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