Navigating Balance Deepha Romuwalt RPT , C/NDT Proactive Physio Plus 1796 16 th Street East Owen Sound N4K 5N3 1 proactivephysioplus@gmail.com www.proactivephysioplus.ca
Balance u It is the product of integrated inputs to the body as a mechanical system that interacts with the nervous system in a continuously changing environment 2
Simple to Complex 3
Balance Proactive Reactive Balance Balance 4
Factors Intrinsic Extrinsic factors factors 5
Framework of balance/ postural control Constraints of Dynamic control mechanical system Sensory strategies Orientation in space Movement strategies Cognitive processing 6
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Posture: Modes of control u Ankle and Hip strategies u Brain needs reference points: some times the light touch finger tip contact corrects our balance u Trunk gain and a leg gain happens with pertubation. u People with vestibular hypo function have less trunk gain generally u Reduced sensory input shifts the compensatory strategies: leg driven more than trunk driven 8
Few points on visual/ vestibular and sensory integration u Sensory Organization: Involves the complex processes that determine appropriate timing, direction and amplitude of corrective postural actions from incoming information from our Visual, Vestibular and Somatosensory System u Cervicocollic reflex stabilises head in respect to trunk (cervical muscle spindles) u Vestibulocular reflex stabilises eye during head movement (VOR) u Vestibulospinal reflex stabilises body in space: generates compensatory body movements (VSR) u Vestibulocollic reflex stabilises head in space u The ratio of eye to head movement (GAIN) should be 1:1. Abnormal gain can cause symptoms of blurry vision or vertigo 9
Vital Checklist u Verticality and appropriate orientation: Provides efficient able starting position u Impaired reactive control: The ability to successfully recover from instability is the most critical aspect for fall avoidance u We have to be careful in selecting or asking the question: Screening or intervention selection or treatment 10
Starting Point u Fall Risk assessment u Total of 66 test: Out of 66 validated standardized balance test: - High proportion of the test measures only a few components. - On the brighter side, evolving test also suggest that balance measures are continuing to widen with different combination 11
Starting point.... u Functionally relevant components were missing u Eg. reactive postural control and corrective responses after instability were there 23% of the test. u This has to be regularly implemented 12
Application u All activities improve participants confidence in the ability u Proprioceptive task improve performance in static tasks and strength task improve performance in dynamic task u All community resource programs are great for the first three components. u Extremes are easy; strive for balance 13
Example 1 u 65 year old gentleman presented with complaints that he is bumping into things, people and had difficulty to orient into a living room after he comes out of a narrow space. u Outcome measure I chose u Intervention strategy u Treatment outcome 14
Example 2 u 55 year old client with Parkinson’s disease recently diagnosed, difficulty turning, unable to walk confidently. u Outcome measures I chose u Intervention strategy u Treatment outcome 15
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Empowering Community Erasing Falls.... 17
Deepha Romuwalt RPT , C/NDT 1796 16 th Street East Owen Sound N4K 5N3 18 proactivephysioplus@gmail.com www.proactivephysioplus.ca
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