Balance Assessment and Treatment

Fall risk factors

Hx of falls, certain meds, alcohol misuse, reports of dizziness, reported fear of falling, urinary incontinence, visual impairments

Cone of stability

The area in which the body can maintain positions without changing the base of support. Moves with person throughout positional changes

Limits of stability

Maximum distance someone is willing or able to lean in any direction without a loss of balance

Sway envelope

The path of the body’s motion in static standing or sitting

Types of postural control tasks

Maintaining positions, performing voluntary movement, responding to external perturbations

Maintaining position tests

Romberg, SLS test, BESS, CTSIB

Dynamic posture tests

Sensory organization test (SOT). Teases out how pts are integrating sensory information

Voluntary movement tests

Functional reach test, Berg Balance Scale, Four Square Step Test

Anticipatory postural adjustment (APA)

Contracting postural muscles in anticipation of movement to maintain balance during a task

Automatic postural reactions (APR)

Motions that help regain balance following a sudden internal or external perturbation

Ankle strategy

Produces rotational torque against the support system, but requires large support surface

Hip strategy

Produces shear force against support surface and can work with small support surface. Unsafe to perform on slippery surfaces due to shear forces

Factors to vary for interventions

Sensory conditions, base of support, perturbation types, speed demands, attention demands