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Introduction to Balance Cheat Sheet by

Introduction to Balance and Postural Control

Postural Control

Includes contro­lling the body’s position in space for the dual purposes of stability and orient­ation
- Postural orient­ation -The ability to maintain an approp­riate relati­onship between body segments, as well as, between the body and the enviro­nment for the task.
- Postural Stability - ability to control the center of mass (COM) in relati­onship to the base of support (BOS)

Balance

Balance is the ability to keep one’s center of gravity over one’s base of support in any given sensory conditions
Postural control and balance are often used interc­han­geably
Balance emerges from the intera­ction of the indivi­dual, the postural task and the enviro­nment

What the individual contribute to postural control

Visual, vestib­ular, and somato­sensory are the primary sensory neural components contri­buting to balanc­e/p­ostural control

Individual sensory neural components

Visual – provides inform­ation about the enviro­nment
Somato­sen­sory: sensory receptors in joints, muscle, and skin to provide percep­tions of movement and position in space
Vestibular – provides inform­ation on angular & linear accele­ration as well as position in space

Vision

Comprised of focal and ambient vision
- Focal- specia­lizes in object motion perception and object recogn­ition
- Ambient -assoc­iated with the mainte­nance of spatial orient­ation and visual functions that depend on periph­eral, precon­scious visual inputs
Decreased visual acuity, contrast sensit­ivity and depth perception are all associated with increase risk for falls

Somato­sensory

Inform­ation gathered from receptors located in muscles, joints and skin
Provides inform­ation regarding body segment movement in space and force generation

Vestibular

Both sensory system and motor system therefore can impact many different components of postural control
Provides inform­ation about head motion, head position, and the direction of gravity that the central nervous system needs for postural control
Affects motor control through two outputs, the vestibular ocular reflex (VOR) and the vestibular spinal reflex (VSR)
- VOR – stabil­izing visual images during head movement
- VSR – stabilize the body

Sensory Integr­ation and Motor Outputs

Sensory signals are integrated in the CNS and result in descending motor commands to muscle
Reactive and proactive and postural responses allow for adjust­ments to postural contro­l(b­alance) in the presence of a changing enviro­nment or tasks

Falls/­Balance Screening vs. Assessment

Screening
Assessment
Identifies persons at risk for falling or with balance impairment
In-depth, multif­act­orial measure(s)
Helps guide clinicians in determ­ining who should receive a multif­act­orial assessment
Examines potential cause of falls
 
Provides sufficient detail so as to guide interv­entions

Falls/­Balance Screening

STEADI Stay Indepe­ndent
John Hopkins Fall Risk Assessment Tool
Fall Risk Assessment and Screening Tool (FRAST)
Quick 12 question survey
developed to facilitate early detection of risk for antici­pated physio­logic falls in adult inpatients
Created by physical therapists for use in primary care offices
Good sensit­ivity discri­min­ating fallers and predicting future falls in community dwelling adults
JHFRAT is reliable, with high sensit­ivity and negative predictive validity
Compiled from previously validated falls screening and assessment measures
  
Uses the Timed Up and Go as the assessment

psycho­metric properties

Reliab­ility
The ability of a test to produce consistent results from one test to the next
Validity
The degree to which an instrument (test/­ass­ess­ment) measures what we intend to measure
Ceiling Effect
A signif­icant percent of a certain group/­pop­ulation scores at the highest end of the test, therefore differ­ent­iating between these indivi­duals or truly assessing them is not possible with this measure.
Floor Effect
A signif­icant percent of a certain group/­pop­ulation scores at the lowest end of the test, therefore differ­ent­iating between these indivi­duals or truly assessing them is not possible with this measure.
Minimal Detectable Change (MDC)
The minimum amount of change in a patient's score that ensures the change isn't the result of measur­ement error
Minimally Clinically Important Difference (MCID)
Represents the smallest amount of change in an outcome that might be considered important by the patient or clinic­ian. 

Balance Assess­ments

Timed Up and Go (TUG) – Manual and Cognitive
A component of the STEADI falls assess­ment; Provides insight on balance, streng­th/­power, walking ability, and fall risk; Indivi­duals are given verbal instru­ctions to stand up from a chair, walk 3 meters as quickly and safely as possible, cross a line marked on the floor, turn around, walk back, and sit down
30-Second Chair Stand Test
Admini­stered using a chair without arms, with seat height of 17 inches (43.2 cm). The chair may be placed against a wall to prevent it from moving.
4-Stage Balance Test
If the patient can hold a position for 10 seconds without moving their feet or needing support, go on to the next position. If not, STOP the test.
10 Meter walk Test
Two trials are admini­stered at the patient’s comfor­table walking speed, followed by 2 trials at his/her fast walking speed. The 2 trials, for each speed, are averaged and the 2 gait speeds are documented in meters­/se­cond.
Modified Clinical test of Sensory Intera­ction in Balance (CTSIB-M)
Provides the clinician with a means to quantify postural control under various sensory condit­ions. Designed to assess if available sensory systems are being used effect­ively for balance
       
 

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