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Balance, Coordination
Lecture and Lab
139
Medical
Graduate
07/16/2015

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Term
what are the various systems that are involved in maintaining a stable posture (4)
Definition
vestibular, visual, sensory, musculoskeletal
Term
what are the nervous system components that are involved in maintaining a stable posture (3)
Definition
vestibular nuclei, oculomotor nuclei, cerebellum
Term
3 roles of the cerebellum
Definition
anticipatory, feedback, learning
Term
repetitive practive in varied environments will influence the CPG's. which role of the cerebellum?
Definition
motor learning
Term
did you miss the golf ball? let's give you a bigger ball or a weighted club. these are examples of providing what to the cerebellum?
Definition
feedback
Term
attempting to pick up a box filled with books but its only filled with air results in you almost falling. which role of the cerebellum prepares you to pick up the box
Definition
anticipatory
Term
the ability to hold the body uprigth in opposition to gravity trying to pull us down
Definition
balance
Term
Parts of the musculoskeletal system needed to maintain balance (3)
Definition
AROM, Strength, and Core muscles
Term
somatosensation includes what 5 sensations
Definition
localization, proprioception, vibration, pain, and temp
Term
somatosensation: patient being able to indicate where you are touching them
Definition
localization
Term
somatosensation: patient being able to match the movement of one limb with the other
Definition
proprioception
Term
components of ocular motility for balance (5)
Definition
smooth pursuits, saccades, convergence, visual field, dynamic visual acuity
Term
ocular motility: how does one test smooth pursuits
Definition
finger tracking
Term
ocular motility: how does one test for saccades
Definition
looking back and forth between the fingers of the PT
Term
ocular motility: how does one test for convergence
Definition
ptnt focuses on PT's finger. PT bring's their finger to ptnt's nose and asks when double vision occurs. 6 cm is normal
Term
ocular motility: how does one test for visual field
Definition
which section of the visual field is missing
Term
loss of fixation during vestibuloocular testing indicates what
Definition
interruption of signals within the brainstem
Term
failing to fixate during the VOR may also be accompanied by these S/S
Definition
increased dizziness, oscillopsia
Term
what does the Hallpike test for
Definition
benign paroxysmal postional vertigo
Term
how is benign paroxysmal positional vertigo
Definition
hallpike
Term
how is balance assessed in a functional perspective
Definition
sitting, standing, static, dynamic, while observing for duration, LOB, hand support
Term
other diagnostic tests used in balance dysfunction (5)
Definition
posturography, platform, calorics, electronystagmography, videonystagmography
Term
using calorics to test for balance assess what exactly?
Definition
unilateral vestibular loss
Term
Clinical Test for Sensory Interaction in balance
Definition
Rhomberg test on/off foam
Term
test which assesses balance while walking variably (changing speed, changing direction of gaze, stepping over objects, stairs)
Definition
dynamic gait index
Term
4 named balance tests
Definition
berg balance, tinettti, fuduka stepping, postural stress test
Term
test in which ptnt marches in place with arms out, if ptnt veers the test is positive
Definition
fuduka stepping
Term
of the 4 named balance tests which is the only one which tells you the underlying impairment
Definition
postural stress test
Term
during teh postural stress test, a drop of how many mmHg would indicate postural hypotension
Definition
20 mmHg
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness CNS (10)
Definition
migraine, head truma, brain-stem stroke, vertebrobasilar insuffiency, cerebellar degeneration, MS, CN involvement, coordination testing, spasticity, hyperreflexia
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness: CNS: migraines could exhibit what symptoms? migraines could be a result of what?
