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What are intrinsic factors that contribute to balance?
- ROM
- muscle strength
- muscle tone
- spinal cord reflexes and CNS reactions
- coordination
- individual senses (vision, vestibular, somatosensory)
- cognition
- auditory impairment
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What are extrinsic factors that contribute to balance?
- environmental hazards
- nutrition
- social support
- financial situation
- footwear
- medication
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What is the ideal footwear and surface to test in?
- important to document both
- avoid slippers, socks, open clogs, >1" heel, poor fitting shoes
- low pile surface is better than vinyl/wooden
- use plush carpet for safety
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What is balance training?
- the concept of movement strategies to accomplish dynamic balance with impairments as underlying factor
- movement strategies- ankle, hip and stepping
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What are examples of the three movement strategies?
- ankle- on a bus, swaying or on foam
- hip- loss of balance in forward direction, causes hip extensors and back muscles to be activated
- stepping- person is forced to step because balance is out of the area of stability
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What is a way to measure static balance?
- one legged stance time
- can do eyes open or close
- in elderly: <5 sec = high risk, 5-20= moderate risk, >20= low risk
- in young: >30 sec = low risk
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What is a way to measure dynamic balance?
- functional reach test
- closed fist, height of shoulder, 3rd metacarpal
- <6"= high risk, 6-10"= moderate risk, >10"= low risk
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What is considered the 6th vital sign?
- walking speed
- speed of 1.2 m/sec necessary to cross street
- + correlated with quad strength, stair climbing ability, decreased fall risk and survival
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What is a way to measure gait velocity?
- 6 m walk test
- 8 m walk test
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What is agility?
ability to accelerate, decelerate, stabilize and change directions quickly while maintaining balance and proper posture
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What are agility tests for young and old?
- young: figure 8 test, shuttle run
- old: TUG, other tests
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What are characteristics of the figure 8 test?
- 10 meters in length, 4 meters in width
- timed test
- tests are sensitive to weakness, pain, and swelling in knee
- disadvantage: need significant space
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What are characteristics of the TUG test?
- done on elderly
- can use AD
- 10' (senior fitness test is 8')
- chair with back and armrests
- <13.5 seconds = low fall risk
- >30 secs= need assistance with ADL
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What is the dynamic gait index used for?
- agility
- aging adults
- includes accelerations/decelerations, pivot turns, abrupt stops, head turns
- poor performance correlated with vestibular dysfunction
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What is the tinnetti test used for?
- two parts- gait and balance
- <19/28 = high risk for falling
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How is the Berg scored and what is significant?
- evaluates balance impairment in elderly and predicts fall risk
- <45 = need for AD
- higher the score = lower risk for falling
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What does stair climbing measure?
highly correlated to functional abilites in older adults
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What are single limb hop tests for and what are the 4 tests?
- functional tests for athletes
- single hop for distance
- triple crossover hop for distance
- stright triple hop for distance
- timed hop
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What is the 4 square step test for?
- dynamic balance for aging, non frail adults
- >15 secs= should be referred to PT for exam adn exercise prescription
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What is agility training?
- combination of physical speed, fluidity, and skill
- the ability to explosively brake, change direction and accelerate again
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What is the progression of agility training?
begin with static, bilateral and stable surfaces and progress to dynamic, unilateral, and unstable surfaces
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What is the progression of balance training?
progress from static to dynamic balance
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What interventions are used to improve balance and decrease fall risk?
- multifactorial- no one exercise technique or type of exercise has been shown effective in balance (except tai chi)
- recommend balance, flexibility, & strengthening exercises
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