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 |
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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 |
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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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