PT 662: Management of Pa0ents with Neurological Disorders

Midterm Assignment

Systems Approach to Balance Control

I work with elderly popula1on wherein most of my pa1ents are at high risk of fall. Learning about
the different systems that affects balance has given me addi1onal insight where I can improve my
assessment and treatment approach to address balance deficits. As discussed in part 4, there are
six systems that can affect balance. These are: (1) Biomechanical constraints, (2) Stability
limits/Ver1cality, (3) An1cipatory, (4) Postural responses, (5) Sensory orienta1on, and (6) Stability
in Gait.

One of the systems, the biomechanical constraints, shows that basic strength and postural tes1ng
is also important during assessment as it can also affect a person’s balance control. Mobility,
strength, and postural tes1ng are the basic part of my assessment, but I oTen overlook the
importance of it and most of the 1me I focus on func1onal findings. In this lecture, it shows that
addressing basic mobility, flexibility and posture is also cri1cal as it can affect pa1ent’s response
to perturba1ons. For example, a pa1ent with decreased ankle strength and flexibility may affect
his/her ability to u1lize ankle strategy to regain balance. Hence, treatment plan and goals should
include addressing mobility, strength, and posture deficits to regain balance control.

Sensory orienta1on is another system to balance control. There are 3 sensory that affects balance,
somatosensory, vision and ves1bular. I tend to focus only on improving somatosensory
orienta1on on my pa1ents and occasionally vision orienta1on. Ves1bular orienta1on is a sensory
orienta1on that I overlook. One of the reasons I overlook ves1bular orienta1on is because it’s not
included in berg balance scale (BBS) test. BBS is the main test I use for balance tes1ng for my
pa1ents. In this system, I learned that u1lizing CTSIB would be able to give me a beZer perspec1ve
on which sensory orienta1on my pa1ent needs to improve on. It’s important that pa1ents would
be able to u1lize and switch to different sensory systems depending on the environment they are
in to decrease fall risk and increase safety in naviga1ng their environment.

There are six systems that affects balance control, although biomechanical & sensory orienta1on
are the systems that I tend to overlook, it is important to assess all six systems to have a beZer
understanding on which system/s my pa1ents and I need to improve on to retrain for balance
control. U1lizing BESTest or even the miniBEST would allow me to have a comprehensive balance
assessment for my pa1ents as it has items that tests each systems category. Hence, moving
forward, I would u1lize BESTest or miniBEST in my assessments.