Transcript Impaired Balance

Impaired Balance
Dr. Sumayah Abujaber
Impaired balance
• Injury or disease to any
structures involved in the
three stages of
information processing :
1. Sensory input
2. Sensorimotor integration
3. Motor output generation
Sensory Input Impairments
• Sensory Input Impairments includes:
1. Somatosensory deficits
2. Visual deficits
3. Vestibular deficits
Somatosensory deficits
• ↓ somatosensation & proprioceptive deficits:
1. Balance deficits
2. Increased risk for falls
Causes? Which population?
• Peripheral polyneuropathies in elderly subjects &
individuals with diabetes →Rely more heavily on a hip
strategy than do those without somatosensory deficits
• Proprioceptive deficits following LE and trunk injuries or
pathologies
1. Ankle sprains
2. knee ligamentous injuries
3. degenerative joint disease
Visual deficits
• Visual loss or specific deficits caused by disease,
trauma, or aging can impair balance and lead to falls.
Visual deficits
1. Acuity (acuteness or clearness of vision)
2. Contrast sensitivity (ability of the visual system to
distinguish bright and dim components of a static image)
3. Peripheral field vision (the total area in which objects can
be seen in the side (peripheral) vision while you focus
your eyes on a central point)
4. Depth perception (the visual ability to perceive the world
in three dimensions (3D) and the distance of an object)
Vestibular deficits
• Damage to the vestibular
system due to
1. Viral infections
2. Traumatic brain injury
3. Aging
Vestibular deficits
• The most common vestibular diseases
1. Vestibular neuritis (infection of the “balance branch”, of
vestibular nerve, vertigo)
2. Labyrinthitis(infection of the vestibule-cochlear branch of
vestibular nerve, vertigo)
3. Ménière's disease (episodes of spontaneous episodes of
vertigo, fluctuating hearing loss, ringing in the ear
(tinnitus), and a feeling of fullness or pressure in your ear)
4. Benign paroxysmal positional vertigo (BPPV) (repeated
episodes of positional vertigo caused by changes in the
position of the head)
Sensorimotor Integration
• Damage to the basal ganglia,
cerebellum, or supplementary motor
area impair processing of incoming
sensory information
 Difficulty adapting sensory information in response
to environmental changes
 Disruption of anticipatory and reactive postural
adjustments
• E.g. with external perturbations:
 Parkinson’s disease →a smaller response than
normal due to co-activation
 Cerebellar lesions → larger response
amplitudes
Sensorimotor Integration
• Sensory organization problems
1. Overreliance on one particular sense for balance control
2. Generalized inability to select an appropriate sense for
balance control when one or more senses give inaccurate
information
• visually dependent OR surface dependent → become
unstable or fall under conditions where the preferred sense
is either absent or inaccurate
• Individuals with generalized adaptation problems are
unstable in any condition in which a sensory input is not
accurate
Biomechanical and Motor Output
Deficits
Musculoskeletal system impairment:
1. Poor posture, e.g. thoracic kyphosis
2. Joint ROM limitations, e.g. ankle Jt.
contractures, or wearing ankle-foot orthoses
3. Decreased muscle performance, e.g.
dorsiflexor weakness
 Ankle vs. hip strategy?
Biomechanical and Motor Output
Deficits
 Neuromuscular system impairment:
1. Abnormal tone, or impaired coordination (neurological
conditions e.g. Stroke, Traumatic Brain Injury, Parkinson's
disease)
 Failure to generate adequate muscle forces ↓ability to recruit
muscles required for balance
2. Pain
 Pain can alter movements, reduce a person’s normal stability limits,
and if persistent produce secondary strength and mobility
impairments.
Deficits with Aging
• Deficits with aging process:
1. Declines in all sensory systems (somatosensory, vision,
vestibular) and
2. Declines in all three stages of information processing (i.e.,
sensory processing, sensorimotor integration, motor
output)
Most Common Risk Factors for Falls
Among the Elderly
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Muscle weakness
History of falls
Gait deficit
Balance deficit
Use of assistive device
Visual deficit
Arthritis
Impaired activities of daily living
Depression
Cognitive impairment
Age> 80 years
Deficits with Aging
• Older adults demonstrate impaired anticipatory postural
adjustments
• When compared to young adults, older adults have:
1. Slower-onset latencies
2. More frequent use of a hip strategy for balance control
• Two reliable, valid, and sensitive tools for assessing fall risk
in the elderly are the
1.
Tinetti Performance-Oriented Mobility Assessment (Tinetti Mobility
Test)
2.
the Berg Balance Scale
Medications
• Impaired balance due to dizziness or other side
effects of taking certain medications
Hypnotics
 sedatives
tricyclic antidepressants
Tranquilizers
antihypertensive