give me some quiz questions based on this content:
  Objectives
1. List and describe components of physical function.
2. Discuss elements of balance and coordination.
3. Demonstrate competency in instructing and performing therapeutic exercise
to improve balance and coordination based on an established plan of care.
 
   Balance Terminology
Center of Mass - (COM) the center of the total body mass (perfect equilibrium)
Center of Gravity - (COG) vertical projection of the center of mass to the ground where all planes intersect.
→ The balance point of an object
→ Slightly anterior to 2nd sacral vertebrae
Line of Gravity - (LOG) vertical line passing vertically through the body
Momentum - product of mass X velocity
     
   Balance Terminology
Base of Support (BOS)- Perimeter of contact area between body and support surface, tetrapod more stable
Limit of Stability - The sway boundary in which an individual can maintain stability without changing the base of support
 
  Limits of Stability
   
  Balance Terminology
Ground Reaction Force - (GRF) contact force between the body and the ground is always equal and opposite.
Newton’s 3 law
Highest- low: running- walking Center of Pressure
→ Location of the vertical projection of the GRF
→ SLS the center of pressure is in the stance foot
→ Double leg stance, COP is between the two feet-evenly distributed
   
 Balance is a complex motor task that involves the body’s ability to react/ respond to changes in:
Position Motion Environment
 Balance
What controls balance?
Visual - eyes; position of the head, including
orientation, direction of movement, and speed Somatosensory - proprioception; body parts relative
to one another and the body’s position in space Vestibular - inner ear; position and movement of the
head relative to gravity
*What happens if we lose one?

 Balance Control
visual
 
   Balance Control
 
  Balance Control
Hip Strategy - rapid hip flexion or extension to move the COM within the BOS- vestibular system
Ankle Strategy - ankle PF and DF in the anteroposterior plane to restore balance-no vestibular system – yes proprioception
Step strategy - forward or backward step used to enlarged BOS- vestibular system- wide BOS, COG outside of BOS
 
   BOS
Movement
Muscles
Response
Ankle Strategy
Shoulder-width apart
Small, unexpected perturbation- movement get you outside of BOS, push patient
Gastroc/ soleus
Activation: distal → proximal
Sway (at ankle); head moves in the direction of the sway
Hip Strategy
Narrow
Large amplitude or high-velocity perturbation
Activation: proximal→ distal
Large-amplitude sway; head moves in opposite direction of hips
Step Strategy
Shoulder-width apart
Large amplitude or high-velocity perturbation
Activation: similar to gait cycle
Change in width of BOS occurs as a result of step
                
  Balance Control
Motor Strategies
Reactive postural adjustments to maintain balance
 Hip stategy
 
  Balance Control
Weight Shift Strategy (Lateral Plane): Controls medial/lateral movement, weight shift from one leg to the other
Suspension Strategy: Lowering the COM by flexing the knees, causing flexion of ankles and hips also. Half squat on bosu
Combined Strategies: Movement is complex. Combination of things.
 
  Impaired Balance**
What are the causes?
Diabete 2
Ankle sprain anything swelling. Peripheral Neuropathy Proprioceptive (Sensory input) deficits
CNS disorders- stoke.cerebellum ,
Biomechanical Deficits- hypermobility- ligament deficit , muscles, Aging – degenerate with aging , vision hearing
Medication, 1,pain 2, sleep 3, blood pressure 4, anxiety/depression Vestibular system dysfunction
Vision changes
 
  Balance Assessments
Fall Risk
- Berg Balance Test(no gait), Tinetti(gait), Timed up and go (TUG), Dynamic Gait Index (DGI), Functional Gait Assessment, 5 times sit to stand
Static Dynamic
5 times sit to stand, postural transitions(sit-to-stand and stand-to-sit) or functional movements(push,pull)
Clinical Test of Sensory Integration on Balance Test (CTSIB) Balance Error Scoring System (BESS)
Romberg, sharpened Romberg (tandem), Single Leg Balance Test
 
