Using bracing, AD, taping/compression, and adaptive equipment are examples of _____.

general compensatory approaches