Balance and Coordination Test
What is protective reactions
extremity movements in response to rapid changes in body position ex: putting arms out
What are fine motor skills
extremity movements that use small muscle groups
What does static balance control
maintain a stable antigravity position while as rest such as standing and sitting
What are some postural control issues
Alignment Impaired perfection of midline Poor postural sway Poor weight shifting Poor limb control Delayed reactive postural response
The Balance domain model describes how we can achieve our patient's goals which include
Limits of stability Anticipatory control Reactive control Sensory orientation Stability during gait Biomechanics
Regulation of movement is dependent on
Sensory afferent
What system come into play for achieving postural control/balance in varying postures, task and environment
Sensory processing system Sensorimotor integration Nashners strategies
What is the Berg Balance Scale
This tests how much balance a patient has while doing different tasks
If you start to sway backward, what muscles will keep you from falling
Tib Anterior Quads Abdominal
Based on an unstable/compliant surface what are the % of systems used
10% somatosensory 30% visual 60% vestibular
Anticipatory adjustments take ______ as long in SLS vs both legs
2x
what are the 2 treatments of vertigo
Epley maneuvers Brandt-Daroff Exercises
What is the Dynamic Gait Index
Examines walking, changing speeds with head turns, stepping over objects and pivoting.
What is condition 2 of the mCTSIB
Eyes closed/firm surface
What is condition 4 of the mCTSIB
Eyes closed/unstable surface
What is condition 3 of the mCTSIB
Eyes open/Unstable surface
What is condition 1 of the mCTSIB
Eyes open/firm surface
What is the correct order of the protective reactions
anterior lateral posterior
Overall goal of postural control is
stability and function
What does dynamic balance control
stabilize the body when the support surface is moving or when the body is moving on a stable surface such as sit to stand
What is mCTSIAB test
this is testing postural control under different conditions and determine which system is affecting their balance impairments
What is an utricle
this is a gelatinous movement that detects horizontal head tilt and linear movement
What is anticipatory processing
this is anticipating a certain reaction
What is the semicircular canal
this is oriented in three planes and gives sense to an angular acceleration of the head
What is reactive processing
this is reacting to a specific stimulus
What is quiet standing
this is standing still
What is ankle strategy
this is swaying at the ankles
What is the functional reach test
this tests how far outside the BOS before you lose balance
What is the TUG test
this tests how long it takes for someone to go 10ft and back
What are examples of non coordination test
Finger to nose Finger to finger Finger opposition Tapping foot
What muscles go with anterior displacement of ankle
Gastroc Hamstring Paraspinals
If you start to sway forward, what muscles will keep you from falling
Gastroc Hamstrings Paraspinals
When discussing framework for postural control, what are the 3 categories
Individual Postural Task Environment
Stability
Maintain postural stability and orientation with COM over BOS while body is not in motion
What is an example of an issue with the somatosensory system
Peripheral Neuropathy
What is equilirium
ability to align body segments against gravity over the BOS without falling
What are the crystals in the ear called
otoconia
Cognition concerns with balance include
Easily distracted Fear Following directions Medications
Impacts of aging on coordination
-Decrease strength/ROM -Decrease reaction time -Postural changes -Impaired balance
Neuromuscular balance progression consists of
-Assessing ability to assume position -Ability to move within position -Ability to reach outside of limits -Quality of postural reactions
What are examples of Frenkel's coordination exercises
-Flex and extend at hip and knee with heel off the table -Flex one leg while extending the other -Walk along winding strip -Walking and changing directions
Most common risk factors for falls among the elderly
-Muscle Weakness -History of Falls -Gait Deficit -Balance Deficit -Assistive Device -Visual deficit -Arthritis -Impaired ADL -Depression -Cognitive impairment -Over 80 years old
Coordination treatment progression
-Unilateral extremity -Bilateral Symmetrical Extremities -Bilateral Asymmetrical Extremities -Multi limb
What are the 3 anatomic divisions of the Cerebellum that account for 3 types of dysfunction
1. Midline which underlies titubation, truncal ataxia, orthostatic tremor, and gait imbalance 2. Hemispheres contribute to limb ataxia, dysarthria, hypotonia 3. Posterior which influences posture, gait and eye movement
What are the degrees of postural sway for anterior, lateral and posterior
6 degrees forward 4 degrees backward 8 degrees laterally
Based on a firm/stable surface what are the % of systems used
70% Somatosensory 10% Visual 20% Vestibular
What plane does every other strategy occur in
AP
What muscles go with posterior displacement of hips
Abdominals Quadriceps
What are the types of Nashner's Strategies
