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Includes controlling the body’s position in space for the dual purposes of stability and orientation
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- Postural orientation -The ability to maintain an appropriate relationship between body segments, as well as, between the body and the environment for the task.
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- Postural Stability - ability to control the center of mass (COM) in relationship to the base of support (BOS)
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Balance is the ability to keep one’s center of gravity over one’s base of support in any given sensory conditions
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Postural control and balance are often used interchangeably
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Balance emerges from the interaction of the individual, the postural task and the environment
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Visual, vestibular, and somatosensory are the primary sensory neural components contributing to balance/postural control
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Visual – provides information about the environment
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Somatosensory: sensory receptors in joints, muscle, and skin to provide perceptions of movement and position in space
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Vestibular – provides information on angular & linear acceleration as well as position in space
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Comprised of focal and ambient vision
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- Focal- specializes in object motion perception and object recognition
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- Ambient -associated with the maintenance of spatial orientation and visual functions that depend on peripheral, preconscious visual inputs
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Decreased visual acuity, contrast sensitivity and depth perception are all associated with increase risk for falls
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Information gathered from receptors located in muscles, joints and skin
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Provides information regarding body segment movement in space and force generation
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Both sensory system and motor system therefore can impact many different components of postural control
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Provides information about head motion, head position, and the direction of gravity that the central nervous system needs for postural control
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Affects motor control through two outputs, the vestibular ocular reflex (VOR) and the vestibular spinal reflex (VSR)
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- VOR – stabilizing visual images during head movement
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- VSR – stabilize the body
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Sensory signals are integrated in the CNS and result in descending motor commands to muscle
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Reactive and proactive and postural responses allow for adjustments to postural control(balance) in the presence of a changing environment or tasks
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Screening
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Assessment
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Identifies persons at risk for falling or with balance impairment
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In-depth, multifactorial measure(s)
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Helps guide clinicians in determining who should receive a multifactorial assessment
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Examines potential cause of falls
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Provides sufficient detail so as to guide interventions
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STEADI Stay Independent
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John Hopkins Fall Risk Assessment Tool
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Fall Risk Assessment and Screening Tool (FRAST)
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Quick 12 question survey
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developed to facilitate early detection of risk for anticipated physiologic falls in adult inpatients
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Created by physical therapists for use in primary care offices
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Good sensitivity discriminating fallers and predicting future falls in community dwelling adults
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JHFRAT is reliable, with high sensitivity and negative predictive validity
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Compiled from previously validated falls screening and assessment measures
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Uses the Timed Up and Go as the assessment
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Reliability
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The ability of a test to produce consistent results from one test to the next
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Validity
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The degree to which an instrument (test/assessment) measures what we intend to measure
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Ceiling Effect
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A significant percent of a certain group/population scores at the highest end of the test, therefore differentiating between these individuals or truly assessing them is not possible with this measure.
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Floor Effect
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A significant percent of a certain group/population scores at the lowest end of the test, therefore differentiating between these individuals or truly assessing them is not possible with this measure.
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Minimal Detectable Change (MDC)
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The minimum amount of change in a patient's score that ensures the change isn't the result of measurement error
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Minimally Clinically Important Difference (MCID)
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Represents the smallest amount of change in an outcome that might be considered important by the patient or clinician.
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Timed Up and Go (TUG) – Manual and Cognitive
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A component of the STEADI falls assessment; Provides insight on balance, strength/power, walking ability, and fall risk; Individuals are given verbal instructions to stand up from a chair, walk 3 meters as quickly and safely as possible, cross a line marked on the floor, turn around, walk back, and sit down
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30-Second Chair Stand Test
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Administered using a chair without arms, with seat height of 17 inches (43.2 cm). The chair may be placed against a wall to prevent it from moving.
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4-Stage Balance Test
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If the patient can hold a position for 10 seconds without moving their feet or needing support, go on to the next position. If not, STOP the test.
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10 Meter walk Test
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Two trials are administered at the patient’s comfortable walking speed, followed by 2 trials at his/her fast walking speed. The 2 trials, for each speed, are averaged and the 2 gait speeds are documented in meters/second.
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Modified Clinical test of Sensory Interaction in Balance (CTSIB-M)
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Provides the clinician with a means to quantify postural control under various sensory conditions. Designed to assess if available sensory systems are being used effectively for balance
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