Podcast
Questions and Answers
Which statement accurately describes the relationship between 'posture' and 'balance'?
Which statement accurately describes the relationship between 'posture' and 'balance'?
- Posture includes dynamic movements, while balance refers to maintaining a static position.
- Posture refers to holding a static position, while balance involves moving effectively without falling. (correct)
- Posture is a component of motor strategies, while balance relates to sensory strategies.
- Posture encompasses the sensory environment, and balance describes the limits of stability.
The ability to maintain one's center of gravity within the limits of stability in a given sensory environment defines:
The ability to maintain one's center of gravity within the limits of stability in a given sensory environment defines:
- Postural control. (correct)
- Volitional movement.
- Anticipatory control.
- Static posture.
Limits of stability are best described as:
Limits of stability are best described as:
- The area where a person's base of support cannot be changed.
- Fixed boundaries that remain constant irrespective of the activity.
- The fixed biomechanics of the individual, regardless of the task.
- The area where the body can maintain its position without changing its base of support. (correct)
The somatosensory system contributes to balance by providing information about:
The somatosensory system contributes to balance by providing information about:
Damage to the vestibulocochlear nerve (CN VIII) would most directly affect:
Damage to the vestibulocochlear nerve (CN VIII) would most directly affect:
A patient is having difficulty maintaining their balance when standing on a moving bus. Which sensory system is the MOST important for maintaining balance in this scenario?
A patient is having difficulty maintaining their balance when standing on a moving bus. Which sensory system is the MOST important for maintaining balance in this scenario?
In what way does the visual system contribute to maintaining balance?
In what way does the visual system contribute to maintaining balance?
A patient sways at the ankles to re-establish equilibrium after a small external perturbation. Which balance strategy is being utilized:
A patient sways at the ankles to re-establish equilibrium after a small external perturbation. Which balance strategy is being utilized:
According to Horak and Nashner, which sequence represents the typical order of motor strategy utilization during a balance perturbation, starting with the first response?
According to Horak and Nashner, which sequence represents the typical order of motor strategy utilization during a balance perturbation, starting with the first response?
Which of the following situations Primarily requires an anticipatory postural control strategy?
Which of the following situations Primarily requires an anticipatory postural control strategy?
A patient with impaired ankle plantarflexion due to peripheral neuropathy will MOST likely have difficulty utilizing which balance strategy?
A patient with impaired ankle plantarflexion due to peripheral neuropathy will MOST likely have difficulty utilizing which balance strategy?
Which scenario would likely cause an individual to utilize a stepping strategy to maintain balance?
Which scenario would likely cause an individual to utilize a stepping strategy to maintain balance?
Which condition is MOST likely to result in impaired somatosensory feedback contributing to balance deficits?
Which condition is MOST likely to result in impaired somatosensory feedback contributing to balance deficits?
Which of the following visual impairments is MOST likely to cause balance problems?
Which of the following visual impairments is MOST likely to cause balance problems?
Impairment of ankle and foot somatosensation is MOST likely to affect which balance mechanism?
Impairment of ankle and foot somatosensation is MOST likely to affect which balance mechanism?
Which neurological condition is characterized by ataxia and dysmetria, directly affecting balance control?
Which neurological condition is characterized by ataxia and dysmetria, directly affecting balance control?
Multisensory disequilibrium, which can impair balance, is characterized by dysfunction in which combination of systems?
Multisensory disequilibrium, which can impair balance, is characterized by dysfunction in which combination of systems?
During a balance assessment, why is it important to consider sensory conflict?
During a balance assessment, why is it important to consider sensory conflict?
Increased variability of stride length and decreased step length, observed during gait, are MOST likely indicative of:
Increased variability of stride length and decreased step length, observed during gait, are MOST likely indicative of:
Which examination finding would be MOST indicative of a vestibular disorder?
Which examination finding would be MOST indicative of a vestibular disorder?
When assessing a patient's DTRs(deep tendon reflexes) as part of a balance evaluation, which nerve roots are typically assessed?
When assessing a patient's DTRs(deep tendon reflexes) as part of a balance evaluation, which nerve roots are typically assessed?
The BEST method to examine a patient's ability to integrate sensory information for balance would be:
The BEST method to examine a patient's ability to integrate sensory information for balance would be:
Which of the following is NOT a component of a typical balance assessment?
