Session 14 Lab Guide (Student)_2024 Update PDF

Session 14 Lab Guide ==================== ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients #### Course Goal 16: Implement effective balance interventions for non-complex patients BALANCE TRAINING ACTIVITIES -------------...

Session 14 Lab Guide ==================== ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients #### Course Goal 16: Implement effective balance interventions for non-complex patients BALANCE TRAINING ACTIVITIES --------------------------- **Balance Considerations** **Balance Across the Stages of Motor Control** 1527\_FA\_08  **Motor Strategies for Balance Control**  **Strategies:** - **Ankle Strategy** - **Weight-shift Strategy (lateral)** - **Suspension Strategy** - **Hip Strategy** - **Stepping Strategy** - **Combined Strategies** - Construction worker female with solid fillGuarding and Safety Considerations: - **Use a gait belt** - **Stand where your pt is likely to fall** - **Ensure a safe environment with no sharp edges and a stable surface to hold onto if needed** - **Guard pt at all times** - **Prepare** - **Think about the goal and the type of desired balance training** - **Will this exercise be completed in the clinic or as part of an HEP?** - **Position** - **Ensure pt safety** - **What equipment may be necessary?** - **Think about alignment and posture. Watch for substitutions** - **Perform** - **Guard! Guard! Guard!** - **Ensure that the pt has safe footwear on their feet depending on the goal of the session** - **Watch for correct performance** - **Balance Training** - **Steady State Balance Control** - **Steady State Static** - **Steady State Dynamic** - **Anticipatory Postural Control** - **Reactive Postural Control** - **Sensory Organization** **Base of Support (Static)** **Hand Support** **Surface** **Eyes** -- ------------------------------ -------------------------------- ------------------------------------ ----------------------------------------------------- **Normal Stance** **2 hands** **Normal hard surface** **Eyes open** **Rhomberg's Stance** **1 hand** **Foam block** **Changing point of focus (vision, head position)** **Off-set Tandem** **1 finger** **Dynadisc** **Eyes closed (not for dynamic exercises)** **Tandem Stance** **No hand and arms wide** **Rocker board** **Single Leg Stance** **No hand and arms near body** **Multi-directional wobble board** PATIENT CASES ------------- **LOGISTICS:** - *Each person at your table will be assigned to a case to be the "pt"* - *The other pod members will think of what additional information they need from their pt and then complete a brief "interview" to gain more information from the "patient" (pt is free to take artistic liberty).* - *Tablemates will take 2 minutes to come up with the questions* - *Interviews should last only 2-3 minutes.* - *Then in the tablemates will work to answer the questions and develop an exercise program including 3 exercises:* - ***In-Clinic Exercise*** - ***HEP Exercise** (written on the wall as if it were give to the pt as an HEP)* - ***Progression**- create an exercise for this patient in the future* - *Each student should serve as the primary PT for 1 of the cases and support for the other cases.* **[CASE \#1]** Mrs Doubtfire is 68 y.o. who recently fell at home getting out of the shower. Mrs. Doubtfire lives alone and is now very fearful of falling but does not want to move into a nursing home. Ask your pt for further information. - What environment or contextual modifications would you suggest? - What exercises would you work on in the clinic to improve steady state (static or dynamic), anticipatory, and reactive balance? Provide a detailed list - Teach the pt 1 in-clinic exercise - Provide some exercises for a HEP to work on balance at home. Provide a detailed list - Teach the pt 1 HEP exercise - Describe how can you progress these exercises in the next 3 weeks? **[CASE \#2]** Mary Poppins is a 35 y.o. with a recent exacerbation of MS. She has weakness in her LEs (4-/5). She was previously walking with a rolling walker but has been transitioned to a SBQC and has had 2 episodes at home where she had to reach out for furniture to avoid falling. Ask your pt for further information. - What environment or contextual modifications would you suggest? - What exercises would you work on in the clinic to improve steady state (static or dynamic), anticipatory, and reactive balance? Provide a detailed list - Teach the pt 1 in-clinic exercise - Provide some exercises for a HEP to work on balance at home. Provide a detailed list - Describe how can you progress these exercises in the next 3 weeks? **[Case \#3]** Pippi Longstocking is an 38 y.o. s/p L CVA. She does not use an assistive device but she reports that when she is outside walking at the park she falls a lot more when she moves fast. Ask your pt for further information. - What environment or contextual modifications would you suggest? - What exercises would you work on in the clinic to improve steady state (static or dynamic), anticipatory, and reactive balance? Provide a detailed list - Teach the pt 1 in-clinic exercise - Provide