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Laboratory evaluation of balance

‫ ﺑﺲ ﻋﺎﻳﺰﻳﻦ ﻧﻘﻮل ﺷﻮﻳﺔ ﺣﺎﺟﺎت ف اﻻول‬balance ‫ﺑﺘﻘﻴﺲ ال‬objective ‫ﻫﻨﺘﻜﻠﻢ ف اﻟﻤﺤﺎﺿﺮة دﻳﻪ ﺑﺈذن ﷲ ﻋﻦ ﺣﺎﺟﺎت‬

laboratory ‫ اﻣﺎ ال‬special test ‫ و ع ﺑﻌﺾ ال‬subjective ‫ ف ﻣﻌﻈﻢ اﻷﺣﻴﺎن ﺑﻴﻌﺘﻤﺪ ع ﺣﺎﺟﺎت‬evaluation ‫اوﻻ ان ال‬
‫ و وﻣﻤﻜﻦ ﺳﻌﺮﻫﺎ ﻳﻮﺻﻞ ﻟﻠﻤﻼﻳﻴﻦ و دﻳﻪ‬very expensive ‫ ﺑﺲ ﻣﺸﻜﻠﺔ اﻷﺟﻬﺰة دﻳﻪ اﻧﻬﺎ ﺑﺘﻜﻮن‬objective ‫ﺑﺘﻜﻮن ﺣﺎﺟﺎت‬
‫ و رﺳﺎﺋﻞ اﻟﻤﺎﺟﺴﺘﻴﺮ واﻟﺪﻛﺘﻮراه‬research ‫ﻣﻦ ﻋﻴﻮﺑﻬﺎ و ده ﺑﻴﺨﻠﻴﻬﺎ ﻏﺎﻟﺒﺎ ﺗﺴﺘﺨﺪم ف ال‬

‫ﻷﻧﻬﺎ دﻗﻴﻘﺔ ﺟﺪا و‬re-evaluation ‫و ﺧﺼﻮﺻﺎ ال‬treatment ‫و ال‬assessment ‫ﺑﺲ دا ﻣﻴﻤﻨﻌﺶ أﻧﻬﺎ ﺑﺘﻔﺮق ف ال‬
traditional ‫ﻣﻨﻘﺪرش ﻧﻮﺻﻠﻬﺎ ﺑﺎﻷﺟﻬﺰة ال‬data ‫ﺑﺘﻄﻠﻊ اﻟﻨﺘﺎﺋﺞ ﺑﺄرﻗﺎم و ﺑﺘﺪﻳﻨﻲ‬

 Effective treatment of postural instability depends on identifying the patient's functional

disabilities and the components that are abnormally constraining.
 The problem – solving task begins by gathering both subjective information and objective measures
of the patient's postural behavior.

effective treatment ‫ ﻣﻔﻴﺶ‬effective assessment ‫ﻃﺒﻌﺎ اﺣﻨﺎ اﺗﻌﻠﻤﻨﺎ أن ﻟﻮ ﻣﻔﻴﺶ‬

‫ ﺑﺘﺒﻘﻲ ﺣﺎﺟﺔ ﻣﺮﺗﺒﻄﺔ ﺑﺎﻟﺜﻴﺮاﺑﻴﺴﺖ ﻫﻮ‬subjective ‫ و أن ال‬objective ‫ و ال‬subjective ‫زي ﻣﺎ اﺣﻨﺎ ﻋﺎرﻓﻴﻦ اﻟﻔﺮق ﺑﻴﻦ ال‬
evaluation ‫ ﻓﺒﺎﻟﺘﺎﻟﻲ ال‬palpation ‫ و ال‬inspection ‫ اﻟﻠﻲ ﺑﺘﺸﻤﻞ ال‬physical examinations ‫اﻟﻠﻲ ﺑﻴﻌﻤﻠﻬﺎ زي ال‬
‫ ﻣﺒﻴﺨﺘﻠﻔﺶ ﻋﻠﻴﻬﺎ اﺗﻨﻴﻦ وﻋﺸﺎن اﺣﺪد ﻣﺸﻜﻠﺔ‬objective ‫ﺑﺘﺎﻋﻪ ﻳﺨﺘﻠﻒ ﻋﻦ ﻏﻴﺮه ﻛﻞ واﺣﺪ ﻟﻴﻪ ﻧﻈﺮة أﻣﺎ اﻟﺤﺎﺟﺎت ال‬
.‫ﻣﻊ ﺑﻌﺾ‬two measures ‫ﻟﻞ‬combine ‫اﻟﻤﺮﻳﺾ و اﻋﺮف اﻋﺎﻟﺠﻪ ﻻزم اﻋﻤﻞ‬