Which of the following is NOT a component of a typical balance assessment?
During the Clinical Test of Sensory Integration in Balance (CTSIB), which of the following conditions assesses the patient's reliance on vestibular input for balance?
During the Clinical Test of Sensory Integration in Balance (CTSIB), which of the following conditions assesses the patient's reliance on vestibular input for balance?
What is the MOST likely purpose of using a foam pad during balance testing?
What is the MOST likely purpose of using a foam pad during balance testing?
Which of the following is an example of postural control with functional mobility?
Which of the following is an example of postural control with functional mobility?
Adaptation exercises aim to:
Adaptation exercises aim to:
What is the primary goal of habituation exercises in vestibular rehabilitation?
What is the primary goal of habituation exercises in vestibular rehabilitation?
A patient reports feeling off balance and unsteady, even when sitting, after recovering from a bout of vertigo. Select the intervention that best manages this condition?:
A patient reports feeling off balance and unsteady, even when sitting, after recovering from a bout of vertigo. Select the intervention that best manages this condition?:
What is the primary focus of gaze stabilization exercises (e.g., X1 viewing) in vestibular rehabilitation?
What is the primary focus of gaze stabilization exercises (e.g., X1 viewing) in vestibular rehabilitation?
A patient who reports brief spinning sensation (vertigo) with changes in head position is MOST likely experiencing:
A patient who reports brief spinning sensation (vertigo) with changes in head position is MOST likely experiencing:
When assessing a patient for potential BPPV, what is the primary purpose of the Dix-Hallpike test?
When assessing a patient for potential BPPV, what is the primary purpose of the Dix-Hallpike test?
The central nervous system uses which processes to accurately sense ones orientation?
The central nervous system uses which processes to accurately sense ones orientation?
Choose the TRUE statement about the Otoliths.
Choose the TRUE statement about the Otoliths.
A patient demonstrates quick, involuntary, small movements of the eyes from side to side. Choose the correct term that describes this condition:
A patient demonstrates quick, involuntary, small movements of the eyes from side to side. Choose the correct term that describes this condition:
Please select the BEST descriptor of the Vestibulo-ocular reflex:
Please select the BEST descriptor of the Vestibulo-ocular reflex:
Pick the appropriate test that identifies the vestibulo-ocular relfex:
Pick the appropriate test that identifies the vestibulo-ocular relfex:
Choose the BEST definition of 'oscillopsia':
Choose the BEST definition of 'oscillopsia':
With unilateral vestibular hypofunction, which intervention technique below is MOST appropriate:
With unilateral vestibular hypofunction, which intervention technique below is MOST appropriate:
Pick the BEST choice that fits into the category of 'central vestibulopathy':
Pick the BEST choice that fits into the category of 'central vestibulopathy':
What is the focus of postural control?
What is the focus of postural control?
How are limits of stability BEST characterized?
How are limits of stability BEST characterized?
When a patient is exposed to a variety of visual stimuli, which sensory system is engaged?
When a patient is exposed to a variety of visual stimuli, which sensory system is engaged?
What is the role of the somatosensory system in balance determined by?
What is the role of the somatosensory system in balance determined by?
What is the MOST important role of the vestibular system?
What is the MOST important role of the vestibular system?
Which of the following reflects information from the person's postural alignment?
Which of the following reflects information from the person's postural alignment?
According to Horak and Nashner, which of the following is NOT a motor strategy used to recover balance?
According to Horak and Nashner, which of the following is NOT a motor strategy used to recover balance?
What best describes a reactive postural control?
What best describes a reactive postural control?
What is the MOST likely result of impaired motor function affecting the ankle strategy?
What is the MOST likely result of impaired motor function affecting the ankle strategy?
During which activities would the hip strategy to MOST likely be utilized?
During which activities would the hip strategy to MOST likely be utilized?
What is the MOST likely outcome if a person presents with decreased strength in lower extremities?
What is the MOST likely outcome if a person presents with decreased strength in lower extremities?
Which sensory system provides information about head position relative to the environment?
Which sensory system provides information about head position relative to the environment?
How might age related multi sensory disequilibrium present?
How might age related multi sensory disequilibrium present?