Definition
dizziness, neck/posturla issues
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness CNS: Examples of head trauma
Definition
concussion, TBI
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness CNS S/S of cerebellar degeneation
Definition
ataxia, coordination deficits
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness CNS: issues associated with MS
Definition
vestibular ocular issues, regular motility issues, cerebellar issues
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: 7 disorders
Definition
BPPV, vestibular neuritis, Meniere's Disease, Endolymphatic Hydrops, Perilymphatic fistula, vestibular paroxysmia, bilateral vestibular disorders
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: disorder in which one side of teh vestibular nerve is inflammed
Definition
vestibular neuritis
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: 2 disorders in which there is a problem with the fluid of the inner ear
Definition
meniere's disease, endolymphatic hydrops
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: disorder which PT's do not treat
Definition
perilymphatic fistula
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: disorder in which there is a tear in the oval/round window
Definition
perilymphatic fistula
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: disorder in which there is interrupted blood supply to the nerve in the inner ear and is very difficult to diagnose
Definition
vestibular paroxysmia
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: unilateral vestibular disorders cause what symptom
Definition
dizziness
Term
Pathologic conditions that contribute to imbalance, disequilibrium, or dizziness PNS: bilaterael vestibular disorderes caused what sign
Definition
balance issues
Term
5 PT diagnoses for balance issues
Definition
gait dysfunction d/t imbalance, BPPV, hypofunctioning unilateral, hypofuncitoning bilatereal, CNS imbalance, Cervicogenic vertigo
Term
vestibular ocular communcation goes through what nervous system structure
Definition
medial longitudinal fasiculus
Term
a cerebellar lesion would have these types of s/s
Definition
low tone, hypotonic, d/t cerebellar influence on vestibular/ocular control
Term
how to train OM deficits?
Definition
perform tests as exercises but with decreased rate, distance, time
Term
what is ataxia
Definition
coordination deficit characterized by over reaching, staggering/drunken gait, intention tremor, dysmetria
Term
when testing coordination, what is the most important thing to test first
Definition
whether strength is at least 3/5
Term
what are the 3 theories on how the cerebellum function (what role does it play for movement)
Definition
anticipation, motor learning, feedback
Term
term to describe general weakness
Definition
asthenia
Term
term to describe low tone
Definition
hypotonia
Term
poor articulation of muscles and mouth, difficulty talking
Definition
dysarthria
Term
overshoot/undershoot
Definition
dysmetria
Term
when multiple joints need to move together but don't move cohesively, resulting in a slow delayed movement
Definition
movement decompisition
Term
ability of the cerebellum to turn on/off the antagonist of the muscle
Definition
rebound phenomena
Term
difficulty performing rapid/alternating movements
Definition
dysdiadochokinesia
Term
coordination is tested in 4 main movement capabilites. what are they
Definition
reciprocal motion, movement composition, movement accuracy, fixation/postural holding
Term
examples of reciprocal motion
Definition
supination to pronation, toe tapping
Term
examples of movement composition
Definition
sequencing multiple joints in one extrimty or moving both UE's together thru ROM
Term
examples of movement accuracy
Definition
absence of dysmetria, intention tremor
Term
example of fixaiton
Definition
proximal holding for stability to complete distal tasks
Term
3 assumptions to being able to test coordination
Definition
isolated selective movements are possible, adequate strength, adequate ROM
Term
when testing for coordination, if there is adequate strength then there is adequate ____
Definition
ROM
Term
another factor to test in coordination
Definition
speed, ability of the ptnt to do the activity in a normal period of time and then also at an increased rate
Term
basal ganglia problems include (8)
Definition
bradykinesia, rigidity, tremor, akinesia, chorea, athetosis, hemiballismus, dystonia
Term
dorsal column lesion problems include (6)
Definition
proprioceptive loss, WBOS in stance and gait, dysmetria, balance problems, equilibrium problems, slowing of voluntary movements
Term
clinical tests to determine if coordination is intact (7)
Definition
finger to nose self x5, finger to nose and PT's finger x5 c variable speed, drawing numbers/alphabet with fingers/toes, heel to shin/ankle c/s contact, tracking test, writing, gross movement patterns, rapid alternating movements
Term
6 standardized tests to determine if coordinationt is intact
Definition
fitt's tapping test, frenchay arm test, rivermead etst, peg tests, box and blocks test, jebsen hand function
Term
ataxia in which the ptnt walks with a broad BOS and throwing out feet which come down first on the heel and then on the toes with a slapping sound (double tap). Ptnt's watch feet while walking. Gait may appear normal with eyes open, but with eyes closed ptnt may stagger, be unstead, or unable to walk
Definition
spinal ataxia
Term
ataxia in which gait deviation is equally severe with eyes open or closed. gait is wide-based, unsteady, or irregular. Ptnt staggers and is unable to walk tandem or to follow a straight line.