The three parts of physical therapist's postural control evaluation include:

1. Subjective patient's report

2. Objective measures of postural control
3. Impressions and recommendations
‫ ﺑﺘﺎع‬history ‫ ع ال‬dependent ‫اﻟﻠﻲ ﺑﺘﺒﻘﻲ‬examinations ‫ اﻧﺖ ﺑﺘﻌﻤﻞ ﺑﻌﺾ ال‬evaluation ‫ ﺧﺪ ﺑﺎﻟﻚ و اﻧﺖ ﺑﺘﻌﻤﻞ‬
‫اﻟﻤﺮﻳﺾ ﻋﺸﺎن ﺗﺒﺺ ع ﺣﺎﺟﺎت ﻣﻌﻴﻨﺔ‬
‫ﻃﺐ ﺑﻌﺪ ﻛﺪا ﺑﻘﻲ ﻋﻨﺪك‬.... objective ‫ ﺑﺘﺎﻋﻚ اﺷﺘﻐﻞ ﺑﻘﻲ ب أﺟﻬﺰة‬examination ‫ و ﻋﻤﻠﺖ‬history ‫ ﺑﻌﺪ ﻣﺎ ﺧﺪت ال‬
‫ ﻋﺸﺎن ﺗﻜﻤﻞ‬recommendations and impressions ‫ اﻟﺪاﺗﺎ دﻳﻪ ﻋﺸﺎن ﺗﺸﻮف ال‬analysis ‫ ﺗﺒﺪأ ﺗﻌﻤﻞ‬objective data
evaluation ‫ اﻟﺸﻜﻞ ﺑﺘﺎع ال‬/ ‫اﻟﺼﻮرة‬
 The patient is examined in various environments to determine the presence of normal automatic
postural strategies.
 Postural coordination in response to displacements, in preparation for volitional limb movement
and in voluntary weight shifting is also evaluated.
‫ ﻓﻲ‬examinations/evaluation ‫ ف ﻻزم اﻋﻤﻞ ال‬balance and postural stability ‫ ﻟﻮ ﻫﻌﺘﻤﺪ ف اﻟﻔﺤﺺ ﺑﺎﻟﺬات ع ال‬
various environments
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‫ﺣﻮاﻟﻴﻪ ﺑﺘﺪﻳﻨﻲ ﻣﺆﺷﺮ ع‬environment ‫؟ اﻳﻮا ﺑﺲ ﻫﻞ ال‬balance ‫ ﻳﻌﻨﻲ ﻟﻤﺎ زﻣﻴﻠﻚ ﻳﻤﺸﻲ ﻗﺪاﻣﻚ ف اﻟﻤﺪرج ﻫﻞ ﻛﺪا ﻋﻨﺪه‬
various environments ‫ ﻓﻼزم اﺑﺺ ع اﻟﻤﺮﻳﺾ ف‬،‫ﺑﺘﺎﻋﺘﻪ ف اﻟﻌﻤﻮم ؟ ﻷ‬general balance and postural reaction ‫ال‬
and different situations.
‫ﺑﺘﻌﺘﻤﺪ ﻧﻔﺲ اﻟﻜﻼم ﻋﺸﺎن ﻟﻮ اﻟﻤﺮﻳﺾ ﻣﺜﻼ ﺑﻴﻌﺮف ﻳﻤﺸﻲ ﻗﺪاﻣﻚ ﻛﺬا ﻣﺮة و ﻋﻨﺪه ﺗﻮازن ع ال‬treatment ‫ ﺣﺘﻲ ف ال‬
‫ﺑﺲ ﻟﻤﺎ ﻳﺠﻲ ﻳﺮوح اﻟﺒﻴﺖ ﻣﻤﻜﻦ ﻳﻜﻌﺒﻞ ف اﻟﻄﺮﻳﻖ أو ﻳﺘﺰﺣﻠﻖ ع اﻟﺴﻴﺮاﻣﻴﻚ و دا ﻟﻴﻪ ؟ ﻋﺸﺎن اﻧﺖ ﻟﺴﻪ‬smooth surface
accommodate with different surfaces ‫ﻣﻮﺻﻠﺘﺶ اﻟﻤﺮﻳﺾ أﻧﻪ ﻳﻘﺪر ي‬

