Balance and Gait Assessment

Balance Assessment

• Balance is the ability to maintain positions and move, adapting to intrinsic and extrinsic changes in posture under the influence of gravity.
• The three major afferent systems that contribute to balance are:
  • Visual
  • Vestibular
  • Somatosensory
• Stability involves processing afferent and efferent information, resisting and anticipating disturbances, and maintaining a stable static position while allowing movement.

Balance Disorders

• Direct way: injury to major afferent systems and integrative system (e.g., deafferentation, damage to sensors or nerves, alteration of CNS).
• Indirect way: impairment of nerve signal transduction (e.g., bony-joint trauma, prolonged immobilization).

Balance Assessment Tools

• Functional assessment tools (tests or scales) to define deficits, establish a treatment plan, and achieve patient functional independence.
• Functional tests must consider three aspects: functional skills, motor and sensory strategies, and sensory, motor, and cognitive deficiencies.
• Examples of commonly used tests:
  • Balance ability Self assessment
  • Activities-specific Balance Confidence (ABC) Scale
  • Falls Efficacy Scale-International (FES-I)
  • Berg Balance test (assesses balance in elderly and neurological patients)

Berg Balance Test

• Measures balance in elderly and neurological patients
• Consists of an assessment of functional tasks
• 14-item scale
• Equipment: ruler, 2 chairs, stool, stopwatch
• Time: 15-20 minutes
• Scoring: 0-56 points
• Interpretation:
  • 41-46: low fall risk
  • 21-40: medium fall risk
  • 0-20: high fall risk

Evaluation of Equilibrium Strategies

• Motor strategies:
  • Alignment (sitting and standing position)
  • Movement strategies (patient ability to maintain postural control)
• Sensitive strategies:
  • Romberg Test
  • Dynamic posturography
  • Sensory Organization Test (SOT)
• Visual strategies:
  • Ability to organize and select sensory information in response to changing visual conditions

Gait Assessment

• Gait is a neuromuscular and musculoskeletal action of the whole body that requires coordination of both legs and multiple joints and muscles.
• Functional assessment tools to define deficits, establish a treatment plan, and achieve patient functional independence.
• Functional tests must consider three aspects: functional skills, motor and sensory strategies, and sensory, motor, and cognitive deficiencies.

Gait Assessment Tools

• Cadence: 111-117 steps/min
• Speed: 82 m/min (adult, normal speed on flat ground)
• Monitoring tools:
  • Stopwatch
  • Podometer
  • Step watch activity monitor
• Examples of commonly used tests:
  • Hoffer Functional Ambulation Scale
  • Figure of 8 walk test
  • Gillette Functional Assessment Questionnaire

Evaluation of Gait Strategies

• Functional Ambulation Classification
• Ranches Los Amigos Walking Ability Questionnaire (RLAH)
• Rivermead Visual Gait Assessment (RVGA)
• Motor Assessment Scale

Scales Limitations

• Mobility, balance, or general motor control does not provide information about the way in which the activity occurs.
• These measures do not delve into the underlying deficits that require treatment.
• Scales covering a wider range of gait abilities, especially in community living, are required.