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Questions and Answers
What does the term 'participation limitations' refer to?
Which of the following best describes 'activity' as per the ICF model?
What type of technology measures the forces exerted on the ground during movement?
Which factors are considered contextual factors in the ICF model?
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Which of the following does NOT fall under the definition of body functions according to the ICF?
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Which assessment focuses on the execution of a balance task in an individual?
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What physiological factors can influence movement capabilities?
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What is the primary role of the center of mass (COM) in postural control?
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Which type of balance control primarily allows stability recovery after an unexpected perturbation?
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What is a characteristic feature of proactive (anticipatory) balance control?
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How do environmental constraints impact postural control?
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What adaptation occurs in sensory organization as a person learns a new motor skill?
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What is a significant consequence of aging on postural control systems?
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In the context of steady-state balance, what does optimal alignment refer to?
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Which factor does NOT significantly impact postural stability limits?
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Study Notes
Postural Control Definition
- Postural control is the ability to maintain a stable and upright posture against gravity.
Center of Mass, Base of Support, and Stability
- Center of Mass (COM): The weighted average of the center of mass of each body segment.
- Center of Gravity (COG): The vertical projection of the COM.
- Base of Support (BOS): The area of the body in contact with the support surface.
- Stability: The ability to control the COM in relation to the BOS.
Types of Postural Control
- Steady-state: Maintaining balance in predictable, non-changing conditions (e.g., sitting, standing).
- Reactive: Recovering stability after an unexpected disturbance (e.g., tripping).
- Proactive/Anticipatory: Activating muscles in advance of potentially destabilizing movements (e.g., lifting a heavy object).
Steady-State Balance
- Alignment: Optimal alignment minimizes energy expenditure.
- Tone: Muscle tone counteracts gravity.
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Movement Strategies: Small adjustments to maintain stability.
- Ankle Strategy: Both leg and trunk segments move in phase.
- Hip Strategy: Leg and trunk segments move out of phase.
Sensory Inputs for Steady-State Balance
- Visual: Orientation information.
- Somatosensory: Position and motion information about the body.
- Vestibular: Information about head position and movement.
Reactive Balance Control
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Movement Strategies: Strategies to recover stability.
- Fixed-support Strategies: Ankle strategy, hip strategy.
- Change-in-support Strategies: Step strategy, reach-to-grasp strategy.
Proactive/Anticipatory Balance Control
- Preparatory Phase: Muscles are activated before movement to compensate.
- Compensatory Phase: Feedback from the movement activates muscles to stabilize.
Cognitive Systems in Balance Control
- Attentional Resources: Information processing resources required to complete a task.
- Dual-Task Interference: Two tasks performed simultaneously, attentional resources may decrease in performance on one or more tasks.
Aging and Systems Changes
- Neuromuscular System: Decline in muscle strength, endurance, and mass.
- Sensory System: Decline in somatosensation, vision, and vestibular function.
- Cognitive System: Increased attentional demands, fear of falling.
Falls
- Extrinsic Factors: Environmental.
- Intrinsic Factors: Physiological, musculoskeletal, and psychosocial.
Aging and Postural Control
- Steady-State Balance: Reduced stability limits.
- Reactive Balance: Problems with coordination of muscle responses.
- Anticipatory Balance: Difficulty activating postural muscles in advance of movement.
ICF Framework
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Body Functions and Structures: Sensory-motor and cogntive impairments.
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Activities and Participation: Walking, transferring, etc.### ICF Model
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The International Classification of Functioning, Disability, and Health (ICF) framework emphasizes the importance of environmental and personal factors in influencing individual functioning.
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The ICF model considers functioning at three levels: body, individual, and society.
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Body Level: Focuses on body functions, body structures, and impairments.
- Body functions refer to physiological functions of body systems, including psychological functions.
- Body structures encompass anatomical parts of the body like organs, limbs, and their components.
- Impairments denote problems in body function or structure, such as significant deviation or loss.
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Individual Level: Focuses on activities and activity limitations.
- Activities involve the execution of tasks or actions by an individual.
- Activity limitations highlight difficulties individuals may encounter while performing activities.
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Society Level: Focuses on participation and participation limitations.
- Participation refers to involvement in a life situation.
- Participation limitations describe problems an individual might experience when engaging in life situations.
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Contextual Factors: These factors influence an individual's functioning and include environmental factors and personal factors.
- Environmental factors encompass the physical, social, and attitudinal environment where individuals live and function.
- Personal factors are unique to the person, reflecting their unique experiences, beliefs, and values.
Factors Influencing Movement
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Individual Factors:
- Gender: Can influence muscle mass, strength, and movement strategies.
- Age and Maturation: Impact physical capabilities, coordination, and balance.
- Activity/Sport Level: Influences fitness, strength, and movement patterns.
- Anthropometrics: Body measurements like height, weight, and body composition affect movement capabilities.
- Anatomical and Morphological Factors: Individual variations in bone structure, joint angles, and muscle attachments impact movement.
- Injury History: Previous injuries can affect movement patterns, strength, and stability.
- Movement History: Past experience with specific movements influences skill acquisition and efficiency.
- Pain: Can significantly limit movement range, strength, and participation.
- Mobility and Flexibility: Joint range of motion and muscle flexibility affect movement quality and ease.
- Sensorimotor Factors: Proprioception, kinesthesia, and sensory integration play crucial roles in movement control and coordination.
