Navigating Balance Deepha Romuwalt RPT , C/NDT Proactive Physio - - PowerPoint PPT Presentation

Navigating Balance

Deepha Romuwalt RPT , C/NDT Proactive Physio Plus 1796 16th Street East Owen Sound N4K 5N3

proactivephysioplus@gmail.com www.proactivephysioplus.ca

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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

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Simple to Complex

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Balance

Proactive Balance Reactive Balance

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Factors

Intrinsic factors Extrinsic factors

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Framework of balance/ postural control

Constraints of mechanical system

Sensory strategies Movement strategies

Dynamic control

Orientation in space Cognitive processing

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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

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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

• ur 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

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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

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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

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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

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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

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Example 1

u 65 year old gentleman presented with complaints that

he is bumping into things, people and had difficulty to

• rient into a living room after he comes out of a narrow

space.

u Outcome measure I chose u Intervention strategy u Treatment outcome

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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

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Empowering Community Erasing Falls....

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Deepha Romuwalt RPT , C/NDT 1796 16th Street East Owen Sound N4K 5N3

proactivephysioplus@gmail.com www.proactivephysioplus.ca

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