MOTOR CONTROL LECTURE 8/9/10: POSTURAL CONTROL AND BALANCE FOR EXAM II

Postural control/balance examination:

- examine the effect of balance on participation (____)

- examine the effect of balance on functional activities (____ _____)

- examine the effect of balance on body structure & function (_____)

Restrictions; activity limitations; impairments

No single test measures all aspects of ____ (need multiple tests & measures)

Balance

What to ask your patient about falls:

- ____ of falls

- ____ leading to the fall

Frequency; circumstances

You should gather the history and context of fall over the previous ____ months

12

Ask your patient about perception of difficulty with _____ or ____

Balance or walking

CPG self report scales for falls:

Activities specific balance confidence scale (ABC)

____ fall risk factors:

- cognitive impairment

- sensory loss

- > 4 medications

- postural hypotension

- urinary incontinence

Intrinsic

____ fall risk factors:

- poor lighting

- inappropriate footwear

- undeveloped surfaces

Extrinsic

There is a ____ ___ for the activities of balance scale

Cutoff score

The activities balance scale is best for assessing confidence doing things in the ___ & ____

Home & community

The falls efficacy scale is best for assessing confidence for doing things in the ___

Home

How to assess ____ system:

- vision

- somatosensory

- vestibular

Sensory

How to assess ____ system:

- assess steady state

- assess reactive balance strategies

- assess anticipatory balance strategies

Motor

Ask your patient how long its been since they've been to the ____ doctor

Eye

How to test ____:

- visual acuity

- visual field testing

- depth perception

- oculomotor control

- contrast sensitivity

Vision

How to test ____:

- light touch

- kinesthesia

- vibration

- proprioception

- touch pressure

Somatosensory

If someone complains of dizziness, assess the ____ system

Vestibular

How to test the _____ system:

- attention screens

- cognitive screens

- reaction time

- depression/anxiety scale

Cognitive

_____ _____:

- ankle

- hip

- stepping

- reach and grasp

Reactive strategies

___ ___ can minimize effect of gravitational forces

Body alignment

______ test:

- arms across chest

- eyes open/closed

- tandem position

Romberg

Tandem position challenges the _____ system

Somatosensory

Document the ____ of single leg stance

Quality

___ ____ ____ is reliable and valid but is seldom used alone

Single leg stance

___ ____ ____ ___ ___:

- patient cannot use their hands

- arms across chest

- patient needs to be sitting in a certain chair (18 inches from the ground)

Five times sit to stand

___ ___ ____ ____ ____ measures one aspect of transfer skill

Five times sit to stand

>/= ___ seconds on the five times sit to stand test indicates the need to further assess for falls

12

>/= ____ seconds on the five times sit to stand test indicates risk of falls

15

The score for the ____ ____ ___ ___ ____ test is the amount of time it takes a patient to transfer from a seated to a standing position and back to sitting five times

Five times sit to stand

___ ___ ___ is the maximum distance one can lean in any direction without losing balance or changing BOS (reaching or stepping)

Limits of stability

AP LOS is ____ degrees

12

ML LOS is ____ degrees

16

____ LOS is influenced by height and foot length

AP

_____ LOS is influenced by height and distance between feet

ML

Functional reach test is a ____ test

LOS

____ ___ ____ is developed as a quick balance screen that is predictive of falls in neuro intact older adults

Functional reach test

< ___ inches on the functional reach test indicates a 4x fall risk

6

With the ___ ___ ___, perform multiple trials and average the last 2

Functional reach test

___ looks at the patient standing, walking & turning

TUG

____ is a quick screen for fall risk in older adults tested with:

- stroke

- CDOA

- frail elderly

- PD

TUG

> _____ seconds on the TUG indicated risk of falls in CDOA

13.5

The four square step test has a ____ score

Cutoff

Patient may have trouble following directions or clearing the object with the ___ ___ ___ ___

Four square step test

____ ___ ____ ____:

- developed for CDOA

- high interrater reliability

- validity correlated with TUG, FRT and step test

- high sensitivity/specificity for identifying fall risks

Four square step test

Berg balance scale measures ____ ____ & _____ balance

Steady state & anticipatory

____ _____ ____:

- 14 functional tasks (rated 0-4)

- good predictor for falls in CDOA (cutoff score)

- 15-20 minutes to administer

- minimal equipment

- excellent test-retest & interrater/intrarater reliability and predictive validity

- core equipment measures for patients with neuro diagnosis

Berg balance scale

22

_____ ____ _____:

- assesses postural stability during walking

- assesses ability to perform motor tasks while walking

- 15-20 minutes to administer

- minimal equipment

Functional gait assessment

Cutoff score for the figure 8 walking test is _____ seconds

8.2

___ ___ ____ test:

- time the patient, count steps, accuracy of path

- excellent test retest, interrater & intrarater reliability

Figure 8 walking

_____:

- has a cutoff score

- gait and balance assessment

- looks at all elements of balance (steady state, anticipatory, reactive)

Tinetti

The ____ ___ ___ test is a 14 item test that examines steady state, anticipatory balance, and reactive balance

Function in sitting

The function in sitting test is scored on a ___ point scale with a ____ defined as complete assistance and a ____ as independent

5;0;4

Function in sitting has a cutoff score for ___ ____ but not fall risk

Discharge destination

_____ of testing:

- may not predict performance in complex environments

- few tests examine all aspects of postural control

- many do not address quality of movement

Limitations

_____-_____ tests all 6 balance systems

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