What is the function of central integration in balance control?
What is the function of central integration in balance control?
What is an effect on gait, that result from an impaired ankle strategy?
What is an effect on gait, that result from an impaired ankle strategy?
When a PTA is gathering previous medical history of a patient, what information would NOT contribute to balance?
When a PTA is gathering previous medical history of a patient, what information would NOT contribute to balance?
When conducting a PT evaluation for balance, concerning the patient's sensory or motor skills, which measure would be the MOST appropriate?
When conducting a PT evaluation for balance, concerning the patient's sensory or motor skills, which measure would be the MOST appropriate?
When examining DTRs, which nerve roots are typically assessed?
When examining DTRs, which nerve roots are typically assessed?
During a balance assessment using the CTSIB, what sensory component is being assessed when the patient is standing with eyes closed on a firm surface?
During a balance assessment using the CTSIB, what sensory component is being assessed when the patient is standing with eyes closed on a firm surface?
What is the primary goal of utilizing a 'foam and dome' test?
What is the primary goal of utilizing a 'foam and dome' test?
According to the slide titled 'Balance Rehabilitation', what are the main components to focus on?
According to the slide titled 'Balance Rehabilitation', what are the main components to focus on?
Why do vestibular adaptation exercises involve head movements?
Why do vestibular adaptation exercises involve head movements?
During X1 viewing, what are the movements of the head and eyes?
During X1 viewing, what are the movements of the head and eyes?
What is a sign indicating dysfunction of VOR?
What is a sign indicating dysfunction of VOR?
Which of the following strategies is MOST appropriate when the vestibular system is severely impaired?
Which of the following strategies is MOST appropriate when the vestibular system is severely impaired?
What is the primary goal of habituation?
What is the primary goal of habituation?
What is being assessed when performing the 'Head-Impulse test'?
What is being assessed when performing the 'Head-Impulse test'?
For patients who reports dizziness when moving in certain positions, what would be the PRIMARY examination method?
For patients who reports dizziness when moving in certain positions, what would be the PRIMARY examination method?
A patient presents with dizziness after a recent head trauma. Which subjective description is MOST indicative of BPPV:
A patient presents with dizziness after a recent head trauma. Which subjective description is MOST indicative of BPPV:
What are causes of peripheral vestibular dysfunction?
What are causes of peripheral vestibular dysfunction?
A patient is diagnosed with Unilateral Vestibular Hypofunction (UVH). They are likely to have?
A patient is diagnosed with Unilateral Vestibular Hypofunction (UVH). They are likely to have?
A person presents with hearing loss, SIGNIFICANT oscillopsia, and is experiencing disequilibrium in dark environments. What is the MOST likely condition?
A person presents with hearing loss, SIGNIFICANT oscillopsia, and is experiencing disequilibrium in dark environments. What is the MOST likely condition?
What is the PRIMARY intervention strategies for a patient with Bilateral Vestibular Hypofunction?
What is the PRIMARY intervention strategies for a patient with Bilateral Vestibular Hypofunction?
What is the MOST likely cause of central vestibular dysfunction?
What is the MOST likely cause of central vestibular dysfunction?
When testing for Dix-Hallpike, what is the purpose of observing the eyes?
When testing for Dix-Hallpike, what is the purpose of observing the eyes?
While reviewing the plan of care for a patient with BPPV who presents with posterior canal involvement, what intervention can the PTA expect to utilize?
While reviewing the plan of care for a patient with BPPV who presents with posterior canal involvement, what intervention can the PTA expect to utilize?
What is the KEY to vestibular rehab when performing habituation?
What is the KEY to vestibular rehab when performing habituation?
What is the MOST accurate definition of 'limits of stability' concerning postural control?
What is the MOST accurate definition of 'limits of stability' concerning postural control?
Which scenario BEST exemplifies anticipatory postural control?
Which scenario BEST exemplifies anticipatory postural control?
During a balance assessment, a patient demonstrates a delayed response to perturbations. Assuming intact sensory systems, which of the following impairments would MOST explain this?
During a balance assessment, a patient demonstrates a delayed response to perturbations. Assuming intact sensory systems, which of the following impairments would MOST explain this?