Ankle Hip Stepping Lateral Weight Shift Suspension
Target during ROM and posture include what muscles
Ankle DF, inversion, and eversion Hip Extension Trunk Extension/ Rotation
The amount of sway anterior, laterally and posterior
Anterior - 6 Lateral - 8 Posterior - 4
What is the control of body parts in relation to each other and the forces of gravity
Balance
Stability and Function is accomplished through the integration of
CNS Musculoskeletal Responses Context of task and environment
What describes perfect equilibrium
COM
What are the stages for motor control
Capacity for Mobility Stability Controlled Mobility Skill
What are the 3 main types of nuclei in basal ganglia
Caudate Nucleus Putamen Globus Pallidus
Skill
Consistently perform coordinated movement sequences
Gross motor skills in order
Creeping Kneeling Standing Walking Running
Causes of impaired balance
Disease Process Proprioception Weakness Limited ROM Pain Impaired Posture Impaired motor planning Medications Fear of Falling
Muscles for ankle strategies are said _______ to _________
Distal to Proximal
What does the berg balance test assess
Fall risk
What are the components of equilibrium
Head and Trunk UE/LE Trunk rotation away from weight shift
What muscles are involved in the weight shift strategy
Hip adductors/abductors Ankle invertors/evertors
What is the primary function of the basal ganglia
Initiate and regulate gross intentional movements as well as plan and execute complex motor responses
Examples of skill
Jumping jacks drinking water
What plane does the weight shift strategy occur in
Lateral
What are examples of equilibrium
March in place Walk on heels/toes Jumping jacks Standing on one foot
What are the causes of vertigo
Meniere's Disease - chronic vertigo; extra production of epidemial fluid Multiple Sclerosis - same symptoms as meniere BPPV - most common in females and adults
Frenkel exercises require a high degree of _______ ________ and ________
Mental concentration and effort
Capacity for mobility stage
Move from one posture to another
What is the primary source of input for somatosensory
Muscle spindles
What is the balance treatment progression
Musculoskeletal Neuromuscular Sensory Cognition
A blind person with limited vision would depend on what two systems
Musculoskeletal Systems Nervous System
Is rigidity velocity dependent
NO
What involves the planning, programming and executing balance responses
Nashner's Motor Strategies
What is a sign of dislodged crystals
Nystagmus (uncontrolled movement of the eyes)
What muscles go with anterior displacement of hip
Paraspinals Hamstrings
What diseases are associated with the Basal Ganglia
Parkinson's Huntington's Chorea Wilson's Disease
Majority of impairments in coordination are associated with what 3 areas of the brain
Periphery Cerebellum Basal Ganglia
What all must align
Person Task Environment
What is the neurological developmental sequence
Prone on Elbow Quadruped Hooklying Sitting Kneeling 1/2 kneeling Modified Plantigrade Standing
Examples of stability
Prone on elbows Quadruped Sitting Kneeling Plantigrade Standing
What does the Romberg test assess?
Proprioceptions
Muscles for the hip strategy are said _______ to _______
Proximal to distal
What are the 4 types of Balance control
Reactive (automatic) Anticipatory (proactive) Adaptive (modifications) Closed Loop (sensory only)
What is the correct order of the development of these reactions
Righting Protective Equilibrium
Examples of Capacity for mobility stage
Rolling Supine to Sit Sit to stand Transfers
What is dexterity
Skillful use of the fingers in fine motor tasks
What system does the Cerebellum control
Somatosensory
What are the 3 sensory processing systems
Somatosensory Vision Vestibular
The quality of specific movements depend on
Speed Timing Direction Distance Muscle Tension Ability to control
What factors impact balance strategies
Speed and Intensity Support Surface Magnitude of displacement of COM Awareness to upcoming displacement Posture at time of displacement Prior experience
When discussing framework for postural control, what falls under the postural tasks category
Steady State Proactive Reactive
What strategy do parkinson's patients use
Stepping strategy
When discussing framework for postural control, what falls under the environment category
Support Surfaces Sensory Context Cognitive Load
What is the Romberg test
Tests the patients ability to stand with feed parallel and together with eyes open and closed for 30 seconds TEST POSTURAL SWAY
What muscles go with posterior displacement of ankle
Tib Anterior Quad Abdominals
3 main components of the vestibular system
Utricle Saccule Semicircular Canals
What is an issue of the vestibular system
Vertigo
What system does the supplemental motor area control
Vestibular
What are the 2 main types of vertigo
Vestibular Ocular Reflex (VOR) Benign Paroxysmal Positional Vertigo (BPPV)
Which system has the final response
Vestibular System
When you have vestibular apparatus, what nerve does it affect
Vestibulocochlear nerve
What system does the Basal Ganglia control
Visual
What are the sensory processing systems
Visual Somatosensory Vestibular
Examples of controlled mobility
Weight shifting Limb reaching
Is spasticity velocity dependent
YES
What are Frenkel's coordination exercises?