some exercises for a HEP to work on balance at home. Provide a detailed list - Teach the pt 1 HEP exercise - Describe how can you progress these exercises in the next 3 weeks? - **[CASE \#4 ]** Forrest Gump is a 28 y.o. man who sprained his ankle when running and his foot landed on a rock, causing him to fall. Forrest is in the Army. He is four months post-sprain. He is eager to get back to running. Ask your patient for further information. - What environment or contextual modifications would you suggest? - What exercises would you work on in the clinic to improve steady state (static or dynamic), anticipatory, and reactive balance? Provide a detailed list - Teach the pt 1 in-clinic exercise - Provide some exercises for a HEP to work on balance at home. Provide a detailed list - Teach the pt 1 HEP exercise - Describe how can you progress these exercises in the next 3 weeks? Putting It Together Case Pt: Elroy Jetson - Starting Position: Supine in hospital bed - PMH: Elroy sustained a head injury after a fall from his hoverboard on his way to school. He was in a medically induced coma for 3 weeks and has recently regained consciousness, he is A&O x4, very weak and has trouble sitting up without help. He wants to be able to eat sitting at the EOB without falling over or be able to close his eyes in the shower when sitting on the shower chair without losing his balance. - PT Plan: In today's session you want to work on some balance exercises at the EOB and then transfer him to his wheelchair. - Write a goal of Elroy. - Perform an appropriate treatment session for him. PT will be able to independently short sit at EOB for 10 minutes within one week to consume a meal. Pt: Jane Jetson - Starting Position: Sitting in her w/c - PMH: Jane had a L THA yesterday. She is WBAT but is having trouble learning to walk with a walker because she feels unsteady and "wobbly". She has trouble standing and moving the walker forward or reaching for things that are not close by without losing her balance. - PT Plan: In today's session you want to work on Jane's balance and transfer her to the bed after the session. - Perform and appropriate treatment session for her. - Write a brief SOAP note for your treatment session with Jane Balance Review Questions ------------------------ 1. What is the difference between center of mass and center of gravity? 2. What 3 sensory systems work together to create balance control? 3. Place the balance strategies in order of benefit from minimal perturbation to large perturbation: Stepping Strategy, Suspension Strategy, Weight-Shift Strategy, Ankle Strategy, Hip Strategy. Give an example of when you would use each of these. 4. If a patient is standing on a piece of foam practicing eyes open and eyes closed what kind of balance would that be? 5. If a patient is standing on the ground playing catch with a 2lb medicine ball utilizing only chest passes, what balance training type would this be? **Here are explanations for each question regarding balance control:** **1. \*\*Difference Between Center of Mass (COM) and Center of Gravity (COG)\*\*:** **- \*\*Center of Mass\*\* (COM) refers to the point where the body's mass is equally distributed in all directions.** **- \*\*Center of Gravity\*\* (COG) is the vertical projection of the COM to the ground. The COG shifts as the body moves, while the COM remains constant unless mass is gained or lost.** **2. \*\*Three Sensory Systems for Balance Control\*\*:** **- \*\*Visual system\*\*: Provides information about body position relative to surroundings.** **- \*\*Vestibular system\*\*: Detects head movement and orientation to help maintain equilibrium.** **- \*\*Somatosensory system\*\*: Provides feedback on body position via sensors in muscles and joints.** **3. \*\*Balance Strategies in Order of Benefit from Minimal to Large Perturbation\*\*:** **- \*\*Ankle Strategy\*\*: Used for minimal perturbations (e.g., slight sway while standing).** **- \*\*Weight-Shift Strategy\*\*: Used for moderate adjustments, shifting weight side to side (e.g., reaching sideways).** **- \*\*Hip Strategy\*\*: Activated with larger perturbations that require quick balance correction (e.g., standing on a bus when it stops suddenly).** **- \*\*Suspension Strategy\*\*: Involves lowering the COM by bending knees and hips to maintain stability (e.g., sudden crouch on uneven terrain).** **- \*\*Stepping Strategy\*\*: For significant perturbations, taking a step to reestablish a wide base of support (e.g., catching balance after being bumped).** **4. \*\*Balance Type for Standing on Foam with Eyes Open and Closed\*\*:** **- This is \*\*sensory organization or proprioceptive balance training\*\*. Removing visual input while standing on an unstable surface challenges balance control by relying on somatosensory and vestibular systems.** **5. \*\*Balance Type for Standing on Ground Playing Catch with Medicine Ball (Chest Passes)\*\*:** **- This is \*\*anticipatory balance training\*\*, as it requires planning and control for the expected movement of catching and throwing the ball. It challenges balance through weight shifting and dynamic stability.**