A patient demonstrates an inability to maintain their balance when standing with their eyes closed on a foam surface. This MOST likely indicates difficulty integrating:
A patient demonstrates an inability to maintain their balance when standing with their eyes closed on a foam surface. This MOST likely indicates difficulty integrating:
A patient recovering from a stroke exhibits impaired balance characterized by rigidity and bradykinesia. These symptoms MOST closely align with which co-existing neurological condition?
A patient recovering from a stroke exhibits impaired balance characterized by rigidity and bradykinesia. These symptoms MOST closely align with which co-existing neurological condition?
An elderly patient with diabetes reports increasing difficulty with balance, especially in low-light conditions. This presentation is MOST consistent with:
An elderly patient with diabetes reports increasing difficulty with balance, especially in low-light conditions. This presentation is MOST consistent with:
A patient demonstrates increased postural sway and reports unsteadiness ONLY when walking on uneven surfaces such as gravel or thick carpet. Which sensory system is MOST likely impaired?
A patient demonstrates increased postural sway and reports unsteadiness ONLY when walking on uneven surfaces such as gravel or thick carpet. Which sensory system is MOST likely impaired?
A patient is being treated for balance issues. The plan of care includes interventions that require the patient to walk on a treadmill while performing mental math. What is the PRIMARY purpose of dual-tasking in this scenario?
A patient is being treated for balance issues. The plan of care includes interventions that require the patient to walk on a treadmill while performing mental math. What is the PRIMARY purpose of dual-tasking in this scenario?
During a PT examination, the patient reports their vision occasionally blurs with quick head movements during the day. What intervention addresses this patient's PRIMARY complaint?
During a PT examination, the patient reports their vision occasionally blurs with quick head movements during the day. What intervention addresses this patient's PRIMARY complaint?
Select the MOST appropriate strategy when the vestibular system is severely impaired?
Select the MOST appropriate strategy when the vestibular system is severely impaired?
A patient reports feeling unsteady and 'off' after recovering from a recent bout of vertigo. What is the MOST important management consideration?
A patient reports feeling unsteady and 'off' after recovering from a recent bout of vertigo. What is the MOST important management consideration?
During vestibular rehabilitation, which of the following components is MOST critical, to improve both gaze stability and balance.
During vestibular rehabilitation, which of the following components is MOST critical, to improve both gaze stability and balance.
A patient is referred to PT with complaints of dizziness due to suspected central pathology origin. Which sign or symptom below is MOST likely associated?
A patient is referred to PT with complaints of dizziness due to suspected central pathology origin. Which sign or symptom below is MOST likely associated?
When examining for smooth pursuits, VOR, and saccades; what is the PTA observing for?
When examining for smooth pursuits, VOR, and saccades; what is the PTA observing for?
During a PT evaluation of a patient complaining of imbalance, the PTA observes the patient has a wide base of support, and unequal step length. What is this patient likely demonstrating?
During a PT evaluation of a patient complaining of imbalance, the PTA observes the patient has a wide base of support, and unequal step length. What is this patient likely demonstrating?
Select the option that is NOT a component of central integration.
Select the option that is NOT a component of central integration.
What is the MOST important component to communicate with patients regarding habituation training?
What is the MOST important component to communicate with patients regarding habituation training?
Which of the following parameters is MOST important when performing adaptation exercises?
Which of the following parameters is MOST important when performing adaptation exercises?
A patient presents to the clinic with vertigo, but no reports of dizziness. What is the BEST option?
A patient presents to the clinic with vertigo, but no reports of dizziness. What is the BEST option?
Select the TRUE statement regarding the Dix-Hallpike test:
Select the TRUE statement regarding the Dix-Hallpike test:
Flashcards
What does posture imply?
What does posture imply?
The term implies holding a particular static position.
What do postural control and balance refer to?
What do postural control and balance refer to?
It refers to the ability to move efficiently and effectively in a variety of environments and situations without falling.
What is postural control?
What is postural control?
The ability to control the center of gravity within specific limits of stability in a given sensory environment.
What are limits of stability?
What are limits of stability?
Signup and view all the flashcards
Name the sensory systems involved in balance.
Name the sensory systems involved in balance.
Signup and view all the flashcards
Name the motor systems involved in balance.
Name the motor systems involved in balance.
