balance and posture assessment

• postural control

  • biochemical constraint (muscle tendon strength flexibility)
  • cognitive processing (attention, planning)
  • perception of verticality (gravity)
  • movement strategies (hip, ankle stepping strategies)
  • sensory integration and reweighting CNS
  • sensory modalities (visual, vestibular system)
• functional testing

  • times up and go: patient stand up from chair, walk short distance, turn around, sit back down, evaluate mobility and assess risk if fall, >30 sec=high dependency
  • functional reach test: test anterior displacement of weight transfer in standing <18.5 cm indicate fall risk
  • POMA evaluate steady state balance in sitting and standing list 19>=high risk
  • berg balance scale: balance function assessment in standing 23>multple faller
  • basic gross motor assessment
  • trunk impairement scale
  • clinical test for sensory interaction in balance
• motor strategy

  body alignment: observe if symmertric/ weight discrepancies

  self initiated sway: spontaneous sway to maintain balance

  anticipatory strategies to external perturbation: adjust posture in preparation for expected external force

  hip/ankle/stepping strategy: utilise joint to maintain balance

  nudge test: evaluate patient ability to maintain balance after small push
• posture abnormalities:

  • lordosis/kyphosis
  • rotation of pelvis
  • shoulder girdle protractiond depression
  • upper limb flexor pattern/ lower limb extensor pattern
  • positive support reaction: foot on ground calf muscle still contract
  • pusher syndrome: leaning to normal side
• clinical test for sensory interaction in balance CTSIB

  • test vestibular/ visual/somatosensory system

  normal: patient stand on firm surface with eyes opened

  blind fold/black box/ stand on foam
• technological measurement

  EMG: assess muscular activiy, identify abnormalities

  mats: measure plantar loading, tract COP moving

  accelerometers: measure displacement of limbs, distinguish postural sway