Examination of postural control

Safety of therapist and patient is the first concern. Examination of balance in a functional context Tasks may reflect the need for: -steady state postural control -anticipatory postural control -reactive postural control

Steady state postural control Example: maintaining a safe independent sitting or standing position

Anticipatory postural control Example: ability to maintain stability while performing tasks that are potentially destabilising such as reaching, leaning or lifting

Reactive postural control Recovering a stable position following an unexpected perturbation

Self report measure for balance ability (subjective) Self report information on the number of recent falls and circumstances leading to falls or loss of balance This helps the therapist to hypothesise about which aspects op postural control are impaired and to determine the next step in the examination. Additional insight can be gained from a patient’s perceptions regarding how balance abilities have an impact on daily life

Self report measure for balance ability Examples of self report measures: -Activities specific balance confidence scale (Powell and Myers 1995) -Falls efficacy Scale (Tinetti 1990)

Performance based measure of balance (objective) Provides clinician with information on the patient’s level of performance compared with established norms Examples: -Timed up and go test -Reach test -Performance oriented mobility assessment (POMA) -Berg Balance Test -Short performance battery

Limitations of functional tests and measures Patient’s performance is examined under a limited set of environmental conditions Few test examine all three aspects of postural control Most tests provide little insight into the quality of movement used to accomplish the task THUS OTHER OBJECTIVE ASSESSING STRATEGIES FOR BALANCE

Assessing strategies for balance (objective) Alignment Motor strategies Movement strategies Sensory strategies Underlying impairments

Motor strategies self initiated body sway Alignment Motor strategies self initiated body sway Movement strategies response to externally induced sway Sensory strategies anticipation to a potential instability observing mvt made to maintain stability in response to changing task demands Underlying impairments

Movement strategies Self initiated body sway -Patient voluntarily shifts the weight forward, backwards, side ways -Sitting and standing -strategies

Movement strategies Response to externally induced sway -Therapist’s hands on patient’s hips, displaces hips in multiple directions -Strategies?

Movement strategies Anticipatory to a potentially destabilising movement -Ask patient to lift a heavy object as rapidly as possible or by placing one foot on top of a stool

Movement strategies Observing movements made to maintain stability in response to changing task demands. -Standing on one foot, standing tandem, etc. -Strategies?

Sensory strategies Stability must be maintained in a wide variety of environments Instability when certain sensory cues are unavailable Can provide insight into environmental conditions likely to produce instability The clinical test for sensory interaction in balance (Shumway, Cook, Horak 1987)

Examination of underlying impairments Impairments that will have the most direct impact on postural control Strenght ROM Proprioception * You would have detected this within your normal objective evaluation.

Interpreting the results of examination Interpret results Identify problems (impairments and participation restriction) Goals Plan