Lifespan Quiz 6 - Balance, Locomotion, Outcome Measures

Static functioning posture description

Functions to maintain alignment of the body segments in ANY position

Postural control description

Anticipates change and allows body to engage in voluntary, goal-directed movements

Need for quick adapation description

Posture changes in reaction to unexpected perturbations

Is posture an active or a pasive state?

ACTIVE

T/F: postural control IS balance and integrates MSK, NM, and Sensory systems

True

T/F: According to the ICF model, balance can either be a body structure, a function, or an activity

TRUE

What is the definiton of postural control?

mantaining posture and performing a motor skill

Models of postural organization

1. Body Scheme Level: posture as reference to gravity, its anatomical relationships, and the concept of support

2. Representation level: postural control as the basis of information from the representation level to form postural networks - how we interpret what we have

What is the concept of postural networks?

• Posture is represented as a WHOLE ENTITITY rather than just its components

  • Develops as a child experiences a combination of muscle movement

The ontogenetic model for senosrimotor organization

1. Birth → Upright stance: cephalocaudal development

2. Upright stance → 6 years: Control is ascending from the static support surface (in CKC)

3. 6 - 7 years: control returns to a descending organization with an “en block”/articulated linkage between head and trunk

4. Adulthood: Adds selectivity to the articulated operation of the head and trunk, ↑ DoF for the neck

T/F: According to the oncogenetic model, in CKC the head is the frame of reference (top → bottom)

FALSE. In CKC, the frame of reference is the SUPPORT SURFACE

Static balance

Maintaining upright posture and keeping the line of gravity within the base of support (BOS).

Dynamic balance

Maintaining postural control when mobile/outside BOS

Balance performance classifications

• Static steady state: Maintains a “quasi-static” position while standing or sitting (body’s COM within BOS)

• Dynamic steady state: Maintains steady position while walking

• Anticipatory: Anticipates a predicted postural disturbance

• Reactive: Compensation of postural disturbance

Components of a postural control system

1. Biomechanical constraints - viscoelastic properties of STs and muscle tone

2. Orientation in space

3. Sensory strategies

4. Movement strategies - regulate the relationship between COM and BOS

Physiological perturbations

Events that disrupt the operation of the NS, such as loss of posture or orthostatic hypotension

Mechanical perturbations

Events that disturb balance - slip, trip, or shove

Informational perturbations

Changes in sensory infomration - walking into a dark room or changing your path when avoiding an obstacle

________ _______ is influenced by the attentional demands of the task as well as the environment in which the task occurs.

Posture control

T/F: Posture needs cognitive processing and can be influenced by mental, visual. and manual distractions

True

Righting reactions begin at birth and peak at _______. They are elicited by _______________________. They become incorporated into _______ ____________ and persist as part of our automatic _______ __________

Righting reactions begin at birth and peak at 10-12 months. They are elicited by ANY sensory stimulus (vestibular, proprioceptive, visual, or tactile). They become incorporated into equilibrium reactions and persist as part of our automatic reactive balance

T/F: Righting reactions are more sophisticated than equilibrium reactions and involve a total body response to a fast shift of the COG

FALSE. Equilibrium > righting, and the shift in COG is SLOW

Protective reactions

• Extremity response to a QUICK shift in COG outside the BOX

  • LEs downward response → 4 mos

  • Protective extension → 8 mos

Balance strategies

a) Ankle

b) Hip

c) Stepping

d) Suspension

T/f: Postural control develops cephalocaudal and proximal → distal

True

Sensory contributions to balance in infants

• Infants use visual information to learn balance

• Vestibular and somatosensory systems can also trigger balance responses

At what age are kids somatosensory-vestibular dependent?

By 3 years old

4-6 year olds can use propioceptive info, but the balance responses in STANDING are _____ ________

Highly variable

T/f: Anticipatory control occurs after a movment takes place

FALSE. Anticipatory control happens before

What is the culprit of many of the changes in movement patterns seen in older adults?

Inactivity and lack of motor performance

STEADY-STATE BALANCE IN OLDER ADULTS

more asymmetrical

Increased postural sway is a predictor of _____ in older adults.

