Balance & Proprioception

what is the sensory motor system involved in?

maintaining joint homeostasis during bodily movements

what provides proprioceptive information?

receptors in the skin and muscle combined with joint receptors

what is proprioception?

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

what inputs are intertwined in regards to propriception?

visual, vestibular and sensorimotor

what happens if one of the visual, vestibular or sensorimotor inputs is diminished?

increase dependence on another

what are the functions of proprioception?

static joint position awareness

motion, direction, velocity perception

facilitates efferent response

what does facilitating the efferent response entail?

reactive, proactive, coordination of muscle firing sequences, maintenance of balance

what is balance?

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

what is true of balance?

it is very complex, involving multiple systems

what are related to balance?

postural control and normative movement patterns

what is normal stance (quiet stance)?

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

what is postural sway?

normal continuous shifting of the body’s center of gravity

how much postural sway occurs in the sagittal plane?

5-7 mm

how much postural sway occurs in the coronal plane?

3-4 mm

what three things have an effect on sensory input on balance?

proprioception, vision, vestibular

what is the role of proprioception in regards to the effect of sensory input on balance?

body position relative to support surface

what is the role of vision in regards to the effect of sensory input on balance?

head/eye position relative to surrounding objects

what is the role of vestibular in regards to the effect of sensory input on balance?

head position relative to gravity and inertial space

essential under surface/vision conflict conditions

what is the vestibulo-ocular component of the vestibular system?

responsible for coordinating vision and head position

what is the vestibulo-ocular reflex?

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

what is the vistibulo-spinal component?

responsible for regulating postural stability

what is true of vestibular rehabilitation?

the vestibular system cannot repair itself when damaged, recovery must happen through the CNS compensation/adaptation techniques

what needs to be retrained in vestibular rehabilitation?

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

how is VOR x1 gaze stabilization training done?

patient fixates on a target, the target is stationary while the patient moves their head

how is VOR x2 gaze stabilization training done?

the patient fixates on a target, the target and the patient’s head move in opposite directions

what is the next step in gaze stabilization training once VORx1 and x2 are firmly estabilished?

progress to different postures to challenge the patient

what should postural modifiers try to mimic in gaze stabilization training?

ADLs required by the patient

what are the functional goals of vestibular rehabilitation?

decrease disequilibrium

decrease oscillopsia

improve functional static and dynamic balance

improve activity level and physical conditioning

reduce social isolation and promote active involvement for improved quality of life

what is disequilibrium?

sense of being off balance

how is disequilibrium decreased in vestibular rehabilitation?

habituation, gradual exposure to movements that provoke symptoms

how is oscillopsia decreased in vestibular rehabilitation?

achieved through gaze stabilization

what is oscillopsia?

visual blurring during head movement

when does falling occur?

whenever your center of gravity off base of support

what can a fall limit?

the ability of an older adult to remain independent

how many people fall?

more than 1/3 of people 65 and up

how much more likely is the chance that are person who has fallen will fall again?

2 to 3 time more likely

what percent of people who fall suffer moderate to severe injuries such as contusions, fractures and head trauma?

30%

what increases the risk of falls?

when 4 or more medications are use concomitantly

when is the fall risk increased in regards to medication?

the days after a medication is stopped, dosage adjusted added or changed

what is the ankle strategy in regards to stance and stability?

motion to stabilize the body against a perturbation occurs only at the ankle

what are the key stabilizers during passive satance in ankle strategy stance and stability?

ankle plantarflexors and dorsiflexors

what is the most commonly used stability strategy?

ankle strategy

during A to P perturbations, which muscles engage in hip strategy of stabilization?

hip flexors and extensors

during M to L perturbations, which muscles engage in hip strategy of stabilization?

hip abductors and adductors

when does stepping strategy activate in stance and stability activate?

when the fixed base support strategies are overwhelmed

in normal individuals on a flat surface, how are postural adjustments achieved?

using an ankle strategy

when is hip strategy used for balance control?

when standing on a short base or during sudden perturbations on a flat surface

where is the center of pressure located in LBP patients?

more posterior

what is crucial in training proprioception?

improving balance and speed of muscle contraction is crucial in spine stabilization

what may reduced ability to use hip strategy be due to?

reduced hip motion of hip as a result of increased activity of lumbopelvic muscles

the increased chance of a fall risk after changing the dosage of a medication lasts for how many days?

1-9

what is the goal of sensorimotor training?

to integrate peripheral function with central programming

what is true of movements that require conscious and willful activation?

they may be monotonous and prematurely fatiguing

what movements require less concentration and are faster acting and can be eventually automatized?

those that are subcortical and reflexive in nature