- Fatigue: Reduces strength, endurance, and coordination, impacting movement performance.
- Psychological Factors: Motivation, anxiety, and stress can influence movement execution.
- Visual-Perceptual Skills: Visual perception, depth perception, and coordination impact movement accuracy and safety.
- Neurocognitive Factors: Cognitive abilities, attention, and decision-making influence movement planning and execution.
- Systemic/Other Physiological Systems: Cardiovascular, respiratory, and endocrine systems affect movement capacity and endurance.
Mobility and ICF
- Mobility is a domain within the "activity and participation" component of the ICF.
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Mobility encompasses various aspects:
- Changing and maintaining body position.
- Carrying, moving, and handling objects.
- Walking, including distance, surfaces, and obstacles.
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Mobility can be assessed in different environments:
- In the home.
- In other buildings.
- Outdoors.
- Gait pattern function, part of "body function and structure" component, is also relevant to mobility.
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Contextual factors influencing mobility include:
- Terrain.
- Age.
- Sex.
- Self-efficacy.
Upper Extremity Function and ICF
- Upper extremity function is crucial for various daily activities.
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Neuromusculoskeletal and movement-related functions involve:
- Control of voluntary movements.
- Visually directed movements.
- Eye-hand coordination.
- Mobility for carrying, moving, and handling objects.
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Contextual factors influencing upper extremity function include:
- Environmental factors, such as the weight and size of objects to be lifted or carried.
Technology for Movement Analysis
- Emerging technologies offer objective assessment of movement.
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Motion Capture
- Utilizes reflective markers placed on specific body parts.
- Cameras track the movement of markers, providing data on joint angles and movement patterns.
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Applications:
- Analyzing joint angles during gait and other movements.
- Quantifying movement kinematics and kinetics.
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Surface Electromyography (EMG)
- Electrodes placed on the skin measure muscle electrical activity.
- Provides information on:
- Muscle activation patterns.
- Timing and intensity of muscle contractions.
- Antagonistic and synergistic muscle activity.
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Limitations:
- Difficulty differentiating between adjacent muscles.
- Amplitudes can be influenced by various factors and may not be accurate for cross-day comparisons.
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Force Plates
- Measure forces exerted by a person on the ground.
- Based on Newton's Third Law of Motion (action-reaction forces).
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Applications:
- Analyzing ground reaction forces during walking, running, and jumping.
- Assessing postural stability, explosive force, power, and reaction force.
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Pressure Sensitive Walkway
- Measures temporal and spatial parameters of walking.
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Data captured:
- Step time.
- Cycle time.
- Step length.
- Stride length.
- Helps identify gait abnormalities.
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Accelerometers and Inertial Measurement Units (IMUs)
- Accelerometer: Measures acceleration, providing gait characteristics.
- IMU: Combines a gyroscope (measures angular rates) and an accelerometer (force and acceleration data).
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Applications:
- Assessing gait parameters and movement in three dimensions (3D).
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Smart Watches
- Collect data on gait parameters like walking speed, step length, double support time, and stair ascent/descent.
- Some watches can also track heart rate, sleep patterns, and other health-related metrics.
Case Study: Assessing Mobility and Balance
- Case Study: An individual experiencing weakness in the lower legs and fear of falling.
- Body function/structures: Lower leg weakness, potentially affecting muscle strength and proprioception.
- Activities: Walking, balance, and other daily activities potentially affected due to fear and weakness.
- Participation: Limited participation in activities due to fear and mobility challenges.
- Environmental factors: Uneven surfaces may increase risk of falling.
- Personal factors: Fear of falling can significantly impact confidence and motivation for mobility.
Evaluating Balance
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Balance Assessments:
- Steady-state balance: Assesses stability while maintaining a static position.
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Romberg balance: Evaluates postural control with eyes closed.
- The individual stands with feet together, eyes closed, and assesses postural sway.
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Tug test: Measures the ability to rise from a chair quickly.
- The individual sits in a standard chair with arms crossed, stands up, and sits down once.
- Gait assessment: Evaluates walking pattern and stability.
- Functional reach test: Measures forward reach while maintaining balance.
- Sit to stand: Assesses the ability to transfer from a seated to standing position.
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Perturbations: Introduces external challenges to assess reactive balance.
- Examples include pushing on the individual's shoulder or asking them to stand on an unstable surface.
- Tandem stance: Assesses balance while standing with one foot directly in front of the other.
- Fatigue and balance: Evaluates the impact of fatigue on balance control.
Assessing Steady-state and Reactive Balance
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Steady-state balance assessment:
- Use the Romberg test or variations of the single-leg stance test.
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Reactive balance assessment:
- Utilize perturbation methods:
- Foam pad standing/walking: This challenges balance and tests the ability to regain stability.
- Sway test: Can be used to assess the body's response to perturbations.
- Utilize perturbation methods:
Understanding Talocrural Joint Motion
- Dorsiflexion: Movement of the foot upwards toward the shin bone.
- Talocrural joint: The ankle joint.
- The talus, the ankle bone, rolls and glides forward on the tibia (shin bone) and fibula (lower leg bone) during dorsiflexion.
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Description
This quiz covers the fundamental concepts of postural control, including the definitions of center of mass, base of support, and different types of postural control. Additionally, it explores the importance of alignment and muscle tone in maintaining steady-state balance. Test your knowledge on how these concepts contribute to overall stability.