❶ The potentiometric displacement transducer

 It records the sway patterns of subjects by measuring the displacement at their waist.
 The subjects wear an aluminum pad around their waist, connected by a fishing line to the
displacement transducer.
 The transducer records the subject's anteroposterior sway.
‫ ﺑﻴﺘﻠﻒ‬sensor ‫ و ﻫﻮ ﻋﺒﺎرة ﻋﻦ‬anteroposterior sway ‫ ﺧﺼﻮﺻﺎ ال‬sway patterns ‫ اول ﺟﻬﺎز ﻣﻌﺎﻧﺎ و ﻫﻮ ﺑﻴﻘﻴﺲ ال‬
‫ﺣﻮاﻟﻴﻦ اﻟﻮﺳﻂ ﻛﺪا‬
‫ ﻟﻮ زادت ﺑﺸﻜﻞ ﻛﺒﻴﺮ ﻳﺒﻘﻲ ال‬displacement ‫ﺑﻨﺴﺒﺔ ﺑﺴﻴﻄﺔ ﺑﺲ ال‬normal sway ‫ ﻃﺒﻌﺎ زي ﻣﺎ اﺣﻨﺎ ﻋﺎرﻓﻴﻦ أن ﻓﻴﻪ‬
‫ ﺑﺘﺎﻋﻪ‬static balance ‫ ﻋﻨﺪه ﻣﺸﻜﻠﺔ ف ال‬patient
 This technique has been used to evaluate the sway patterns of healthy volunteers, below – knee
amputees and elderly people with a history of falls.
 This technique provides information about anteroposterior sway only under static conditions.
dynamic balance ‫اﻣﺎ ﻣﺶ ﺑﻴﻘﻴﺲ ال‬kneeling ‫أو ال‬standing ‫زي ال‬static conditions ‫ ال‬
 It loads the subjects at the waist and would therefore not be recommended for frail patients.
There have been no reported studies regarding the reliability or accuracy of potentiometric
displacement transducer.

❷ Static force platforms

 It measures the displacement of a subject's center of pressure while standing still, using three
or four force transducers.
‫ﺑﺘﺒﻘﻲ ﺗﻼﺗﺔ أو‬force transducer ‫و ﺑﻴﺒﻘﻲ ﻋﺒﺎرة ﻋﻦ ﺑﻼﻃﺔ ﻛﺪا اﺳﻤﻬﺎ‬static balance ‫ دا ﻧﻮع ﺗﺎﻧﻲ ﺑﺮده ﺑﻴﻘﻴﺲ ال‬
centre of pressure during standing ‫أرﺑﻌﺔ و ﺑﺘﻘﻴﺲ ال‬
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  Static force platforms have been used to evaluate subjects with balance disorders as a result of
neurological damage and elderly people with a history of falls and balance disorders caused by
the ageing process.
elderly people ‫ اﻗﺪر اﻋﻤﻠﻪ ﻣﻊ اي ﺣﺪ ﻣﺶ ﺷﺮط ال‬
‫ ﻳﻀﻐﻂ ع اﻟﻨﺎﺣﻴﺔ اﻟﻴﻤﻴﻦ و ﺑﻌﺪﻳﻦ اﻟﺸﻤﺎل‬weight shifting ‫ و ﻳﺒﺪأ ال‬two platforms ‫ ﺑﻴﺘﻌﻤﻞ ازاي ؟ اﻟﻤﺮﻳﺾ ﺑﻴﻘﻒ ع‬
center of ‫ و ﺑﺘﺤﺪد ﺑﺎﻟﻀﺒﻂ ال‬screen ‫ ﻛﺪا ﺑﺘﻈﻬﺮ ع‬print ‫ و ﻛﻞ دا ﺑﻴﺒﺎن ﻋﻨﺪك زي‬forefoot ‫ و‬rear foot ‫و ﻳﻄﻠﻊ ﻟﻞ‬
pressure.

