Balance and Proprioception Rehab

Sensory Motor System

involved in maintaining joint homeostasis during bodily movements (functional joint stability)

Proprioception

afferent info arising from internal peripheral areas of the body that contribute to postural control and joint stability

Receptors in the ___ and ____ combine with ___ receptors to provide proprioceptive information.

skin and muscle with joint

what are the functions of proprioception?

• static joint position awareness

• motion, direction, and velocity perception

• facilitates efferent response (reactive, proactive, coordination of muscle firing sequences, maintenance of balance)

Balance

the ability to maintain your center of mass over your base of support

• postural control and normative movement patterns related to balance

normal stance/quiet stance

body’s ability to stand with no movement over the base of support

postural sway

normal continuous shifting of the body’s center of gravity over its base of support

Vestibular system

responsible for coordinating vision and head movement

vestibule-occular reflex

ability of the vestibular system to trigger eye movement to stabilize images as the head is moving v

vestibule-spinal component

responsible for regulating postural stability

vestibular rehab

retrain the brain to recognize and accurately process signals from the sensory input system that affect balance

how is decreased disequilibrium (sense of being off balance) achieved in VRT?

habituation: gradual exposure to movements that provoke symptoms

how is decreased oscillopsia (visual blurring during head movement) achieved with VRT?

gaze stabilization training

More than __ of people aged 65 or older fall each year, those who fall are _ to times more likely to fall again.

1/3, 2 to 3 times

___% of people who fall suffer moderate to severe injuries such as contusions, fractures, and head trauma

30%

Fall risk is increased when ___ or more medications are used concomitantly.

4

When does fall risk increase significantly in regards to medication?

after medication is stopped, dosage is adjusted, added or changed (risk triples if they have a history of falling)

Ankle strategy: key stabilizers during passive stance are…

ankle plantar-flexors and dorsiflexors

• most commonly used stability strategy

Motion to stabilize the body against a perturbation only occurs at…

the ankle

Hip strategy: during A to P perturbations (sagittal plane), ____ and ___ engage

hip flexors and extensors

Hip strategy: during M to L/L to M perturbations (coronal plane), ____ and ___ engage

hip abductors and adductors

when is the stepping strategy activated?

when the fixed base of support strategies are overwhelmed

Those with a history of ___ were less likely to keep a wobble board steady.

LBP

Hip strategy for balance control is reduced in ___ patients.

LBP

In normal individuals, on a flat surface, postural adjustments are achieved using an…

ankle strategy

____ is used when standing on a short base or during sudden perturbations on a flat surface.

hip strategy

postural control involves elements of both ___ and ___

ankle and hip strategy

The center of pressure (COP) is more in LBP patient.

posterior

Changes in postural activity of trunk muscles in acute and chronic LBP patients:

• deficits of deep abdominal and deep paraspinal muscles

• increased activity in superficial back muscles

• deficits in proprioception in lumbar spine

Those with LBP have poor balance especially when support base is ___ and when ___ is removed

small, vision

If the quality of feedback from one segment of the body is poor, the dependency on ___ is likely to be increased.

visual input

Improving and is crucial in spinal stabilization.

balance and speed of muscle contraction

Unexpected perturbations lead to ____

reactive responses

Expected perturbations lead to

anticipatory postural adjustments (APAs)

• incorporate first with training

What is the goal of sensorimotor training?

integrate peripheral function with central programming

Modification of foot/shoe interface may be a method of reducing ____ during sports

lower limb injury