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What are intrinsic factors that contribute to balance?
- muscle strength
- muscle tone
- spinal cord reflexes and CNS reactions
- individual senses (vision, vestibular, somatosensory)
- auditory impairment
What are extrinsic factors that contribute to balance?
- environmental hazards
- social support
- financial situation
What is the ideal footwear and surface to test in?
- important to document both
- avoid slippers, socks, open clogs, >1" heel, poor fitting shoes
- low pile surface is better than vinyl/wooden
- use plush carpet for safety
What is balance training?
- the concept of movement strategies to accomplish dynamic balance with impairments as underlying factor
- movement strategies- ankle, hip and stepping
What are examples of the three movement strategies?
- ankle- on a bus, swaying or on foam
- hip- loss of balance in forward direction, causes hip extensors and back muscles to be activated
- stepping- person is forced to step because balance is out of the area of stability
What is a way to measure static balance?
- one legged stance time
- can do eyes open or close
- in elderly: <5 sec = high risk, 5-20= moderate risk, >20= low risk
- in young: >30 sec = low risk
What is a way to measure dynamic balance?
- functional reach test
- closed fist, height of shoulder, 3rd metacarpal
- <6"= high risk, 6-10"= moderate risk, >10"= low risk
What is considered the 6th vital sign?
- walking speed
- speed of 1.2 m/sec necessary to cross street
- + correlated with quad strength, stair climbing ability, decreased fall risk and survival
What is a way to measure gait velocity?
- 6 m walk test
- 8 m walk test
What is agility?
ability to accelerate, decelerate, stabilize and change directions quickly while maintaining balance and proper posture
What are agility tests for young and old?
- young: figure 8 test, shuttle run
- old: TUG, other tests
What are characteristics of the figure 8 test?
- 10 meters in length, 4 meters in width
- timed test
- tests are sensitive to weakness, pain, and swelling in knee
- disadvantage: need significant space
What are characteristics of the TUG test?
- done on elderly
- can use AD
- 10' (senior fitness test is 8')
- chair with back and armrests
- <13.5 seconds = low fall risk
- >30 secs= need assistance with ADL
What is the dynamic gait index used for?
- aging adults
- includes accelerations/decelerations, pivot turns, abrupt stops, head turns
- poor performance correlated with vestibular dysfunction
What is the tinnetti test used for?
- two parts- gait and balance
- <19/28 = high risk for falling
How is the Berg scored and what is significant?
- evaluates balance impairment in elderly and predicts fall risk
- <45 = need for AD
- higher the score = lower risk for falling
What does stair climbing measure?
highly correlated to functional abilites in older adults
What are single limb hop tests for and what are the 4 tests?
- functional tests for athletes
- single hop for distance
- triple crossover hop for distance
- stright triple hop for distance
- timed hop
What is the 4 square step test for?
- dynamic balance for aging, non frail adults
- >15 secs= should be referred to PT for exam adn exercise prescription
What is agility training?
- combination of physical speed, fluidity, and skill
- the ability to explosively brake, change direction and accelerate again
What is the progression of agility training?
begin with static, bilateral and stable surfaces and progress to dynamic, unilateral, and unstable surfaces
What is the progression of balance training?
progress from static to dynamic balance
What interventions are used to improve balance and decrease fall risk?
- multifactorial- no one exercise technique or type of exercise has been shown effective in balance (except tai chi)
- recommend balance, flexibility, & strengthening exercises