Signup and view all the flashcards
What motor startegies did Horak and Nashner describe?
What motor startegies did Horak and Nashner describe?
Signup and view all the flashcards
Reactive postural control
Reactive postural control
Signup and view all the flashcards
What is anticipatory postural control?
What is anticipatory postural control?
Signup and view all the flashcards
Key aspects of an Ankle strategy.
Key aspects of an Ankle strategy.
Signup and view all the flashcards
Key aspects of a Hip strategy.
Key aspects of a Hip strategy.
Signup and view all the flashcards
Key aspects of Stepping Strategy
Key aspects of Stepping Strategy
Signup and view all the flashcards
What information does the somatosensory system provide?
What information does the somatosensory system provide?
Signup and view all the flashcards
What information does the visual system provide?
What information does the visual system provide?
Signup and view all the flashcards
What information does the vestibular system provide?
What information does the vestibular system provide?
Signup and view all the flashcards
List four primary roles of the vestibular system.
List four primary roles of the vestibular system.
Signup and view all the flashcards
How does the vestibular system sense motion?
How does the vestibular system sense motion?
Signup and view all the flashcards
Define vestibulo-ocular reflex (VOR)
Define vestibulo-ocular reflex (VOR)
Signup and view all the flashcards
Define vestibulospinal reflex (VSR)
Define vestibulospinal reflex (VSR)
Signup and view all the flashcards
Conjugate eye movements
Conjugate eye movements
Signup and view all the flashcards
Convergence
Convergence
Signup and view all the flashcards
Saccades
Saccades
Signup and view all the flashcards
Smooth pursuit
Smooth pursuit
Signup and view all the flashcards
What is VOR (vestibulo-ocular reflex)?
What is VOR (vestibulo-ocular reflex)?
Signup and view all the flashcards
Nystagmus
Nystagmus
Signup and view all the flashcards
Cerebellar Degeneration
Cerebellar Degeneration
Signup and view all the flashcards
What is Multisensory disequilibrium?
What is Multisensory disequilibrium?
Signup and view all the flashcards
Goals of balance rehabilitation
Goals of balance rehabilitation
Signup and view all the flashcards
Increase somatosensory, what can you do?
Increase somatosensory, what can you do?
Signup and view all the flashcards
What des adaptation exercises in balance rehab do?
What des adaptation exercises in balance rehab do?
Signup and view all the flashcards
How to do X1 viewing
How to do X1 viewing
Signup and view all the flashcards
How to do X2 viewing
How to do X2 viewing
Signup and view all the flashcards
If vestibular has impaired gaze stability, what can you do?
If vestibular has impaired gaze stability, what can you do?
Signup and view all the flashcards
Vestibular rehab specific substitution excercises.
Vestibular rehab specific substitution excercises.
Signup and view all the flashcards
How do disequilibrium exercise help
How do disequilibrium exercise help
Signup and view all the flashcards
What do Habituatation exercises do?
What do Habituatation exercises do?
Signup and view all the flashcards
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV)
Signup and view all the flashcards
Symptoms of Benign Paroxysmal Positional Vertigo (BPPV)
Symptoms of Benign Paroxysmal Positional Vertigo (BPPV)
Signup and view all the flashcards
Canalith Repositioning Maneuver (CRM)
Canalith Repositioning Maneuver (CRM)
Signup and view all the flashcards
Dix-Hallpike Positional Test
Dix-Hallpike Positional Test
Signup and view all the flashcards
Study Notes
- Posture implies holding a particular static position.
- Postural control and balance is the ability to move efficiently and effectively in a variety of environments and situations.
- Postural control controls the center of gravity within specific limits of stability in a given sensory environment.
- Limits of stability define the area or boundaries in which the body can maintain position without changing the base of support (BOS).
- Limits of stability change according to task, the individual's biomechanics and environment.
Sensory and Motor Systems
- Critical components for balance include sensory systems and motor systems.
- Sensory systems include somatosensory, visual and vestibular systems.
- Motor systems include strength, range of motion (ROM), and motor (balance) strategies.
Motor Strategies for Postural Control
- To maintain balance, the body continuously adjusts position in space to keep the center of mass (COM) over the base of support (BOS) or to bring the COM back to that position after a perturbation.