Definition
cerebellar ataxia
Term
if the cerebellar lesion is localized to one hemisphere which side with the ptnt persistently deviate/sway to?
Definition
affected side
Term
sensory information is carried to higher centers for integration of the information via what?
Definition
the dorsal columns
Term
sensory information is carried to higher centers for integration of the information via the dorsal columns, more specifially what 2 pathways
Definition
medial lemniscal system, anterolateral spinothalamic tract
Term
what is carred in the dorsal column medial lemniscal system
Definition
touch, proprioception, kinesthesia
Term
how do we test if the medial lemnisical system is intact
Definition
localization, proprioception
Term
what sensations are carred on the anterolateral spinothalamic tract
Definition
pain and temp, light touch
Term
how do we test if the anterolateral spinothalamic tract is intact
Definition
test for temperature, light touch, and pain
Term
What does the spinocerebellar tract carry and how do we test the integretiy of this tract
Definition
fine coordination of posture and kinesthetic sense of limbs
Term
many ptnts with perceptual deficits have a lesion of what lobe primarily? and secondarily?
Definition
parietal lobe, frontal
Term
frontal lobe is involved with what processes (6)
Definition
planning, abstract reasoning, foresight, premotor cortex, supplemental motor cortex, primary motor cortex
Term
frontal lobe lesion problems include (11)
Definition
problems in starting, problems in stopping, difficulties inmaking mental or behavioral shifts, lack of self awareness, concrete thinkig problems, memory loss, lack of attention, distractibility, diplopia, homononymous hemianopsia and aphasia
Term
Frontal Lobe Lesions: patients with problems in starting will appear
Definition
lazy
Term
Frontal Lobe Lesions: patients who present with problems in stopping will appear
Definition
impulsive, habitual, continually forgets to lock w/c
Term
Frontal Lobe Lesions: patients who present with diffiuclties in making mental or behavioral shifts will appear
Definition
inflexible
Term
Frontal Lobe Lesions: patients who lack self awareness will do this
Definition
not recognize their own errors
Term
Frontal Lobe Lesions: patients who have a problem with concrete thinking will appear as if they...
Definition
lack insight, take everything at face value
Term
Frontal Lobe Lesions: which types of memory loss
Definition
short-term or immediate recall
Term
these deficits can influence motor performance
Definition
sensory deficits
Term
ability to organize, process, and interpret incoming visual, tactile-kinesthetic or both in order to act appropriately based on the information received
Definition
perception
Term
a patient presents with problems in perception, the lesion is most likely located where?