Falls

T/F: Internal perturbations pose a greater risk if present in the UEs

FALSE. LEs are more dangerous

DYNAMIC BALANCE IN OLDER ADULTS

• ↓ RT and SLOWER onset response latency in postural muscles

• Slower RT to weight shift

• ↓ step length

_________ is the most common balance strategy in older adults, but NOT a last resort

Stepping

What are the 3 elements of locomotion

1. Progression (strength dependent)

2. Stability (maintains posture and overcomes gravity)

3. Adaptation

______ ______ is the sixth vital sign

Gait SPEED

Walking velocity definition

measurement of distance per unit of time (m/s)

Slower gait speed is associated with decreased ________

Longevity (higher mortality)

Stance vs swing phase in gait

• Stance = 60%

• Swing = 40%

GAIT ACROSS THE LIFE SPAN

• Adults: Limb is through 50% of the cycle → CL limb starts

• Infants: 50/50 as well, but less variability as they have preferred patterns

• Older adults: reduction of preferred walking speed, cadence, step, and stride length, all related to a more cautious gait

HSSS (head stabilization in space strategy) is used in a variety of walking environments by age _____

7

Anticipatory control of locomotion is not fully developed until _____ ________

early adolesence (11-13)

______ is the most fundamental mobility task and is the key criterion for _________ ____________.

Gait, functional independence

Check gait speed with __________ (outcome measure)

10 meter walk test

The 6MWT measures

endurance, gait deviations

Steps to analyse gait deviations in the eldery

1. Check all systems CAREFULLY

2. Gait speed with w/10-meter WT

3. 6 MWT for deviations in gait

4. Choose AD

5. Look at the shoes

6. OMs for fall risk

The vestibular ocular reflex (VOR) is important for head and _____ _______ in space.

Gaze stabilization

Gait requires decreased _______ ________ and energy expenditure as we age. These factors can determine if we have ___________ _______

tissue stress, long-term viability

Energy expenditure

metabolic cost of walking

5xSTS test

• Area of assessment: Bodily functions

  • LEs strength

• Conditions:

  • Arthritis and Joint Conditions

  • Cerebral Palsy

  • Chronic Pain

  • Mixed Conditions

  • Multiple Sclerosis

  • Stroke

  • Vestibular Disorders

  • Pulmonary Diseases

  • Neurologic Conditions

• Cutoff: >15 s for community-dwelling older adults

• MCID: >2.3 s for vestibular / 2.4 s for PD

BBS

• Area of assessment: Boldily functions, Mental functions

  • STATIC and DYNAMIC balance and fall risk

• Conditions:

  • Arthritis + Joint Conditions

  • Brain Injury Recovery

  • Multiple Sclerosis

  • Parkinson's Disease & Movement Disorders

  • Spinal Cord Injury

  • Stroke Recovery

• Cutoff: ≤ 50 is FALL RISK

• MDC: 6-7 pts for stroke / 5 pts for PD / 1-5 pts for HD

TUG

• Area of assessment: Boldily functions, Vestibular

  • Dual-task dynamic measure to identify fall risk

• Conditions:

  • Parkinson's Disease & Movement Disorders

  • Vestibular

• Cutoff: 13.5s or higher

mCTSIB

• Area of assessment: Bodily functions

  • Postural control under various sensory conditions - STATIC

• Conditions:

  • Brain Injury Recovery

  • Cerebral Palsy

  • Multiple Sclerosis

  • Parkinson's Disease & Movement Disorders

  • Pediatric + Adolescent Rehabilitation

  • Stroke Recovery

  • Vestibular Disorders

• Cutoff: > 30s per task? Or >120s total

DGI

• Area of assessment: Bodily functions

  • Gait and fall risk under different external demands

• Conditions:

  • Multiple Sclerosis

  • Parkinson's Disease & Movement Disorders

  • Stroke Recovery

  • Vestibular Disorders

• Cutoff: < 19 points

MoCA

• Area of assessment: Cognition and Movement

  • Rapid screen for the detection of mild cognitive dysfunctions

• Conditions:

  • Cardiac Dysfunction

  • Parkinson's Disease & Movement Disorders

  • Stroke Recovery

• Cutoff:

  • Memory: 7 or 8

  • Visuospatial: 3

  • Language: 4

  • Attention: 3

  • Executive: 4