- Ankle, hip, and stepping strategies are the three primary movement strategies used by healthy adults to recover balance in response to sudden perturbations of the supporting surface.
Postural Control: Reactive vs. Anticipatory
- Reactive postural control is motor activity used to maintain or restore balance when unexpected events or environmental demands occur, also known as automatic postural responses.
- Aniticipatory postural control is motor activity that occurs before a planned movement to maintain balance when a shift in the center of mass is anticipated.
Motor Strategies
Ankle Strategy
- This maintains center of gravity(COG) over base of support (BOS) with small perturbations.
- The activation pattern goes from distal to proximal.
- This is the "first line of defense".
Hip Strategy
- The hip strategy is used when center of gravity (COG) moves more quickly over base of support (BOS).
- It is used when a patient has large perturbations
- The activation pattern goes from proximal to distal.
Stepping Strategy
- The stepping strategy is engaged when the limits of stability are exceeded or approached.
- It is needed to establish a new base of support by moving a foot to avoid a fall.
Sensory Systems - Somatosensory
- Somatosensory system provides proprioceptive information regarding muscle length and tension, pressure, vibration, light touch and pain, and joint position.
Sensory Systems - Visual
- The visual system provides information regarding head position relative to the environment.
- The visual system allows for detection of objects and obstacles.
- The visual system contributes to anticipatory and reactive postural control.
- The visual system works with the vestibular system for head orientation and gaze stability.
Sensory Systems - Vestibular
- The vestibular system provides the central nervous system (CNS) feedback regarding the position and movement of the head with relation to gravity.
- The vestibular system includes the labyrinths and the vestibulocochlear nerve, which is cranial nerve VIII.
- Primary roles of vestibular system in postural control include sensing self-motion, orienting the head to vertical, and controlling and stabilizing the head.
Vestibular Anatomy
- Labyrinth consists of 5 receptors.
- Receptors in three semicircular canals detect angular acceleration.
- Receptors in two otoliths detect linear acceleration.
Balance - Simplified
- Input from the eyes, inner ear, and feet are synthesised by the central processor.
- Output creates action in the muscles of the neck, trunk, and lower extremities, and the extraocular muscles.
Causes of Impaired Balance
- Can be due to Impairments involving the Peripheral, the Central or Cognitive systems
Causes of Impaired Balance: Peripheral
- Impaired visual feedback due to conditions like glaucoma, cataracts, macular degeneration, diploplia and visual field cuts.
- Impaired somatosensory feedback due to disease or trauma resulting in absent, impaired or inaccurate information.
- Impaired vestibular feedback due to disease or trauma to CN VIII and/or peripheral end organ resulting in vestibular hypofunction/dysfunction (aka vestibulopathy).
Causes of Impaired Balance: Peripheral Motor
- Decreased strength from lower extremities (LEs), limited range of motion (ROM) at ankle, knees and hips results in a impaired stepping strategy.
- Limited ankle range of motion (ROM), impaired plantar and dorsiflexor strength, impaired/absent somatosensation from ankle and foot results in an impaired ankle strategy.
- Impaired hip strength and range of motion (ROM), impaired/absent somatosensation from hips and trunk results in an impaired hip strategy.
Neurological disorders that affect balance
- Cerebellar degeneration which causes ataxia and dysmetria.
- Stroke or head trauma which causes paresis, sensory loss, visual field defects, or impaired spatial perception.
- Parkinson's disease which causes rigidity and bradykinesia.
- Multiple sclerosis (MS) affects balance by impairing function in multiple locations of the brain and spinal cord.
- Multisensory disequilibrium refers to combined dysfunction of the vestibular, visual, and somatosensory systems.
Central Causes of Impaired Balance
- Central integration occurs in the central nervous system (CNS), the central processor
- No one sensory system can provide the central nervous system (CNS) accurate information regarding position and motion of the body.
- Sensory strategies vary as a function of age, task and environment.
- Central processing is important when there are sensory conflicts within or between sensory systems.
- Sensory conflict arises when one sensory system provides inaccurate information or when the central nervous system (CNS) cannot resolve sensory conflict.
- Sensory conflict leads to inappropriate or impaired motor response which results in disequilibrium, dizziness, visuo-spatial disorientation, and/or falls.
