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balance
balance objectives
53
Anatomy
Graduate
11/25/2012

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Term
Define balance
Definition
controlling the COM relative to the BOS; keeps you from falling
Term
what are limits of stability
Definition
how far COM can move in any direction without loss of balance. Edge of the cone of stability
Term
what is the cone of stability
Definition
limits of stability are shaped like a cone
Term
what determines the size of the cone of stability in standing?
Definition
base of support (feet), joint ROM, muscle strength, sensory information
Term
describe the CNS representation of the cone of stability
Definition
the CNS has an internal representation of the cone of stability that it uses to determine how to move to maintain equilibrium.
Term
what happens to older adults with balance disorders and their CNS representation of the cone of stability
Definition
the cone of stability is very small or their central neural representations of that cone of stability are distorted, which affects their selection of movement strategies to maintain equilibrium
Term
what is the postural sway envelope
Definition
in standing, the body undergoes constant swaying, with the sway envelope centered with limits of stability/COM
Term
how big is a sway envelope for someone standing with their feet 4 inches apart
Definition
8 deg forward, 4 deg backward, 8 deg left, 8 deg right
Term
what are the 3 sensory inputs necessary for balance
Definition
somatosensory, visual, vestibular
Term
which sensory input has the fastest mode of transmission?
Definition
somatosensory=
Term
how does sensory input contribute to maintenance of balance
Definition
provides information about orientation of body in space and orientation of body parts to other body parts
Term
what is anticipatory control of balance
Definition
using information about initial conditions and goal to regulate balance during a task
Term
what provides somatosensory information
Definition
tactile and proprioceptive inputs via mechanoreceptors in joint capsule, muscles, skin
Term
when does vestibular sensory come in to play?
Definition
when there is a conflict between somatosensory or vision or when somatosensory/vision are absent
Term
what are motor contributions to maintain balance
Definition
responds to sensory input to adjust body position
Term
what parts of the brain affect motor responses
Definition
basal ganglia and cerebellum regulate responses produced by cerebral cortex (premotor and primary motor cortices)
Term
what does APR stand for
Definition
automatic postural response
Term
what is an APR
Definition
posture as a pre-programmed response
Term
describe medium latency APRs
Definition
brainstem level response that occurs prior to cortical potential, causes stabilizing muscle activation (whole body involved);
Term
describe long latency APRs
Definition
cortical involvement to modify postural response after perturbation: should I step or reach?
Term
what cortical involvements occur in long latency automatic postural response?
Definition
cerebellar-cortical loop: adapts based on prior experience; basal ganglia-cortical loop: optimize response based on current conditions
Term
what is the order of ankle strategy for forward sway (small perturbation)
Definition
gastroc, hamstrings, paraspinals
Term
what is the order of ankle strategy for backward sway (small perturbation)
Definition
tib anterior, quads, abs
Term
what muscles are activated in hip strategy for forward sway
Definition
abs and quads
Term
what muscles are activated in hip strategy for backward sway
Definition
paraspinals, hamstrings
Term
does the head and hip move in same or different directions in ankle strategy?
Definition
same
Term
does the head and hip move in same or different directions in hip strategy?
Definition
different
Term
when do you use hip strategy instead of ankle strategy
Definition
when the perturbation is larger and there is not enough friction between foot and ground.
Term
what are the purposes of APA?
Definition
constrain displacement of body's COM by generate opposing displacement; permit controlled movement of COM over a changing BOS
Term
what influences APA
Definition
movement speed, initial location of COM with respect to BOS, postural support, mass of moving limb, instructional set
Term
is APR feedforward or feedback?
Definition
feedback
Term
is APA feedforward or feedback?
Definition
feedforward
Term
does APR react or anticipate?
Definition
react
Term
does APA react or anticipate?
Definition
anticipate
Term
what is the overall purpose of APR
Definition
regain stability
Term
what is the overall purpose of APA
Definition
maintain stability during active movement
Term
is APR dependent on the environment?
Definition
yes
Term
is APA dependent on the environment?
Definition
yes
Term
what parts of CNS are required by APA
Definition
spinal cord, brain stem, cortex
Term
what parts of the brain are required by APR
Definition
spinal cord, brain stem, cortex
Term
what are important considerations in selection of balance assessments?
Definition
functional observation, sensory impairments, strategies, other impairments
Term
how to do functional observation with balance assessment
Definition
do standardized assessments: static and dynamic
Term
how to test for sensory impairments in selection of balance assessments
Definition
vary sensory inputs
Term
what are some tests to do for balance dysfunction
Definition
functional reach, Berg, Tinetti, TUG, 4SST, DGI, FGA, HiMAT, Community Balance and Mobility Scale, mini BESTest, Push and Release Test
Term
what are the steps/outline of an intervention plan to address balance problems identified in an assessment
Definition
Address underlying impairments. Practice while systematically varying sensory conditions, feedforward vs feedback, point and method of perturbation, speed demands, and attentional demands. Modify environment to compensate for permanent impairments. provide support and cues as needed. provide extrinsic feedback when needed. allow pt to solve problem with minimal feedback. Use biofeedback or STEPFIT to improve stance
Term
are APR responses present in very young children?
Definition
yes
Term
at what age is there a regression in APR organization?
Definition
4-6 years
Term
at what age is a child's APR similar to an adult's
Definition
7-10 years
Term
how does APR change in older adults
Definition
increased TA latencies. Increased co-contraction. Occasional reversals in sequence of leg muscle activation
Term
how does apa change in older adults?
Definition
increased latencies, occasional proximal to distal activation. Increased co-contraction
Term
who generally has increased postural sway?
Definition
young children, older adults
Term
what is the largest sensory contribution for children
Definition
vision
Term
what sensory contribution provides most information to adults to maintain balance
Definition
somatosensory
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