Balance and Motor Control for Patients

factors that can impair balance and motor control

- sensory input

- sensorimotor integration

- biomechanical/motor output deficits

components of sensory input

visual, vestibular, somatosensory

sensorimotor integration

- appropriate integration of each system

- individuals who rely heavily on one system vs the other require challenge of each system individually to identify

types of biomechanical and motor output deficits

- musculoskeletal limitations (fROM, reduced muscular endurance)

- pain

- posture

- inability to actively contract required musculature

effect of aging on visual, somatosensory, and vestibular systems

reduced efficiency

aging results in (FASTER/SLOWER) response to perturbations

slower

aging results in (MORE/LESS) frequent use of hip strategies

more

there is an (INCREASED/DECREASED) fear of falling with aging

increased

what are the 4 main neuro pathologies

CVA, MS, SCI, Parkinson's

how to assess visual system

assess overreliance on visual system by removing visual input

how to improve visual system

allow eyes open during activities while challenging other systems

how to assess somatosensory system

remove ability to use sensorimotor feedback by performing activity on a compliant surface

how to improve somatosensory system

allow use of sensorimotor at first and then progressing difficulty

how to assess vestibular system

have patient change head position during task performance

how to improve vestibular system

habituating to different head positions during tasks

integration requires (SIMILAR/DIFFERENT) challenges during an individual treatment session

different

ways to assess and improve biomechanical/motor output

- ROM

- muscle activation

- strength training

- endurance activities

impact of pain and injury on musculoskeletal injury and motor control

- reduces muscle activation

- impairs integration

if inability to perform movement is present, what should be targeted first

ROM

reasons there may be an impaired ability to perform movement

- impaired muscle innervation

- impaired sensation

- impaired muscle activation

- impaired coordination of muscle activation

how to identify if impaired innervation exists

- knowledge of injury/pathology

- myotome screen

- MMT

- volitional contraction

how to identify if a sensation deficit exists

- knowledge of injury/pathology

- patient report

- dermatome screen

- sensation testing

how to identify if a muscle activation deficit exists

- knowledge of injury/pathology

- myotome screen

- volitional contraction

- palpation during tasks (look for muscle to increase in firmness)

how to identify if impaired coordination exists

- knowledge of injury/pathology

- visual inspection of movement (is there asymmetrical movement or movement "faults" present)

- palpation during movement

treatment for impaired innervation

- electrical stimulation (FES, Russian)

- biofeedback

- manual facilitation techniques (tapping, rubbing)

treatment for impaired sensation

- teach use of other systems to compensate

- patient education on overall health if sensation deficit is related to modifiable disease

treatment for impaired muscle activation

- electrical stimulation

- biofeedback

- manual facilitation

- eccentric load (can override internal inhibition)

- high intensity cross training (can have overflow of neural stimulus to ipsilateral side)

- closed chain activities (increase muscle co-contraction)

treatment for impaired coordination

- task breakdown

- electrical stimulation

- biofeedback

- manual facilitation

palpation for activity

- place hand on muscle group that is expected to activate to perform the motion

- ask patient to perform the task

- feel for increased firmness of the muscle

types of manual facilitation for coordination

- tapping

- rubbing

- pressure

- support through the motion

guidelines for rhythmic stabilization

- place joint in desired position

- instruct patient to hold position and resist manually applied forces

- force then applied in various directions

- can be progressed/regressed by lever arm, pattern productivity, timing, or force application to the area with little to no sensation

guidelines for manual support

- take patient through range of motion passively (if possible)

- ensure patient understands the motion

- have patient begin to perform motion with "guarding" as needed to ensure motion is occurring properly

- remove support as able

internal attention

- concentration on body movement itself

- cues designed to promote proper motion

i.e. "keep your knees inline with your toes", "keep your weight equal between both feet", "squeeze your shoulder blades together"

external attention

- concentration on the intended effect of the body

- cues designed to promote completion of task

i.e. stand on wobble board and instruct patient to "keep the board level"

is internal or external attention more historically used

internal

(INTERNAL/EXTERNAL) cues appear to lead to higher levels of muscle activation

internal

(INTERNAL/EXTERNAL) cues has been hypothesized to produce more efficient movement

external

(INTERNAL/EXTERNAL) cues appear to be more effective in learning

external

true/false: some individuals may only respond to one type of cue

true

ways to progress vestibular treatment

- static --> dynamic

- increase speed of head turns

- eyes open --> eyes closed

- firm surface --> compliant/uneven surface