Balance Impairments

Question 1

Fall

Answer 1

-unexpected event where person loses balance to a degree where pt lands on a lower surface

Question 2

Postural Control

Answer 2

• ability to mntn body in equilibrium, statically and dynamically
• control of COM w/ respect of BOS

Question 3

Maintenance of Balance affected by:

Answer 3

• body alignment/posture/position
• muscle tone
• postural tone

Question 4

Anticipatory Control

Answer 4

• prep/proactive adjustments

- counteract disturbance of COM due to self initiated extremity movement

Question 5

Reactive Control

Answer 5

-strategy or movement pattern to respond to an unexpected perturbation (movement or sensory)

Question 6

Maintaining Balance Strategies

Answer 6

• Motor (hip, ankle, step)
• Sensory (vision, somatosensation, vestibular)
• Higher level processing (cognitive functioning): allows us to adapt

Question 7

Ant/Post Balance Strategies

Answer 7

• distal to proximal muscles
• Ankle: small perturbations, quick
• Hip: large perturb, small surface
• Stepping: above strategies fail

Question 8

Med/Lat balance Strategies

Answer 8

• hip response
• cross-over response
• lateral step response

Question 9

Sensory Strategies

Answer 9

• visual system
• somatosensory system
• vestibular system

Question 10

Visual System in Balance

Answer 10

• position of head

- reference to verticality

Question 11

Somatosensory System in Balance

Answer 11

• position andm ostion of body w/ reference to supporting surface
• main input used by adults

Question 12

Vestibular System in Balance

Answer 12

-position and movement of head with respect to gravity and inertia

Question 13

Sensory Strategies in Quiet Stance

Answer 13

• all three sensory systems
• somatosens from all body parts
• increased sway with eyes closed

Question 14

Sensory Strategies in Perturbed Stance

Answer 14

• somatosens input larger role compared to visual/vestibular

- vestib more active if support surface moves vertically or eyes are closed

Question 15

Quickest system in balance

Answer 15

• Somatosensory system

- Faster than vision

Question 16

Cognition & Postural Control

Answer 16

• Attention: requirements depend on task, age, balance capabilities
• may have increased/decreased sway in dual tasking

Question 17

In pts with neurological problems, most falls occur

Answer 17

In the home

Question 18

In pts with neurological problems, majority of falls due to:

Answer 18

tripping

Question 19

Neural Contributions to Postural Control

Answer 19

• Spinal preparation
• Brainstem
• Basal Ganglia/Cerebellum
• Cortex

Question 20

Medical Causes of Falls

Answer 20

• stroke, PD, dementia
• MSK: OA, Weakness
• Cardiovascular: syncope, impaired BP regs
• Medications

Question 21

Neuro-Related Motor Abnormalities

Answer 21

• sequencing problems
• impaired adaptation
• impaired timing
• impaired scaling

Question 22

Sequencing Problems

Answer 22

• prox to distal: Stroke

- co-contractions: PD

Question 23

Impaired Adaptation

Answer 23

• synergistic movement
• due to cognitive impairment
• inability use right strategy, with the right Mm, with correct force at right time

Ex. PD

Question 24

Impaired Timing

Answer 24

-delayed recruitment

Ex. Stroke, PD

Question 25

Impaired Scaling

Answer 25

• hypermetria
• hypometria

Ex. cerebellar lesions

Question 26

Neuro-Related Sensory Abnormalities

Answer 26

• impact of loss of one or multiple senses
• misinterpretation of stability limits
• inflexible weighting

Question 27

Inflexible Weighting

Answer 27

• inability to switch from using vestibular, vision or somatosensory to another system when required
• leads to: visual dependency, surface dependency or sensory selection problems

Question 28

highest population of fallers

Answer 28

-PD