Impact of Impaired Postural Control on Gait
-An impaired ankle strategy, increased postural sway in standing can affect limb progression during stance phase.
- Gait deviations associated with increased fall risk include decreased gait speed and step length; and increased step width, variability of stride length and width, and decreased toe clearance during swing phase.
PT Examination for "Disequilibrium”
- Includes fall history, medication review, standardized self-report questionnaires, and complaints of imbalance, dizziness, or other symptoms.
- Standardized self-report questionnaires include the Falls Efficacy Scale (FES) and Activities-Specific Balance Confidence Scale (ABC Scale).
PT Evaluation
- The physical therapy (PT) evaluation includes strength testing, sensory screen, deep tendon reflexes(DTRs), cranial nerve (CN) exam, and cerebellar screening, and balance assessment
- The cranial nerve (CN) exam includes oculomotor (CN III) and vestibular (CN VIII) assessments.
- Cerebellar screening looks for rapid alternating movements (RAM) and dysdiadochokinesia.
Balance Assessment
- Assessments include Sensory Organization Test, Clinical Test of Sensory Integration in Balance (CTSIB), aka "Foam and Dome" test, Computerized Dynamic Posturography (CDP), and/or modified CTSIB.
Functional Balance Tests
- Functional balance tests include static and dynamic balance, and functional mobility. Functional mobility tests include TUG, Dynamic Gait Index (DGI), and Functional Gait Assessment
Balance Rehabilitation
- Balance and fall prevention focus on the individual, the task, the environment, and their interactions.
- Balance Rehabilitation include Flexibility and Functional strength training instead of strengthening isolated muscles.
- The goals of the sensory organization portion of balance rehabilitation are to improve sensory organization, balance reactions, postural control with functional mobility and functional strength that contribute impaired balance reactions.
- Balance Rehabilitation aims for a decrease in the level of fall risk, improves self-efficacy
Balance Rehabilitation: Sensory Organization Training:
- Dynamic balance activities improve feedback and accurate use of the visual , vestibular and somatosensory systems for postural control
- If impaired CNS can be trained to assist by "forcing" an impaired sensory system to be more active -Ex: to increase the use of the somatosensory system ask the pt to close their eyes
- If absent approach is to compensate or substitute with another system
Balance Rehabilitation: Postural Strategy Training:
- Is balance reaction
- The selection of which postural tasks will be needed for for each strategy ankle, hip, stepping
- Practice the task in a safe environment then you will progressively start challenging the environment
- Designed to clients assist clients with their apporpriate strategy to prevent falls
Task Specific Training: Locomotion:
- Balance is needed to improve during gait it can be made more challenging by increasing speed, number of stoops/starts, addition to environmental/ surfaces and adding head turns -Gait can be improved on (BWSTT or vector)
- You can add cognitive or manual dual tasks
Sensory Systems - Vestibular
- Provides the CNS with feedback regarding the position movement ot the head with relation to the
- Includes the labyrinths the nerve relating Cranial 8
- The anatomy of the Labyrinth: 5 receptors
- 3 Semicircular cannals ( head movement( with angular rotation)
- and about acceleration/ deacceleration
Vestibular Input
- Uses Receptors into ( 3) canals detect angular
- Receptors in (2) otoliths detect linear
Vestibular System: Two important Reflexes
- The (VOR) vestibulo-ocular relfex: maintains gaze stability with head motion if impaired VOR will result in oscillopsia
- ((VSR) vestibulospinal Reflex : -Maintains posture with head tilts and movements impairments will results in postural instability
Visual and Vestibular together
- Use together to generate and maintain their upright posture , keep track their position in space balance
- Balance conjugation. convergence, saccades. smooth pursuit
- Ocularmotor actions to maintain
What is Normal eyemovements
- Eye maintain their binocular gaze by moving the eye in the same direction
- ( diplopia) double will occur if the Eyes maintain moving at the same time convergence