Definition
right parietal lobe
Term
4 types of perception deficits
Definition
figure-ground, depth perception, spatial relations, position in space
Term
describe figure-ground deficit
Definition
can't differentiate a white shirt on unmade bed, spoon in a crowded drawer
Term
describe depth perception deficit
Definition
inability to correctly determine relative distane between objects, surfaces
Term
describe spatial relations deficit
Definition
problem with spatial orientaiton of objects, such as navigating a w/c through a doorway
Term
describe position in space deficit
Definition
unable to understand in/out, up/down, front/back
Term
5 other perceptual dysfunctions
Definition
topographical disorientation, somatognosia, unilateral neglect, visual/tactile agnosia, dressing ideomotor and ideational apraxia
Term
describe topographical disorientation
Definition
inability to understand and remember relationships of places to one and other, directions
Term
describe somatognosia
Definition
lack of awareness of body structure and recognize own body parts, right, left discrimination
Term
describe visual and tactile agnosia
Definition
inability to recognize objects, visually or with touch
Term
describe dressing, ideomotor, and ideational apraxia
Definition
inability to carry out purposeful movement on command and more serious can't perform sequenced motor tasks, problems in planning movement and initiating
Term
S/S of lesion in left hemisphere (5)
Definition
aphasia, ideomotor and ideational apraxias, number alexia, right-left discrimination, slow in organizaiton and performance
Term
Left hemisphere lesion: aphasia example
Definition
lack functional speech
Term
Left hemisphere lesion: ideomotor and ideational apraxias example
Definition
can not plan and execute serial steps in performances
Term
Left hemisphere lesion: number alexia example
Definition
can not recognize symbols to do simple computations
Term
Left hemisphere lesion: sow in organizaiton and performance examples
Definition
can not remember what they intended to do next
Term
A lesion of the right hemisphere would result in these clinical problems (9)
Definition
visuospatial, left unilateral neglect, body image, dressing apraxia, constructional apraxia, illusions of shortening of time, number concepts/spacial type, rapid organization and performance, depth of language skils
Term
Right hemisphere lesion: visuospatial clinical example
Definition
cannot orient self to changes in environment in moving from place to place
Term
Right hemisphere lesion:left unilateral neglect clinical example
Definition
unaware of objects to the left, could self propel w/c into them
Term
Right hemisphere lesion: body image clinical examples
Definition
distorted awareness and impression of self
Term
Right hemisphere lesion: dressing apraxia clinical example
Definition
applies sweater to r but unable to do left side
Term
Right hemisphere lesion: constructional apraxia
Definition
can't transpose 2-d to 3-d
Term
Right hemisphere lesion: illusion of shortening of time clinical examples
Definition
arrives early
Term
Right hemisphere lesion: number concepts/spatial type clinical examples
Definition
unable to align columns and rows of digits
Term
Right hemisphere lesion: rapid organization and perforamnce
Definition
errors from haste, may cause accidents
Term
Right hemisphere lesion: depth of language skills clinical examples
Definition
may mention task related to prestroke occupation but cannot go into details of it
Term
genu recurvatum is thought to be weakness of what
Definition
gastroc weakness concentrically, gastroc weakness eccentrically, quadsd
Term
which CVA more likely to have sensory loss but decent motor
Definition
right CVA
Term
which CVA is more likely to have motor loss but decent sensory
Definition
Left CVA
Term
the lesion which results in pusher's syndrome is thought to be located where
Definition
thalamus
Term
what connections does the cerebellum have with the spinal cord?
Definition
sensory only via spinocerebellar tract
Term
oldest part of cerebellum
Definition
flocculonodular lobe
Term
the vermis of the cerebellum is responsible for what in terms of balance/coordination
Definition
trunk alignment, midline perception
Term
difficulties with alignment/midline perception may also be demonstrated as what non-cerebellar issues
Definition
sensory-perceptual deficits
Term
how does the vestibular system communicate with the ocular system
Definition
medial longitudinal fasiculus
Term
cerebellar lesion presents with what symptoms
Definition
low tone, hypotonic d/t cerebellar influence on vestibular/ocular control
Term
Lesion of which hemisphere: aphasia
Definition
left
Term
Lesion of which hemisphere: ideomotor and ideational apraxias
Definition
left
Term
Lesion of which hemisphere: number alexia
Definition
left
Term
Lesion of which hemisphere: right left discrimination
Definition
left
Term
Lesion of which hemisphere: slow in organization and performance
Definition
left
Term
Lesion of which hemisphere: visuo-spatial
Definition
right
Term
Lesion of which hemisphere: left unilateral neglect
Definition
right
Term
Lesion of which hemisphere: body image
Definition
right
Term
Lesion of which hemisphere: dressing apraxia
Definition
right
Term
Lesion of which hemisphere: construcitonal apraxia
Definition
right
Term
Lesion of which hemisphere: illusions of shortening of time
Definition
right
Term
Lesion of which hemisphere: number concepts/spatial type
Definition
right
Term
Lesion of which hemisphere: rapid organization and performance
Definition
right
Term
Lesion of which hemisphere: depth of language skills
Definition
right
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