  The Berg balance scale
——
or Berg balance test
   assessment to determine your balance abilities. The test contains 14 specific tasks you’ll
 perform while you’re standing, sitting or making simple movements. The entire test takes
 about 20 minutes to complete.
 The DGI tests the ability of the participant to maintain walking balance while responding to different task demands, through various dynamic conditions. It is a useful test in individuals with vestibular and balance problems and those at risk of falls.
-
   The FGA is used to assess postural stability during walking and assesses an individual's
 ability to perform multiple motor tasks while walking. The tool is a modification of the 8
  item Dynamic Gait Index, developed to improve reliability and reduce ceiling effect.
is a widely used, standardized
 
  Romberg:
Pt stand with feet parallel with eyes open and closed for 30s.
sharpened Romberg (tandem):
Pt stand heel to toe with arm folded and eye closed for 1 min.
Single Leg Balance Test (SLB)
- Ask the pt to stand on one leg without shoes with arms crossed or hand on hips without legs touching. 3 - 30 second trials and a best or mean time recorded
 
  Clinical Test of Sensory Integration on Balance Test (CTSIB):
a timed test that systematically measures the influence of visual, vestibular, and somatosensory input on standing balance
Balance Error Scoring System (BESS)
static postural stability. . Stance position (double leg, single leg, tandem) stand on firm surface then on a foam.
Balance Error Scoring System (BESS)-athlete
- Pt assumes 3 different stance positions (double leg, single leg, tandem) with hands on hips on firm and then foam surface with eyes closed for 20 seconds each trial. Tester observes for number of errors.
 
  Balance Assessments (cont)
Single Leg Balance Test (SLB)
- Ask the pt to stand on one leg without shoes with arms crossed or hand on hips without legs touching. 3 - 30 second trials and a best or mean time recorded
Balance Error Scoring System (BESS)-athlete
- Pt assumes 3 different stance positions (double leg, single leg, tandem) with hands on hips on firm and then foam surface with eyes closed for 20 seconds each trial. Tester observes for number of errors.
 
   Balance Training
Static
Stationary
Maintain a stable antigravity(no supine) position, sitting standing at rest Sitting, half-kneeling, tall-kneeling, standing postures
Dynamic
Stabilize the body when surface or body is moving
Movement outside BOS purposefully
Sit to stand, walking, obstacle courses, step onto step, reaching away
Move your COG outside your BOS
   
  Balance Training
Anticipatory (proactive) Balance - preparation for movement to maintain balance - verbal or visual cuing to anticipate
Multi-directional reaching to touch or grasp objects
Catching, kicking ball, or balloon
Reactive Balance
Unanticipated perturbations
to train the ankle, hip, stepping strategies
Both for fall risk
  
   Balance Training
Internal - includes voluntary movement of the body, our muscles activating to move us
External - includes forces applied to move the body (ex: perturbations to challenge a patient). This is important for returning to activity/ sport.
  
    Balance Training
Vary the reliance on the different sensory systems Relate the balance activity to a functional limitation Dual tasking
   
 Balance Training
*ALWAYS use a gait belt
*Guard properly
*Use the parallel bars, railing if needed
*Assist patient with transfers and moving on/ off equipment
*Ensure treatment area is clear
*Ask about home set-up
*Don’t perform balance exercises near equipment or objects with sharp edges
*Balance prescription - What type of sets and reps might be done? Look for errors
   NO!
 
  Other Considerations
What are the balance needs?
1. Vision loss - consider lighting in the environment, glasses
2. Sensory loss - supportive shoes, AD(crusing)
3. Medications
 
  Progressing Exercises
     Vision
Swiss ball balance Perturbations
Support
Equipment
    Eyes open→ eyes
closed
Wide -> Narrow BOS Seated → standing Double to SLS
Stable -> Unstable surface Perturbations
More complex tasks
     
  HEP Safety & Suggestions
Decrease input from the environment - unstable surfaces Balance during functional activities
Environmental modifications
 
Quiz!
How can we ensure safety when prescribing balance exercises as part of the home exercise program?
More stable and safer