Balance and Gait assessment (1).pdf

TOPIC 9: BALANCE AND GAIT ASSESSMENT Balance The human being has the ability to maintain positions and move Adapting to intrinsic and extrinsic changes in posture under the influence of gravity Balance is the basis for all those movements. Orientation —> Interpretation by the CNS of...

TOPIC 9: BALANCE AND GAIT ASSESSMENT Balance The human being has the ability to maintain positions and move Adapting to intrinsic and extrinsic changes in posture under the influence of gravity Balance is the basis for all those movements. Orientation —> Interpretation by the CNS of afferent stimuli, to maintain a proper body alignment according to the physical environment and tasks performed on it. 3 major Afferent Systems: Visual, Vestibular, Somatosensory Stability Processing afferent, efferent information and mechanisms. Resist + anticipate disturbances (feedback & feedforward) Maintain a stable static position and allow movement at the same time. Integrative system —> Cerebellum (process and modulate all information) Static Information about a body segment relative to one another in a stability. Dynamic Information about the movement speed and direction of one or several body segments. Balance disorders Direct way Injury to the major afferent systems and integrative system: -Deafferentation (afferent nerve fibers injury) going with anatomical structure injury (bones, ligaments, muscles) -Damage of sensors or nerves -Alteration of the CNS Indirect way Impairment of the nerve signal transduction (nerve transduction inhibition) that comes with bony-joint trauma and or prolonged immobilization periods. Balance assessment Functional assessment tools (tests or scales) -Define deficits, establish a treatment plan -Achieve the greatest possible patient functional independence Functional test must take into account three aspects: -Functional skills -Motor and sensory strategies used to maintain postural control in several tasks. -Sensory, motor and cognitive deficiencies that limit the posture control.  It’s mandatory to preserve the patient’s integrity ( protect them from falling at all times!!) Use at least 2 tests, each one will provide different information about how to act. Assessment of functional skills Examine how the patient performs many daily tasks requiring postural control V Are there underlying motor, sensory and cognitive impairments contributing to the imbalance? Limitations: -Don’t evaluate change of context situations -Don’t evaluate the movement quality Most commonly used tests: -Balance ability Self assessment: number of recent falls allows to define what postural control key aspects are affected. -Activities-specific Balance Confidence (ABC) Scale -Falls Efficacy Scale-International (FES-I) Scales for the Measurement of Balance Skills Time Up and Go test (TUG) Reach Test Multi-directional reach test BERG BALANCE TEST Berg Balance test Measures balance in elderly and neurological patients Consist of an assessment of functional tasks 14 item scale Equipment: Ruler, 2 chairs, stool, stopwatch Time: 15-20 min Scoring: assessment between 0 and 4, Total= 56 points Interpretation: 41-46 —> low fall risk 21-40 —> medium fall risk 0-20 —> high fall risk Evaluation of the Equilibrium Strategies 1. Motor strategies: 1.1.Alignement —> Sitting and standing position -Plumb line -Static force plates -Scales 1.1.Movement Strategies -Patient ability to maintain postural control -Performed while the patient changes positions -Movements of the center of gravity at all levels must be controlled 2. Sensitive strategies Romberg Test Dynamic posturography Sensory Organization Test (SOT) 3. Visual Strategies Ability to organise and select sensory information in response to changing visual conditions GAIT Is a neuromuscular & musculoskeletal action of the whole body that requires the coordination of both legs and a large number of joints and muscles working together Problems with mobility management are crucial to solve when regaining functional independence. GAIT Assessment Functional assessment tools ↓ Define deficits, establish a treatment plan (short and long term-term goals) ↓ Achieve the greatest possible patient functional independence. Functional test must take into account three aspects: -Functional skills -Motor and sensory strategies used to maintain postural control in several contexts and tasks -Sensory, motor and cognitive deficiencies that limit the posture control GAIT Assessment part 2 Cadence: Steps/min = 111-117/min Speed: Normal speed on flat ground = 82 m/min (adult) Monitorizing Stopwatch Podometer Step watch activity monitor Assessment of functional skills Hoffer Functional Ambulation Scale Figure of 8 walk test Gillette Functional Assessment Questionaire Evaluation of the 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. Evaluation of sensory, motor, and cognitive deficiencies that limit the posture control and gait PT may need to adopt a flexible position to evaluate and interpret posture, balance and gait in each patient, deciding the significant component OJO Any of the individual factors can be altered ↓ Correlated systems will try to compensate the deficits to achieve the task. Bere balance · Measures balance in elderly and necological patients test · Consists of an assessments of functional task · 14-item scale · Equipment · Ruler · chairs (with and withoutwoms) Stool · · stopwatch · Time · 15-20 min · Scoring · Assessment between O (minimum level) and 4 (max level) · Totel 56 points : Evaluation of 1. Motor strategies. the equilibrium 1 1 allienement > - sitting and standing position · Plumb Line Static force plates · Scales · 1. 2 Movement strategies. Patient ability to maintain postural control · Performed while the patient2 hanges postion · -both voluntarily and during disturbance caused by examinet a Movement of center of pravity, at all levels must be controlled · 2. Sensitive Strategies · Rombere test · Dynamic postergraphy · Sensory organization Test (SOT) · One lep standing test COLST) · Clinical test of sensory organization and balance (CTSOB)