chapter 12 Assessing Balance and Designing Balance Programs
chapter 12 Assessing Balance and Designing Balance Programs Author name here for Edited books
Principles of Balance • Balance is gaining recognition as a key component of functional fitness. • Balance training is emerging as one of the top 10 exercise trends. • For seniors, balance is extremely important to maintenance of independent living status and successful completion of ADLs. • Balance training helps prevent falls.
Definitions and Nature of Balance • Balance is the ability to keep the body’s center of gravity (COG) within the base of support when maintaining a static position, performing voluntary movements, or reacting to external disturbances. – Static – Dynamic – Functional • Define each
Static, Dynamic, and Functional Balance • Static balance is the ability to maintain COG within the supporting base while standing or sitting. • Dynamic balance is maintaining an upright position while COG and base of support are moving and the COG is moving outside of the supporting base. • Functional balance is the ability to perform daily movement tasks requiring balance.
Factors Affecting Balance and Risk of Falling • The further the COG from the base of support, the lower the stability. • The broader the base of support, the higher the stability. • Resistance training and stretching programs may be useful for maintaining and improving balance. • Exercising on unstable surfaces can challenge balance response and provide variety. (continued)
Factors Affecting Balance and Risk of Falling (continued) • Balance, resistance, and flexibility training programs are more effective than endurance training for reducing risk of falling. • No optimal fall prevention program has been identified yet.
Assessment of Balance • Most balance test batteries are comprehensive and include multiple test items to assess both static and dynamic balance. • Direct measures of balance may be obtained using computerized force plate devices.
Balance Assessments • Read in your text or view the video and perform each of the following tests. – Romberg - http: //www. youtube. com/watch? v=U 5 a 4 lbmwm. Ow – Unipedal - https: //www. youtube. com/watch? v=Bk. Ai. YBP 4 rq 0 – Clinical test of sensory integration of balancehttps: //www. youtube. com/watch? v=TMj. R-Jv. G 4 Os – Functional reach tests https: //www. youtube. com/watch? v=QMy. QRFXCVy. E – Timed up and go tests- https: //www. youtube. com/watch? v=ds. Tfqk 9 ZTiw – Star excursion balance test - https: //www. youtube. com/watch? v=Eyk. ZV 08 Ji 7 Q
Assessing Dynamic Balance Using Test Batteries • Tinetti performance-oriented assessment of mobility test (POMA): assesses balance and gait of older adults; contains 14 performance-based items – https: //www. youtube. com/watch? v=7 FNn 2 -i_-og • Berg balance scale: evaluates balance performance of nursing home and community-dwelling older adults; contains 14 functional mobility items – https: //www. youtube. com/watch? v=dxc. Hil 1 tnz. M • Dynamic gait index: composite measure of ability to adapt gait during movement-related tasks – https: //www. youtube. com/watch? v=UQ 4 w_Gn 4 X_Q
Assessing Static and Dynamic Balance With Direct Measures • Uses expensive, computerized force plate with at least three force transducers that quantify vertical pressures applied to the support platform. • System derives coordinates of center of pressure. • Computerized systems provide data about postural sway and steadiness. • Force platform balance tests provide valid information about postural control that can be used to predict risk of falling among older clients. • Balance testing with Wii balance board – https: //www. youtube. com/watch? v=PHVz. LUmk. FDE – http: //www. ncbi. nlm. nih. gov/pubmed/20005112
Assessing Static and Dynamic Balance With Direct Measures • Computerized dynamic posturography assesses the individual and composite functioning of sensory, motor, and biomechanical components of balance. • Can examine ability to maintain an upright posture when visual and proprioceptive sensory information is modified mechanically. • Can be used to assess functional tasks such as walking, turning, and changing posture. • https: //www. youtube. com/watch? v=gf 2 Nblgek 6 o (continued)
Assessing Static and Dynamic Balance With Direct Measures • Limits of stability test measures maximum excursion of COG and assesses degree to which one is able to lean in several directions while maintaining balance over a fixed supporting base. • Limits of stability test provides reliable scores and is predictive of risk of falling. • Biodex Stability System can evaluate and train neuromuscular control by quantifying ability to maintain dynamic postural stability on both stable and unstable surfaces. https: //www. youtube. com/watch? v=1 GHce 5 w. Q 7 HQ
Designing Balance Training Programs • 2008 Physical Activity Guidelines for Americans suggests balance training at least 3 days a week for inactive and active older adults (≥ 65 years). • ACSM stated that balance, agility, and proprioceptive training is effective for preventing falls. • Balance training exercises are effective for reducing the risk of ankle sprains and recurrent sprains in athletes. (continued)
Designing Balance Training Programs (continued) • General guidelines: – Engage in balance activities 2 or 3 days a week. – Progressively increase difficulty of the balance exercises by using a narrower base of support. – Include dynamic movements that challenge the COG. – Use exercises that stress postural muscles.
Balance Training Exercise Prescription • Resistance training, stretching programs, and numerous other forms of exercise may help maintain and improve balance. • Uneven surfaces and computerized balance training systems may add variety and challenge to balance training programs.
Balance Training Exercise Prescription • Exercises specifically designed to improve functional ability of lower extremities may help improve balance and prevent falls in older adults. • They complement flexibility and resistance training routines. • Square-stepping exercise is better than regular walking in reducing risk factors associated with falling.
Balance Training Exercise Prescription • Resistance training as an isolated intervention is not shown to consistently improve balance of older adults. • Therefore, strength alone is not the major underlying mechanism for poor balance. • Muscle power (force x velocity) may be a limiting factor in balance control. • High-intensity strength training targeting key lowerextremity muscle groups can improve postural control in balance-impaired older adults.
Balance Training Exercise Prescription • Research on balance training is scarce. • Therefore, there are no existing guidelines for balance program design other than to individualize the program. • Tai chi is a popular method of exercise with numerous benefits; it has received substantial amount of research interest. • Yoga is not as well researched in terms of balance programming.
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