FPP W11 Tutorial Balance answered 2023, Wto Notes.pdf

Foundations for Physiotherapy Practice 2022-2023 Balance Week 11 UH FPP 2022/23 Learning Outcomes: Following this session and appropriate independent study you should be able to: • Identify the systems that contribute to balance • Describe a selection of exercises to challenge balance • Discuss t...

Foundations for Physiotherapy Practice 2022-2023 Balance Week 11 UH FPP 2022/23 Learning Outcomes: Following this session and appropriate independent study you should be able to: • Identify the systems that contribute to balance • Describe a selection of exercises to challenge balance • Discuss the role of walking aids in maintenance of balance UH FPP 2022-23 Lin e of Gr avi ty Balance Base of Support UH FPP 2020-21 Line of Gravity Balance in biomechanics, is an ability to maintain the line of gravity (vertical line from centre of mass) of a body within the base of support with minimal postural sway. Sway is the horizontal movement of the centre of gravity even when a person is standing still. UH FPP 2022/23 Receive, Integration and output Receive sensory inputs ▪ within body ▪ external to body Integration of sensory information and information from past experiences are then processed in the central nervous system Motor output to muscles to maintain and control balance Feedforward and feedback mechanisms UH FPP 2022-23 Receive, Integration and output UH FPP 2022-23 Task • What is the important sensory input for balance? UH FPP 2022-23 Task What is the important sensory input for balance? • Vision • Touch • Vestibular -inner ear • Hearing • proprioception UH FPP 2022-23 Walking on an uneven surface UH FPP 2022/23 Task What are the motor outputs occur to maintain and control balance? UH FPP 2022/23 Task What are the motor outputs occur to maintain and control balance? • Constant adjusting • Saving reaction UH FPP 2022/23 What about high heeled shoes? UH FPP 2022/23 Task • Describe a selection of exercises to challenge balance UH FPP 2022/23 Jump – elements of jump/ squat Throwing and catching Heel toe walking Balance/wobble board Lunge UH FPP 2022/23 Single leg squat Task Describe a selection of exercises to challenge balance • 360 degree turn • Jump – elements of jump/squat • Heel toe walking • Balance/wobble board • Sit to stand • Single leg cross body punches • Sitting on balance ball • Squat • Turning head • Throwing and catching • Lunge • Step up • Flamingo swing – swinging leg in single leg stand (SLS) • Toe and heel lifts • Single leg squat • Always remember progression and regression of an exercise – challenging but safe! UH FPP 2022/23 Role of walking aids in maintenance of balance • Effect on base of support • Effect on the line of gravity UH FPP 2022/23 Therapist’s role when a patient mobilises… !The therapist is there as a facilitator - you are NOT there to hold them up. Never Lift!! !Where patients are being mobilised for the first time ensure all risks are assessed and managed appropriately. !See local Policies and Procedures LIFT UH FPP 2022/23 Terms defined - Weight bearing status • Non-weight Bearing (NWB) • Full weight bearing (FWB) • Weight Bear as Tolerated (WBAT) • (Toe) Touch Weight Bearing (TWB) • Partial Weight Bearing (PWB) • Protected Weight Bearing (PTWB) UH FPP 2022/23 Terms defined - Weight bearing status • Non-weight Bearing (NWB)- No weight to be put through the affected limb. Frame or crutches essential. • Full weight bearing (FWB)- No restriction on weight bearing • Weight Bear as Tolerated (WBAT)- Similar to FWB, the patient can put as much weight through the limb as is comfortable/pain free and may still use a walking aid e.g. walking stick • (Toe) Touch Weight Bearing (TWB). The foot or toes may touch the floor to maintain balance, but not bear any weight. Frame or crutches essential. • Partial Weight Bearing (PWB) 20%-50% of weight through the limb, can be measured using bathroom scales or biofeedback. Frame or crutches essential. • Protected Weight Bearing (PTWB) The patient can weight bear through the limb as tolerated as long as the limb is protected by the use of a walking aid (generally a frame or crutches) Hustedt et. al, 2012 UH FPP 2022/23 Types of Walking Aids 1 : Walking sticks Fischer UH FPP 2022/23 Types of Walking Aids 1: Walking Sticks • Primarily used for …………….. • Not for ………... • Can also be helpful to warn others that mobility may be ………….. • If used correctly on contralateral side, ……….. of body weight can be taken UH FPP 2022/23 Types of Walking Aids 1: Walking Sticks • Primarily used for balance/ confidence • Not for full support. • Can also be helpful to warn others that mobility may be poor or patient is unsteady • If used correctly on contralateral side, up to 1/3rd of body weight can be taken • SO, it is unsuitable for taking all weight off painful limb (NWB, TWB, PWB, PTWB) UH FPP 2022/23 Types of Walking Aids 2:crutches: Elbow UH FPP 2022/23 Types of Walking Aids 2: Crutches ▪ Elbow, fischer and gutter ▪ Primarily for ………….term use and gives good support ▪ Suitable for ………………..of a limb as allows ‘swing through’ ▪ More stable than ……. UH FPP 2022/23 Types of Walking Aids 2: Crutches ▪ Elbow, fischer and gutter ▪ Primarily for short-term use and gives good support ▪ Suitable for PWB, TWB & NWB of a limb as allows ‘swing through’ ▪ More stable than a stick UH FPP 2022/23 Types of Walking Aids 3: Walking Frames ( static Zimmer frames - ZF) • Stable —for patients with ………………. balance • PWB, TWB, NWB or FWB’ing • Appropriate for …………..term use, especially in the elderly • Other examples of use: post-fracture, post joint surgery, arthritis for support etc. • Static walking frames only allow ‘……………’ rather than ‘step through’ gait pattern • Disadvantages: ………………….,…………………………..,…………………………. UH FPP 2022/23 Types of Walking Aids 3: Walking Frames ( static Zimmer frames - ZF) • Stable for patients with impaired balance • PWB, TWB, NWB or FWB’ing • Appropriate for long-term use, especially in the elderly • Other examples of use: post-fracture, post joint surgery, arthritis for support etc. • Static walking frames only allow ‘Step to’ rather than ‘step through’ gait pattern • Disadvantages: cumbersome and inhibit normal gait pattern and speed, unable to use on stairs UH FPP 2022/23 Types of Walking Aids 4: Wheeled Zimmer frames (Rollator frames –RF or Wheeled Zimmer Frames- WZF) • Wheeled frame with 2, 3 or 4 wheels (see pictures on next slide) • • • • Provide ……… support than a static frame Can be used for ……………………………….. Allows …………………walking pattern than a standard frame 2 wheeled type should be slightly tipped and not pushed or lifted !Unsuitable for NWB/TWB UH FPP 2022/23 Types of Walking Aids 4: • Wheeled Zimmer frames (Rollator frames –RF or Wheeled Zimmer Frames- WZF) • Wheeled frame with 2, 3 or 4 wheels (see pictures on next slide) • Provide less support than a static frame • Can be used for PWB or for balance/confidence • Allows a more “normal” walking pattern than a standard frame • 2 wheeled type should be slightly tipped and not pushed or lifted !Unsuitable for NWB/TWB UH FPP 2022/23 Types of Walking Aids 5: Wheeled frames (Three wheeled walkers- 3WW and Four Wheeled Walkers- 4WW) • Large wheels ideal for …………….. • Larger than wheeled zimmer frames- can be cumbersome indoors although large wheels are better on carpet • Provide ……….. support than a wheeled zimmer frame • Allows ………………walking pattern and …………gait speed than a wheeled zimmer frame • Brakes on during sit to stand • Unsuitable for ……………………… UH FPP 2022/23 Types of Walking Aids 5: • Wheeled frames (Three wheeled walkers- 3WW and Four • • • • • • Wheeled Walkers- 4WW) Large wheels ideal for outdoor use Larger than wheeled zimmer frames- can be cumbersome indoors although large wheels are better on carpet Provide less support than a wheeled zimmer frame Allows a more ‘normal’ walking pattern and a faster gait speed than a wheeled zimmer frame Brakes on during sit to stand Unsuitable for NWB/TWB/PWB/PTWB UH FPP 2022/23 UH FPP 2022/23 Types of Walking Aids 6: Gutter Frames (GF) • Wheeled frames with …… wheels • Allows ………base of support as the user can weight bear through the whole forearm • Useful for those with ………………… • Provides ……….. support than a zimmer frame • More cumbersome to use than a zimmer frame • Suitable for PWB, TWB, NWB or FWB’ing UH FPP 2022/23 Types of Walking Aids 6: Gutter Frames (GF) • Wheeled frames with 2 wheels • Allows an increased base of support as the user can weight bear through the whole forearm • Useful for those with reduced grip • Provides more support than a zimmer frame • More cumbersome to use than a zimmer frame • Suitable for PWB, TWB, NWB or FWB’ing UH FPP 2022/23 Walking Aids that may be considered for balance and confidence • Walking sticks • Walking Frames • Wheeled frames UH FPP 2022/23 Learning Outcomes: • Identify the systems that contribute to balance • Describe a selection of exercises to challenge balance • Discuss the role of walking aids in maintenance of balance Any Questions? UH FPP 2022/23