- rapid eye movment movement in vision
Visual and Vestibular together to maintain
- Eye momvent (Vor) which allows to stabilize to gane durng head monvement which will make the imaging remain stable on retina
- steady gane eye movement during oppsoite head movement
Normal Eye Movement
- Normal eye movement consist of Nystagmus a involuntary eye movement
- Eye movement when it comes to the end of the eyes and there no spontaneous there usually a cause that can be pathogenic
Vestibular Disorders
- Peripheral vestibular dysfunction or Central Vestibular Dysfunction
Peripheral Vestibular Dysfunction
- Dxs: unilateral vestivular hypofucntions due to labrythitis .bilateral vestibular hypofucntion
- Endolymahphtic hyrdrops( meneires DIsease)
- Acoustic neromua
Commonal Synmptoms
- Vertigo Changes or rapid eye movement and position ,Onset suddenly will ,nausea/enviorment dizziness ,MILD to MD diseqilibirium. with closes eyes or in complexes visual Enviornments if there is (VOR) pt report blurry
Peripheral Vestibular Dysfunction
- 1.Unilateral Vetibular Hyperfuntion(Virus) infection on verve
- Results in (VUH) with be impaire will be linnger/ weeks. with intervention Vetsibuar Neurits:same as above but NO COHCLEA impairement
Periphael Vetibular Dsyfucntion
Bilateral Vesitbuar HYPO : from Ototoxicity:caused primarity by antibiotic: chemotheraopy Symtopms; hearing loss. significant oscilllapsia. NO comaplints Intervention:Vestibuarl rehab. compensation
Vesitbuelr Dysfunction
- AKa Meniere's Dieases Inner ear "plumbing problems" The symptom inclue;spinning. loss of balance /vomits will be audial symptiom free and be lasting damage
interevtion
will vestublar rehba and help with laters stages
Peripheral Vesitbular
- acoustic neuroma beging slow growing tumor on C 8
- 3 common intercranial Tumor Sx;progressive . unilateral hearing loss, tinnius
- Intervention: via gamma knif. and balance rehab
Central Vesitbulpathg
Lession or result in cental vestibuapth possible Neuorological disorders: Ms cerebella . Pontine . .TBI common signs and symptoms.
- Near constant vertigo or dizziness
-
- moderate neuro defifcitts such as diplopail. A taxia. coordination parasthesias INTERVETNION; Vestibalr rehab
Postural
Persisten percpeutal dizzzniess or 3PD
- after Acute episodiof Dizziens. vertigo or ibnalce sx;worsens with posiotins.
- Ptintervention rehab and sesnroy organiiztion
PT Interventions
- Subjective history, OoclumtoorExam. motion sensitivity test Functionbal test
OculotorExam
- In dark room, convergence. *head imuplse and dynamic vision
- frezels goggles for head shakes
Head implse
- Reflex
Vesitbair test
Mtion sensitivity test clncias test to assess how to develop the hom exercise prgramot ot assess which sensnory that we can
Dizzness descriptions
if Pt c/o description of lighteadness or BPPv or description for other areas.
Intervention Vestibualr Rehab
with imbalance or dizznes, can pt with diseqillibirum. a histrory of loss of or gait instabity caused by peripheal /c
Three rehab for Vertigo
- Adaptiation exercises in whih brian relearns. helps facilitate adaptation with impared (Vor)
- Inovles hand movement those ptypcaillya avoid
VertibualrRebah:Adopt:
- uses keeping eyes fixed on stationary vsusally while the subject moves teh side. of head move teh head side to side. or or up and down
- 2 vinteing involves maintaniung vsual fixiation . for heads mmoevement
What is impaoired
- The vestibule systems is not there are and compensaor by other system to see we if able to compenaste
the Rehabitlations
- Reps exercises reduce . the symptoms of sytems for a level spcfiic motons
- PAttenuebates that motion. is pt is education pt needs to be the p and we wil idienfy to use msotion
Vertibular Parameter
reps by dose Adaption excersides for:5 for s c
Is Diiziness Always Vestibular?no it could be :
- Banncce disorder. Etiolgy cuold .
- Multi sensory . axneity it ciuldx also : cerbvorgenic dizzy with neck pain pt can get coiboneb of intervention t address cerivcal and vestibul
Proble,
- Impiared gaze with Diznnes
=Primary Adaptation exercises tx =Motion sensitivity -primaty is Habaitiatuion - postual ibmalce = snsorry and motor strategies
- ABsent Vor or Disquilbirumi= rehab vestigo =Canaliith repsosiitng.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
