1. Examination of postural control

2. 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

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

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

5. Reactive postural control
Recovering a stable position following an unexpected
perturbation

6. 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

7. 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)

8. 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

9. 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

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

11. 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

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

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

14. 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

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

16. 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)

17. 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.

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