❸ Dynamic force platforms

 Measure the displacement of a subject's center of pressure under dynamic conditions using
four force transducers and a displacement motor for displacing the support surface of the
force platform.
dynamic balance ‫ ده ﻋﻜﺲ اﻟﻠﻲ ﻓﺎﺗﻮا ﺑﻴﻘﻴﺲ ال‬
center of pressure ‫ و ال‬footprint ‫ و ﻧﻔﺲ ﺑﺮده ﺑﻴﺘﺎﺧﺪ ال‬platforms ‫ ﻋﻠﻲ ال‬walking ‫ أو‬squatting ‫ اﻟﻤﺮﻳﺾ ﺑﻴﻌﻤﻞ‬
platforms ‫ﻋﻠﻲ ال‬

Dynamic force platforms are used to assess the contribution of:

-The visual

-The somatosensory

-The vestibular system

‫ف ﻧﻔﺲ اﻟﻮﻗﺖ‬system ‫ﺑﻴﻌﻤﻞ ﺗﻘﻴﻴﻢ ﻟﻤﺸﺎرﻛﺔ اﻛﺘﺮ ﻣﻦ‬

 Dynamic force platforms have been used to evaluate subjects

with balance disorders as a result of neurological or vestibular damage, elderly people with a
history of falls and balance disorders caused by the ageing process.

❹ Three – dimensional video analysis

 Evaluates three-dimensional standing balance by using three video cameras and a force platform.
 Reflective markers are attached to the subjects.
 They highlight 24 bony landmarks.
bony ‫ و ﺑﻨﺤﻄﻬﺎ ﻋﻠﻲ ال‬markers ‫ﺑﻨﺠﻴﺐ ﺷﻮﻳﺔ‬...‫ ﻟﻠﻤﺸﻴﺔ ﺑﺘﺎﻋﺘﻪ‬analysis ‫ ﺑﻨﺼﻮر اﻟﺸﺨﺺ و ﻫﻮ ﻣﺎﺷﻲ و ﺑﻨﻌﻤﻞ‬
‫ﺑﺘﺒﺘﺪي اﻟﻜﺎﻣﻴﺮات اﻟﻠﻲ ﻋﻠﻲ اﺳﺘﻨﺪات ﺗﻠﻘﻂ اﻟﺤﺮﻛﺎت و‬...infrared ‫ اﻟﻠﻲ ﻣﻮﺟﻮدة ﻓﻲ اﻟﺠﺴﻢ و ﺑﺘﺴﺘﺠﻴﺐ ﻟﻞ‬landmarks
motion analysis ‫ ﻟﻞ‬related ‫ﺑﺘﺒﻘﻲ‬
 The three – dimensional photogrammetric technique are used to recreate the three-dimensional
coordinates of the subject's landmarks while the location of the line of gravity is determined from
the force platform.
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 ‫ اﻣﺎ اﻟﻜﺎﻣﻴﺮا ﺑﺘﺤﺪد ال‬line of gravity ‫ﺑﺘﺤﺪد ال‬force platform ‫ ال‬
‫ﻣﻊ ﺑﻌﻀﻬﺎ‬coordination of joints
 This technique was found to be reliable and very small
deviations of spinal alignment could be detected.
‫ ﺑﺸﻜﻠﻬﺎ اﻟﻄﺒﻴﻌﻲ اﻟﻤﺤﻔﻮظ ﻋﻨﺪﻫﺎ و اي‬landmarks ‫ اﻟﻜﺎﻣﻴﺮا ﺑﺘﺼﻮر ال‬
system ‫ ﺑﻴﺘﻠﻘﻂ و ﻳﺘﺴﺠﻞ ﻋﻠﻲ ال‬normal ‫ ﻋﻦ ال‬deviation
 However, this technique is time – consuming to set up and is
best suited for use in research laboratories.
‫ ﻧﻘﻄﺔ ﻫﺘﺤﺪدﻫﺎ و ﺗﻠﺰﻗﻬﺎ و ﻣﻤﻜﻦ اﻟﻤﺮﻳﺾ و ﻫﻮ ﻣﺎﺷﻲ واﺣﺪة‬٢٤ ‫ ﻣﺸﻜﻠﺔ اﻟﻨﻮع دا أن اﻧﺖ ﻋﻨﺪك ﻛﺎﻣﻴﺮات ﻋﺎﻳﺰ ﺗﺜﺒﺘﻬﺎ و‬
‫ﺗﻔﻚ أو ﺗﻘﻊ و ﻧﻘﻌﺪ ﻧﻈﺒﻂ ف ارﺗﻔﺎع اﻟﻜﺎﻣﻴﺮات و ﻟﻴﻠﺔ زرﻗﺎ ﺳﻌﺘﻚ‬

