week 6

Question 1

centre of mass (COM)

Answer 1

is the point in an object at which its mass is concentrated

Question 2

centre of gravity

Answer 2

The vertical downward projection of the COM

Question 3

base of support

Answer 3

is the area of the body that is in contact with the support surface.

Question 4

centre of pressure (COP)

Answer 4

is a measure of pressure through the soles of the feet

Question 5

Role of the Central Nervous System in balance

Answer 5

responds to the position, the velocity and acceleration of the centre of mass

Question 6

Definition of postural control

Answer 6

1. Postural orientation – maintenance of appropriate relationship between body and environment to meet requirements of the task
2. Postural stability – controlling COM over BOS

Question 7

Steady State Balance

Answer 7

Steady state balance allows us to maintain the body’s position when standing or sitting quietly

Question 8

Limits of Stability

Answer 8

The point at which the person must change their base of support in order to
maintain their postural stability

Question 9

Limits of Stability
Influence of individual characteristics

Answer 9

• Muscle strength
• Muscle length
• Joint ROM
• Motor control
• Fear of falling
• Perception of safety

Question 10

Muscle tone

Answer 10

is the force at which the muscle resists being lengthened

Question 11

Non-neural contribution to muscle tone

Answer 11

thixotrophy

Question 12

Neural contribution

Answer 12

to muscle tone include modulation
by descending motor pathways

Question 13

Postural tone

Answer 13

Postural tone is an increase in activity in the antigravity postural muscles to resist force of gravity

Question 14

Reactive Balance

Answer 14

occurs in response to an external force (external perturbation) acting on the body
Or
An external force acting on the base of support

Question 15

Proactive Balance

Answer 15

Proactive balance control describes the
initiation of postural adjustments before
the destabilising force

Question 16

Postural Adjustments

Answer 16

Postural adjustments are made in anticipation of voluntary movement and help to maintain stability during movement

Question 17

Body Functions and Structures Contributing to Balance Motor

Answer 17

• Postural alignment
• Muscle length
• Joint range of movement
• Muscle Strength / Power / Endurance
• Co-ordination of muscle activation

Question 18

Body Functions and
Structures Contributing to Balance
Sensory

Answer 18

In order to use effective anticipatory and
compensatory postural adjustments the CNS

Question 19

sensory - tactile

Answer 19

skin receptors

Question 20

proprioceptive

Answer 20

muscle and joint mechanoreceptors

Question 21

Body Functions and
Structures Contributing to Balance
Vision

Answer 21

• Visual acuity (for visual fixation)
• Visual fields
• Depth perception
• Contrast sensitivity

Question 22

Body Functions and Structures
Contributing to Balance –
Cognitive Load

Answer 22

Because the control of balance and other cognitive processing share cognitive resources
– Balance can be impaired by a secondary cognitive task
– Performance in secondary cognitive
tasks declines as the difficulty of the balance task increase

Question 23

Environment

Answer 23

Support surface - stationary/ moving, slippery
Sensory context - context will influence how sensory info is used

Question 24

Why assess balance?

Answer 24

• To assess function and functional limitations
• Assess safety during functional tasks
• To identify impairments that may be
  contributing to reduced balance
• To inform design balance / falls
  prevention programs
• Prediction e.g. falls risk, rehabilitation potential, determine if safe to return to work / sport
  To help set functional goals
  To provide patient feedback

Question 25

Qualitative assessment

Answer 25

Observations including essential components

Question 25

Objective examination

Answer 25

Functional Task = sitting/standing/walking balance

Question 26

Quantitative assessment

Answer 26

Objective measures including outcome measures

Question 27

Assessment of steady state balance

Answer 27

1. Functional Task Analysis (Qualitative – descriptive) 2. Objective measurements (Quantitative)

Question 28

essential components Steady State Sitting Balance

Answer 28

* Head level on shoulders * Upper body erect - trunk and neck in neutral * Shoulders over the hips * Anterior pelvic tilt * Hips / knees flexed, ankle DF * Feet and knees a few cm apart * Weight evenly distributed

Question 29

essential components Steady State Standing Balance

Answer 29

* Head on level shoulders * Upper body erect - trunk and neck in neutral * Shoulders over the hips * Feet and knees approx. 10cm apart * Hip and knee extension, DF * Weight evenly distributed

Question 30

Objective Measures

Answer 30

Time (sec) able to maintain position Time under different conditions if appropriate

Question 31

Functional Task Analysis- Steady State Sitting and Standing Balance

Answer 31

Observe and describe the task Level of assistance Aids Postural alignment Direction and size of sway Essential components Compensations Observe under different conditions if appropriate

Question 32

Anticipatory sitting balance

Answer 32

* Head movements * Rotate body to each side * Reaching to arm's length * Reaching beyond arm’s length * Reaching forward and up * reaching forwards and down * reaching side ways reaching sideways to touch floor

Question 32

Anticipatory standing balance

Answer 32

* Head movements * Rotate body to each side * Shift weight in all directions - laterally, forward, backward * Reaching forward, backwards, laterally * Reaching forward and down (controlled trunk flexion - eccentric * Step forward/ sideways * Reaching sideways * Step and reach (left and right foot stepping) * Reaching sideways to touch floor (from a stool) * Step on/off a block

Question 33

Anticipatory standing balance Leaning Tests

Answer 33

A. Functional Reach Test B. Lateral Reach Test

Question 33

Anticipatory balance during gait proactive

Answer 33

ability to respond to known changes of surface and obstacles

Question 34

Anticipatory balance during gait assess

Answer 34

ability to maintain upright stability during gait ability to adapt gait during walking

Question 35

Reactive sitting balance Qualitative

Answer 35

* Describe response to unpredicted nudge in anterior / posterior or lateral direction

Question 36

Reactive sitting balance Quantitative

Answer 36

* Anterior Nudge * Posterior Nudge * Lateral Nudge 0 = dependent 1 = needs assistance 2 = upper extremity support 3 = verbal cues / increased time 4 = independent

Question 37

Reactive standing balance

Answer 37

Pastor, Day & Marsden Test Push and release test

Question 38

Pastor, Day & Marsden Test

Answer 38

Quick tug at shoulders from behind patient

Question 39

Push and release test

Answer 39

Pt leans back into hands of examiner – examiner suddenly removes hands

Question 40

Clinical Test for Sensory Interaction in Balance// Sensory Manipulation Tests

Answer 40

* Used to assess postural control (steady state) under changing sensory conditions * To determine which sensory system the person is most reliant on, and * The person’s ability to resolve sensory conflict

Question 41

Mini BESTest

Answer 41

* 14 items * Anticipatory postural control – sit to stand, stand on one leg * Reactive postural control * Sensory interaction * Dynamic Gait Index

Question 42

Boomer = Balance Outcome Measure for Elder Rehabilitation

Answer 42

* Step test * TUGT * Functional reach test * Static standing feet together eyes closed

Question 43

Patient Reported Outcome Measures re balance

Answer 43

* Fear of Falling Questionnaires – i.e. Falls Efficacy Scale-I * Activity Specific Balance Confidence Scale (ABC)