a series of motioning increasing difficulty performed by ataxic patients to facilitate the restoration of coordination
Balance is most stable when
ability to maintain one's center of gravity or center of mass over their base of support
What is anticipatory control
activation of postural muscles prior to performing
What is adaptive processing
adapting to a specific situation
What is equilibrium reaction
adds extremity movements to the righting reactions to regain equilibrium
What is the dorsal column responsible for
afferent transmission of discriminative sensations
Sensory integration requires _______ neuromuscular system
an Intact
What types of acceleration does the vestibular system detect
angular and linear acceleration
What way does the trunk move when in the equilibrium reaction
away from the trunk
How does the development of postural control form?
cephalocaudal
What direction is the ankle strategy in
distal to proximal
What is suspension strategy
flexing at hips and knees to maintain a BOS
What are examples of fine motor skills
handwriting buttoning a shirt typing manipulation of objects
What is an example of an issue with the vision system
impaired vision/night vision
What is attention allocation
incorporate a cognitive task with a motor challenge with distractions during gait
What is vertigo
it is a dislodging of crystals that causes nausea
What is automatic postural reactions
maintain balance in response to unexpected external perturbation such as standing on a bus that suddenly accelerates forward
Controlled Mobility
maintain postural stability and orientation with COM over the BOS while in motion
What is steadiness
minimal sway
What is dual tasks
mix and match dual tasks with various surfaces or activities
What is adaptive control
modifying or changing a task to do something else
When discussing framework for postural control, what falls under the individual category
motor sensory cognitive
What is reactive control
movements are too fast to rely on sensory feedback
What is a righting reaction
orient head and eyes to the horizon relative to the ground
What is the vestibular system
position and movement of the head in relationship to gravity and intertial forces
What is the vision system
position of the head in relationship to the environment orientation of the head to maintain level gaze
What are gross motor skills
posture, balance, and extremity movements with large muscle groups
What is closed loop control
precise movements requiring sensory control
What is hip strategy
presents with a wide BOS to a narrow BOS
What is somatosensory system
provides position sense and motion of body parts in relationship to each other and the supporting surfaces
What direction is the hip strategy in
proximal to distal
What are examples of anticipatory control
reaching and lifting at various heights transfers at different speeds ball tossing/kicing different sizes kicking, punching, twisting
What are examples of adaptive control
reading a book and the phone rings
What is the primary function of Cerebellum
regulating movement through error correction such as postural control and muscle tone
How are ROM and Strength addressed
simultaneously
What are examples of closed loop control
sitting on a ball jumping on trampoline
Coordination with balance include movements that are
smooth accurate controlled
What is unsteadiness
sway range that is outside the normal
What is the purpose of muscle spindles
tells you about stretch relay signal of a flat surface
What is the purpose of GTO
tells you about the tension and movement in that muscle
What is agility
the ability to stop, start, change direction, and efficiently change body position
What is the Modified Clinical test of Sensory integration and balance (mCTSIB)
this allows the clinician to determine which sensory system is most likely compromised and to assess the areas that process their information
Wha is a saccule
this includes the cilia hairs and detects linear translation of the head in a vertical plane
Posture and movement form _________ so balance is achieved in various postures
together
What is stepping strategy
trying to keep balance after an unexpected push or pull
Examples of reactive control
tug o war dodgeball start / stop push / pull slip training
What is feedforward (open loop motor control)
utilized for movements that occur too fast to rely on sensory feedback or for anticipatory aspects of postural control
Where does the medial lemniscus terminate at
ventral posterolateral thalamus
What is the sway boundary
where one can move and maintain their equilibrium without changing their BOS
