Balance, coordination, and function

Question 1

What are the parts of postural control and balance?

Answer 1

1. stability (static postural control)
2. controlled mobility (dynamic postural control; moving in and out of positions)
3. anticipatory control - know something’s coming and make changes accordingly
4. automatic control - maintaining balance and control when you don’t know it’s coming

Question 2

What are motor strategies for balance?

Answer 2

1. righting reactions - orient head in space and body in relation to the head and support surface
2. equilibrium reactions - protective reactions (ankle, hip, and stepping strategy)

Question 3

What are characteristics of cerebellar impairments?

Answer 3

1. Hypotonia
2. Dysmetria: hypometria and hypermetria
3. Dysdiadochokinesia
4. Intention Tremor
5. Nystagmus: Cb nystagmus, vestibular nystagmus, and positional vertigo
6. rebound phenomenon

Question 4

Control of the position of body parts with respect to each other and gravity

Answer 4

postural control

Question 5

Ability to keep center of mass within the base of support; all forces acting on the body are balanced

Answer 5

balance

Question 6

When doing the Romberg test, the pt has a significant test without eyes closed. what does this indicate?

Answer 6

cerebellar problem

- not an appropriate test

Question 7

Ability to execute smooth, accurate, controlled movements

Answer 7

coordination

- dependent on intact NM system from 3 inputs: visual, somatosensory, and vestibular

Question 8

How do we test Anticipatory Control vs Automatic Control?

Answer 8

• Anticipatory Control – pt has eyes open; “I’m going to push in different directions I want you to hold you position”
• Automatic Control - pt has eyes closed; taking vision out, must rely more on proprioception and vestibular systems; Still tell them what you’re going to be doing; Consider safety, if testing this is appropriate even (fall risk?)

Question 9

What are the balance grades? (4-0)

Answer 9

• 4 - Normal - Static: maintains steady balance wo/HHS; Dynamic: weight shifts easily, w/in full range, in all directions when maximally challenged
• 3 – Good - Static: HHS not req’d; min-postural sway present; Dynamic: accepts mod-challenge; can pick object up off floor
• 2 – Fair - Static: HHS req’d, and occasional min-assist req’d; Dynamic: accepts min-challenge; can turn head
• 1 – Poor: Static: HHS and mod-to-max-assistance req’d; Dynamic: LOB when challenged or attempts movement
  0 - Absent: Unable to maintain static or dynamic balance

Question 10

What are the main areas of the CNS involved if coordination impairments are present?

Answer 10

BG and Cb

Question 11

general muscle weakness

Answer 11

Asthenia
(Cb pathology)
- application of manual resistance to determine ability to hold

Question 12

Loss of ability to associate muscles together for complex movements

Answer 12

asynergia

Cb pathology

Question 13

increased time required to initiate voluntary movement

Answer 13

delayed reaction time

Cb pathology

Question 14

disorder of the motor component of speech articulation

Answer 14

dysarthria

Cb pathology

Question 15

impaired ability to perform rapid alternating movements

Answer 15

dysdiadochokinesia

Cb pathology

Question 16

inability to judge the distance or range of a movement

Answer 16

dysmetria

Cb pathology

Question 17

movement performed in a sequence of component parts rather than as a single, smooth activity; decomposition

Answer 17

dyssynergia
(Cb pathology)
- finger to therapist’s finger, finger to nose, alternate heel to toe, toe to examiners finger

Question 18

ataxic pattern, broad BPS; postural instability; high-guard position of UEs

Answer 18

Gait disorders

Cb pathology

Question 19

rhythmic, quick, oscillatory, back-and-forth movement of the eyes

Answer 19

nystagmus
(Cb pathology)
- red flag when straight vertical; means CNS impairment (vestibular has rotational component

Question 20

inability to halt forceful movements after resistive stimulus removed; pt unable to stop sudden limb motion

Answer 20

rebound phenomenon

Cb pathology

Question 21

involuntary oscillatory movement resulting from alternate contractions of opposite muscle groups

Answer 21

tremor
- intentional = during voluntary movement; increases as limb reaches target
- postural = movement of body in standing posture or of a limb (?) against gravity
(Cb pathology)

Question 22

rhythmic oscillations of the head; axial involvement of the trunk

Answer 22

titubation

Cb pathology

Question 23

inability to initiate movement; associated with fixed posture

Answer 23

akinesia

BG pathology

Question 24

slow, involuntary, writhing, twisting, “wormlike” movements; frequently greater involvement in distal UEs

Answer 24

Athetosis

BG pathology

Question 25

Decreased amplitude and velocity of voluntary movement

Answer 25

Bradykinesia | BG pathology

Question 26

involuntary, rapid, irregular, jerky movements involving multiple joints; most apparent in UEs

Answer 26

chorea | BG pathology

Question 27

movement disorder with features of both chorea and athetosis

Answer 27

choreoathetosis | BG pathology

Question 28

large-amplitude sudden, violent, flailing motions of the arm and leg of one side of the body

Answer 28

hemiballismus | BG pathology

Question 29

abnormally increased m activity or movement

Answer 29

hyperkinesis | BG pathology

Question 30

decreased motor response esp to a specific stimulus

Answer 30

hyopkinesis | BG pathology

Question 31

uniform consistant resistance as limb is moved

Answer 31

lead pipe rigidity | BG pathology

Question 32

series of brief relaxations or catches as limb is passively moved

Answer 32

cogwheel | BG pathology

Question 33

involuntary rhythmic oscillatory movement observed at rest

Answer 33

tremor (resting) | BG pathology

Question 34

What are some functional assessments?

Answer 34

1. Barthel index 2. Functional independence measure (FIM) - req'd for medicare inpatient rehab 3. outcome and assessment information set - req'd for home health initial eval (housekeeping, laundry, phone, locomotion) 4. SF-36

Question 35

What are some gait assessments

Answer 35

1. timed walking tests 2. distance tests (3, 6 qw min) 3. DGI - sensitive in likelihood of falls in elderly and vestibular dysfunction 4. walkie talkie test - determines attentional demands; pt slows down/ staggers/ loses balance/ has to stop = + fall risk

Question 36

What are the purposes of an environmental/ home assessment?

Answer 36

1. Degree of safety and level of function in physical environment 2. ID barriers to performance of tasks - railings? Clutter Lighting? Lighting at Night?Carpets? 3. Make recommendations about accessibility and accommodations 4. Determine need for adaptive equipment or assistive technology 5. Assist in preparing pt and family/support network for return home - Often performed when significant change in status (SCI, Stroke, Significant remission w/MS)

Question 37

What is the progression of balance testing/activities in standing?

Answer 37

1. Feet shoulder width apart 2. Turning head 3. Moving extremities/reaching inside BOS 4. Weight shifts fwd/bwd and lateral 5. Feet together 6. Tandem stance 7. Feet shoulder width apart eyes closed 8. Reaching outside BOS 9. Standing on one leg 10. Perturbations 11. Perturbations with eyes closed - Same progression on a dynamic surface (foam

Question 38

What is the progression of balance testing/activities in sitting?

Answer 38

1. Feet shoulder width apart on floor 2. Turning head 3. Moving extremities/reaching inside BOS 4. Weight shifts fwd/bwd and lateral 5. Raise surface - feet off floor 6. Feet on floor eyes closed 7. Reaching outside BOS 8. Perturbations 9. Perturbations with eyes closed - Same progression on a dynamic surface (foam)