neuro eval lecture 4.5

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neuro eval lecture 4.5
2012-09-12 18:58:50
neuro eval lecture

neuro eval lecture 4.5
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  1. "balance is an emergent property" means what?
    diff motor skills "emerge" due to the constraints of the task, the individual, and the environment, so all movement is emergent, with the CNS organizing mvmnt to meet the contraints of those three items
  2. balance is an interaction btwn _ _ and _
    • task, env, individual
    • pt's job is to understand rel btwn brain and mvmnt
  3. 3 types of constraints of a task
    • spatial
    • kinematic (force pt must produce)
    • temporal (in how much time must task be done)
  4. elements of the environmental aspect of a task
    • surface the pt is standing/sitting/balancing/rolling/hanging on
    • temp
    • light
    • medium (water, air, snow, etc)
  5. spinothalamic tract
    sensory pathway originating in the spinal cord. It transmits information to the thalamus about pain, temperature, itch, and crude touch. The pathway decussates at the level of the spinal cord, rather than in the brainstem like the posterior column-medial lemniscus pathway and corticospinal tract.
  6. individual factors comprising balance
    • sensation - spinothalamic (pain, touch, itch)
    • sensation - dorsal column/medial lemniscus (proprioception ...)
    • force production - (strength - central and peripheral components)
    • motor control - correct force, time, and range - all three initiating and terminating appropriately
    • ROM
    • endurance
    • attention
    • mood
    • vestibular (peripheral and central)
    • vision - though not necessary
    • fatigue - ex: in MS
    • tension (more mental stim --> worse balance)
    • mood - depression or elation can --> falls
  7. posterior column-medial lemniscus pathway -aka- dorsal column-medial lemniscus pathway -aka- dorsal white column-medial lemniscus system
    is the sensory pathway responsible for transmitting fine touch, vibration, and conscious proprioceptive information from the body to the cerebral cortex; as well as tactile pressure, barognosis, graphesthesia, stereognosis, recognition of texture, kinesthesia, and two-point discrimination
  8. balance troubles in PD
    initiation of balance strategies will be delayed
  9. 3 task specific balance tests of which HK approves
    • Berg Balance Scale
    • Dynamic Gait Index (DGI)
    • Timed Up and Go (TUG)
  10.  Berg Balance Scale # of qs, scoring, score that correlates w 100% falls risk
    • 14 item ordinal scale
    • items graded 0-4
    • 56 = perfect score
    • 42 or less correlates w 100% falls risk
  11. the awesome thing about the Berg Balance Scale and the Dynamic Gait Index
    they're based on functional movemnts, so the movements with which the pt has difficulties become the interventions
  12. the basic tasks of the 14 Berg Balance Scale tests and the qualifications for a 4 (don't memorize these - just use this card to get an acquaintanceship with the sequence)
    • 1. sit to stand
    • 2. stand unsupported (2 min)
    • 3. sit w back unsupported
    • 4. stand to sit
    • 5. transfer between a chair w armrest and on w/o
    • 6. stand unsupported w eyes closed (10 sec)
    • 7. stand unsupported w feet together (1 min)
    • 8. reach forward w oustretched arm while standing
    • 9. pick up an object from the floor from standing pos.
    • 10. turn to look behind over L and R shoulders while standing
    • 11. turn 360 degrees in each dir. (4 or less sec)
    • 12. put alternate foot on step or stool while standing unsupported (8 in 20 sec)
    • 13. stand unsupported one foot in front of other (30 sec)
    • 14. stand on one leg (>10 sec)
  13. tasks of the Dynamic Gait Index
    • 1. walk 20 feet
    • 2. walk 5 feet changing speed as PT commands
    • 3. walk while turning head L and R as PT commands
    • 4. walk while turning head up and down as PT commands
    • 5. walk, then stop and turn when PT commands
    • 6. walk and step over an obstacle
    • 7. walk and step around an obstacle
    • 8. walk up stairs
  14. TUG test procedure
    Timed Up and Go test, measured in seconds

     stand from a standard arm chair (seat ~18 in  or ~46 cm), walk 3 meters (10 feet), return to chair, sit

    whear normal shoes and use costomary walking aid. Start w back against chair, arms on armrests, walking aid in hand
  15. 2 variations of the TUG
    cognitive - complete test while counting backwards

    manual - complete while carrying a cup of water
  16. scoring in TUG
    • regular TUG: 13.5 sec or longer gives a prediction rate of 90%
    • TUG manual: 14.5 gives 90%
    • TUG cognitive: 15 sec or longer - 87%