Chris Carpino, MPT - content.ccrn.comcontent.ccrn.com/.../speaker_mats/carpino_new_ideas_in_balance.pdf · Chris Carpino, MPT `Tests designed for ... `Good static balance test `Functional

Chris Carpino, MPT

Tests designed for various populationsObjective is to utilize appropriate assessment◦

Ask yourself:

Is this test addressing this patient’s deficits?Is this test appropriately/inappropriately tasking the patient?

Nearly 1 million people visit ER as a result of a fall1/3 of 65+ year old adults fall at least one time/yearThis will increase with ageThe projected cost for fall injuries is over $30 billion

Anybody over 55 years of ageSomebody who has a fear of falling or previous fallHistory of trauma (motor vehicle accident, head injury, sports trauma)Anybody within this category is appropriate for a Balance Screening

Functional portion of the evaluationLook for functional movement patterns as they apply to balanceAsk yourself…◦

Is this test measuring something the patient would experience on a day to day basis?

Berg Balance TestDynamic Gait IndexRhombergTimed up and go (TUG)

Typically tested on patients with a history of CVAAppropriate for use in an outpatient facilityCan be appropriate for use in an inpatient facility*Good static balance testFunctional and measurableA score of <49/56 indicates a risk for fall

Excellent dynamic balance assessmentFunctional and measurableAppropriate for use in an outpatient facilityCan be appropriate for use in an inpatient facility*Assesses daily movement patternsMost likely to provoke motion sensitive symptomsA score of <19/24 indicates a risk for falls

Appropriate for patients with Parkinsonism Good for patients who experience vertiginous symptoms upon standing and movingMeasure progress with improved times

Assessment of balance and gait for elderly/adult populationsMay not be appropriate for use in most outpatient facilitiesMay be appropriate in inpatient facilities ie: acute, subacute, long-term facilitiesScore <24 indicates risk for fallsNo validity reported

Activities-specific Balance ScaleRhombergFukuda Step TestNormal, Good, Fair, Poor (+/-)Computerized Exam

(Vest. Technologies, Biodex, Metitur)

Static standing balance testProvide information regarding postural sway with eyes open and closedGood objective representation of balance

The 3 systems that control balance:◦

Visual◦

Proprioceptive◦

Vestibular

Remove 1 or 2 of the 3 to strengthen the others.

One’s ability to see their environment Aids in their adaptation to interacting with their environment, as well as make any necessary modificationsPeople have difficultly maintaining their balance in the dark or with impaired vision.

Position senseSense of awareness Incorporates your somatosensory system.

Provides information regarding the speed and direction of the body’s movement. Sensitive to changes in body position and speed of movement. People with vestibular dysfunction are at risk for falling

Ankle Strategy◦

Initial correction attempt◦

Contractions are small, working distal→proximal

Hip Strategy◦

Movements are large and fast◦

Muscle activation is proximal →distal

Static Standing with proprioceptive system altered.◦

Progress with:

closing eyesFeet togetherFeet in tandemSingle Leg

Wobble Board

Reaching◦

Move client’s body outside their base of support◦

Progress with:

Unstable surfaceInclined surfaceUse of weights

Catching◦

Increases reaction time as well as forcing client to extend beyond their base of support◦

Progress with:

Weighted objectsLarge objectsUnstable surfaces

Marching in place◦

On cushion/foam◦

On trampoline

Walking with head turnsSide steppingcarioca

Stepping over objectsStepping around objectsCatching object while walking

Combine Activities◦

Catch a ball on foam◦

Combine all systems

Combine Activities◦

Perform upper extremity exercises while balancing on unstable surface(s)◦

Add a physioball to the mix◦

Add a dynadisc