❺ The balance Master

 Is a commercially available computerized balance assessment and training system.
treatment ‫ أو ال‬assessment ‫ و دا ﺟﻬﺎز ﻣﺸﻬﻮر اوي ﺑﻴﺴﺘﺨﺪم ﺳﻮاء ف ال‬
 It provides the user with visual information about the position of the COG within predefined
(theoretical) limits of stability. By shifting the body weight and COG over the BOS, the user can
track the movement of the COG on the computer screen.
‫ ﺑﺘﺤﺪد ال‬screen ‫ اﻟﻤﺮﻳﺾ ﺑﻴﻘﻒ ع ﺳﻄﺢ ﻣﺪور ﻛﺪا و ﻳﺒﺪأ ﻳﺘﺤﺮك و ﻗﺪاﻣﻪ‬
‫ و ﺑﻴﺒﻘﻲ ﻓﻴﻪ داﺋﺮة ﻓﻴﻬﺎ ف اﻟﻨﺺ ﻧﻘﻄﺔ ﻛﻞ ﻣﺎ اﻟﻤﺮﻳﺾ‬limit of stability
periphery ‫ و ﺗﺘﺤﺮك اﻟﻨﻘﻄﺔ ﻟﻞ‬deviation ‫ﻳﺤﺼﻠﻪ‬
‫ اﻟﻨﻘﻄﺔ ﻫﺘﺘﺤﺮك ﻳﻤﻴﻦ و ﺷﻤﺎل و ﻫﻌﺮف اﺣﺪد ﻣﺴﺘﻮي‬assessment ‫ ك‬
‫ف ﻧﺨﻠﻲ اﻟﻤﺮﻳﺾ ع اد ﻣﺎ ﻳﻘﺪر‬treatment ‫اﻣﺎ ك‬.... ‫اﻟﺘﻮازن ﺑﺘﺎﻋﻪ‬
‫ﻣﻴﻄﻠﻌﺶ اﻟﻨﻘﻄﺔ ﺑﺮا اﻹﻃﺎر و ﻳﺤﺎﻓﻆ ﻋﻠﻰ اﻟﺘﻮازن ﺑﺘﺎﻋﻪ‬

❻ The balance index (BI)

