Balance Retraining

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Balance Retraining

• Chris Byrne
• Epworth Rehabilitation Centre
• Epworth Hospital

2
ABI Population

• 5,500 in Vic per year
• 350 severe brain damage
• 1.2 per 1000

• 70 male
• 75 are lt 25 yrs
• Significant recovery expected within 6-12 months

3
Effects of ABI on Movement

• Ataxia
• Spasticity
• Contracture
• Dyspraxia
• Cognitive Problems
• Paralysis

• Fatigue
• Reduced co-ordination
• Reduced balance
• Heterotrophic ossification
• Behavioural Problems

4
Biomechanics of Balance

• Maintenance of CoG
• Limit of Stability
• Cone of Stability
• Base of Support
• Postural Positioning
• Strategies to Maintain Balance

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Balance Strategies
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Balance Strategies

• Ankle strategies
• Knee strategies
• Hip strategies
• Step strategies

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Sensory Input
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Vestibular Apparatus
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Vestibular Periphery

• Semi circular canals - velocity
• Otolith organs - acceleration
• Provision of sensory input
• Relative head velocity
• Linear acceleration
• Angular acceleration
• Enables VOR to generate eye movement that matches
  head velocity

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Central Processing

• Input from primary afferents
• Vestibular nuclear complex
• Fast connections b/w afferent information motor
  output neurons
• Cerebellum adaptive processor
• Monitors vestibular performance
• Both structures process visual, somatosensory
  vestibular information simultaneously

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Vestibular Nucleus

• Located in the Pons
• 4 components
• Superior, medial, lateral descending
• Superior medial VOR relay
• Lateral vestibulospinal reflex function
• Descending connected to other nuclei
  cerebellum

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Vestibular Reflexes

• Vestibulospinal stabilizes boby
• Vestibulocollic stabilizes head
• Vestibulo-Occular stabilizes vision
• Cervicospinal reflexes neck movements
  connections to other reflex structures

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Vestibular Disorders

• Benign Paroxysmal Positional Vertigo (BPPV)
• Dizziness due to specific head positions
• Rapid neck extension head rotation
• Duration 30 -120 seconds
• Neuritis idiopathic
• Associated with respiratory virus
• Dizziness Nystagmus (eye pulsing)
• Nausea

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Vestibular Disorders

• Menieres Disease
• Ear fullness
• Tinnitus
• Nystagmus
• Nausea Vomiting
• Postural Imbalance

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Visual Conflict
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Visual Conflict

• Conflict b/w vestibular visual input
• Dizziness
• Nausea
• Postural instability
• Difficulty with converging visual information

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Balance Assessment
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Balance Assessment

• Rhomberg Tests
• Fakuda Step Test
• Saccadic Eye Movement
• Gaze Stability Tests
• Posturography

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Group Profile

• ABI
• Orthopaedic
• CVA
• CP

• Incomplete Paraplegia
• Hypoxic Brain Damage
• Multi Trauma

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Aims of Balance Re-Training

• Assess static/dynamic balance
• Identify systemic deficiencies
• Identify postural compensation
• Identify directional deficiencies

• Improve static/dynamic balance
• Facilitate selective trunk control
• Improve confidence
• Progressively challenge balance capabilities