 Is one of the parameters which can be calculated by the system and reports
the variance of platform displacement in degrees from level positions in all
motions during a test.
‫ و ﻳﺒﺪأ ﻳﺘﺤﺮك ف ﻛﻞ اﻻﺗﺠﺎﻫﺎت و ال‬single leg ‫ أو‬bilateral ‫ ﻋﺒﺎرة ﻋﻦ ﺑﻮرد ﺑﻴﻘﻒ ﻋﻠﻴﻬﺎ‬
deviation ‫ﺑﻮرد ﻛﻤﺎن ﺑﻴﺘﺤﺮك ﻣﻌﺎه و ﻳﺒﺘﺪي ﻳﻤﻴﻞ ف ﻟﻘﺪام و ﻟﻮرا و ﻟﻠﺠﻨﺐ و ﻟﻮ ﺣﺼﻞ‬
‫ﺑﻴﺘﻼﺣﻆ و ﻳﺘﺴﺠﻞ‬
 A high BI is indicative of a lot of movement during a test and less stability,
on the contrary a lower BI reflects less time spent away from the level
position, interpreted as a better balance score.
good ‫ﻛﻞ ﻣﺎ ﻗﻮﻟﻨﺎ أن اﻟﺸﺨﺺ دا ﻋﻨﺪه‬BI ‫ ﻛﻞ ﻣﺎ ﻗﻞ ال‬deviation ‫ ﻛﻞ ﻣﺎ ﻗﻞ ال‬
balance
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 The dynamics limits of stability (LOS) test are another test which can be performed by using the
Biodex balance system. Limits of stability (LOS) test are designed to assess an individual's ability to
volitionally move the COG to eight predetermined positions in space. These positions are
represented by square visual targets located on a video screen positioned at eye level and directly
in front of the individual being tested.
‫ ف اي اﺗﺠﺎه ﺑﺪون ﻣﺎ ﻳﻔﻘﺪ ﺗﻮازﻧﻪ أو‬voluntary ‫ اﻟﺸﺨﺺ ﻳﻘﺪر ﻳﺮوﺣﻠﻬﺎ‬deviation / ‫ ﻫﻮ ﻋﺒﺎرة ﻋﻦ اﻗﺼﻲ ﻣﺴﺎﻓﺔ‬LOS ‫ ال‬
cone of stability)) ‫ دﻳﻪ ﻫﻲ ال‬limits ‫ﻳﻌﻨﻲ ال‬.. ‫ﻳﺎﺧﺪ ﺧﻄﻮة ﻟﻘﺪام‬

 The directional control (DC) is a parameter which can be calculated from LOS test. It's a
comparison of the amount of movement in the intended direction (toward the target) to the
amount of extraneous movement (away from the target) and is expressed as percentage. High
(close to 100%) directional scores are good, lower scores are worse.

‫ ﻻﻗﺼﻲ إزاﺣﺔ ﻣﻤﻜﻨﺔ ﻋﻦ‬COG ‫أو ﻣﻘﺪار اﻟﺘﺤﻜﻢ اﻟﺤﺮﻛﻲ ان اﻟﺸﺨﺺ ﻳﺤﺮك ال‬directional control ‫ ﺑﻴﺤﺪد ال‬LOS ‫ ال‬
‫ﻃﺮﻳﻖ أﻧﻪ ﻳﻤﻴﻞ ﺑﺠﺴﻤﻪ‬

‫ ( ﻓﺎﻟﻤﺴﺎﻓﺔ ﺑﻴﻨﻬﻢ ﺧﻂ ﻣﺴﺘﻘﻴﻢ و اﻟﺤﺮﻛﺔ ف ﻧﻔﺲ اﺗﺠﺎه‬target ) ‫ ﻟﻨﻔﺘﺮض أن ﻓﻴﻪ ﺷﺨﺺ واﻗﻒ و ﺣﺪدﻧﺎ ﻟﻴﻪ ﻧﻘﻄﺔ‬
‫ ﻋﻦ اﻟﺨﻂ اﻟﻤﺴﺘﻘﻴﻢ دا ﻳﻌﻨﻲ‬sway/deviation ‫اﻣﺎ ﻟﻮ ﺣﺼﻞ‬... ٪100 ‫ ﺑﺘﺎﻋﻬﺎ‬score ‫اﻟﺨﻂ دا ﻧﺎﺣﻴﺔ اﻟﺘﺎرﺟﺖ ﻫﻴﺒﻘﻲ ال‬
‫ﺑﻌﻴﺪ ﻋﻦ اﻟﺘﺎرﺟﺖ ﻛﻞ ﻣﺎ ﻛﺎن اﻟﺘﻮازن أﻗﻞ‬

‫و ﺑﻜﺪا ﻧﻜﻮن وﺻﻠﻨﺎ ﻟﻨﻬﺎﻳﺔ اﻟﻤﺤﺎﺿﺮة‬

♥ ‫و رﻣﻀﺎن ﻣﺒﺎرك و ﻛﻞ ﻋﺎم وأﻧﺘﻢ ﺑﺨﻴﺮ‬
♥ ‫ﻻ ﺗﻨﺴﻮﻧﺎ ﻣﻦ دﻋﺎﺋﻜﻢ‬

�‫ﱰ ﺑ�ﺴﺖ ﺗ‬
‫ﺛ ا‬
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