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Unit 11 neuro
Developing & Losing Postural Control: Fall and Fall Prevention
88
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Undergraduate 3
11/17/2014

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Term
define postural control.
Definition
controlling the body's position in space for the dual purpose of stability and orientation.
Term
discuss the emergence of postural and motor control.
Definition
first there is cephalocaudal development, growth that precedes longitudinally from the head to the feet, beginning with muscular control of head and neck to trunk and legs.

then there is proximodistal development where growth and motor control of the trunk region and shoulders before wrists, hands and fingers
Term
what is the reflex theory?
Definition
instability is both reflexive and voluntary; therefore, postural control requires the integration of systems as the individual responds to both the task at hand and the environmental demands in an ordered and spontaneous way.
Term
use the systems persecutive to explain and characterize postural control.
Definition
postural control requires the integration of systems as the individual assesses the requirements of the task and the environmental constraints
Term
achieving postural control depends on what?
Definition
the health of the individual systems and ease with which systems integrate
Term
what is the order of control seen in infants according to Gesell and Gesell?
Definition
head to foot and proximally to distally within segments
Term
at what stage do toddlers demonstrate anticipatory behavior and speculate on the significance of this behavior?
Definition
seen by age 1
with 1-3 months of walking experience
refined by 6 months of walking experience
Term
what are the major motor milestones associated with the development of movement?
Definition
crawling
sitting
creeping
pull-to-stand
independent stance
walking
Term
what changes in gait and basic movement are evident in older persons?
Definition
mildly stooped posture
impaired balance
due to the displacement of the center of gravity and the increased rigidity of the lower body
Term
what variables are predictors or contribute to increased risk of falling in older adults?
Definition
mild impairment in motor and sensory function
Term
briefly describe the vestibular decline and their contribution to fall risk in older adults.
Definition
40% loss in vestibular hair and nerve cells
reduces the ability to resolve visual and somatosensory conflict
Term
what types of compensatory muscular responses are produced by older persons in responses differ between young and old subjects?
Definition
Term
what types of interventions are best in terms of reducing the older persons risk of falling?
Definition
Term
what system should be activated to help older persons decrease their risk of falling?
Definition
vestibular system
Term
in the definition of postural control, what does orientation refer to?
Definition
the ability to maintain appropriate relationships between the individual, the task and the environment
Term
proprioception is always fed to the spinal cord and then to where?
Definition
the cerebellum
Term
what allows for postural control?
Definition
instability
changing the base of support or the orientation of body segments
Term
T/F postural control requires higher order control.
Definition
false it is reflexive
Term
what is cephalocaudal development?
Definition
growth that proceeds longitudinally from the head to feet beginning with muscular control of head and neck to trunk and legs.
Term
what is proximodistal control?
Definition
growth and motor control in the trunk region and shoulders before wrists, hands and fingers
Term
what is anticipation?
Definition
a perceptual/ cognitive process built upon experience that emerges as the child learns to predict changes in the environment
Term
give an example of cephalocaudal development.
Definition
an infant responds to noise stimuli with head first then the extremities
Term
when does integration of systems occur?
Definition
begins at birth and becomes more precise
Term
what causes an individual to adapt?
Definition
a continuing process as a result of interacting with the environment
Term
after the task is identified, where is the decision made?
Definition
in the front part of the brain
Term
what is compensatory stepping?
when is it seen?
Definition
steps to recover balance in children with 1-3 months of walking experience
Term
what is lost with aging?
Definition
postural control and balance
Term
explain the relationship of aging and health care costs.
Definition
there is an eventual loss of functional independence with a corresponding increase in health care costs
Term
what percent of people who fall suffer moderate to severe injuries?
Definition
20-30%
Term
___ out of ____ adults 65 and over fall each year.
Definition
1 out of 3
Term
what is the percent of fatal falls in 2007 of persons 65 and over?
Definition
81%
Term
who has a high fatal fall percentage, men or women?
Definition
men
Term
who is likely to be more injured in a fall, men or women?
Definition
women
Term
briefly describe the ROM and mobility decline and their contribution to fall risk in older adults.
Definition
decreased ROM and mobility can cause kyphosis or lordosis in the spine causing a change in the center of mass that goes beyond the base of support.
Term
briefly describe the muscle mass decline and their contribution to fall risk in older adults.
Definition
sarcopenia
largest percent in fast twitch fibers
40% loss of muscle mass from age 30 to 80
ones ability to react to and produce compensatory movement in response to an instability is slower due to sarcopenia
Term
briefly describe the CNS decline and their contribution to fall risk in older adults.
Definition
proprioceptive and cutaneous senses less in unstable older adults
return to stability is slower
loss of receptors and fibers innervating those receptors
Term
briefly describe the vision decline and their contribution to fall risk in older adults.
Definition
vestibulo-ocular reflex
great deal of reliance on vision for balance
cataracts, macular degeneration and brain damage and decrease in visual function increases risk for falling
Term
what factors contribute to sarcopenia?
Definition
decrease GH secretion
decrease oestrogen/androgen
increase inactivity
increase fat mass
increase pro-inflammatory cytokines
Term
extended inflammation causes what in cells?
Definition
apoptosis
Term
what is said regarding muscle loss and older people who maintain their muscle mass?
Definition
maintain power output
Term
T/F attentional demands impact response latency in older adults.
Definition
true
Term
what does conflict between the ability to resolve visual and somatosensory conflict in conjunction with somatosensory input cause in older persons?
Definition
can cause dizziness and unsteadiness
Term
what is the vestibulo-ocular reflex?
what is the pathway?
Definition
visual stimuli causes the head to turn activating the vestibular system

hair cells (increase in K+) to 8th cranial nerve to vestibular nerve in the brain stem
Term
what factors increase the risk of falling in older adults?
Definition
decrease in muscle mass
decrease in CNS
decrease in ROM and mobility
decrease in vision
decrease in vestibular function
Term
what declines are seen of the CNS in healthy 80 year olds?
Definition
mild impairment in motor and sensory function
mildly stooped posture and impaired balance
Term
T/F there is a generalized slowness of behavior in older adults
Definition
true
Term
what is strength loss attributed to in older adults?
Definition
decrease in type 2 fibers
Term
what percent loss is seen in muscle strength between age 30 and 80?
Definition
40%
Term
multifactorial disease is a result of what?
Definition
aging
Term
with increasing age there is a decrease in muscle mass and an increase in fat mass, this results in what in relation to reflexiveness?
Definition
decreased responsiveness
Term
what is believed to form the basis for cognitive decline during aging?
Definition
a decrease in transmission through a brain structure or a shift in the ability to modify synaptic connections could constitute a functional lesion
Term
what increases/ decreases in amplitude as we age?
Definition
sensory evoked responses decrease as latency increases
Term
T/F the more tasks at hand, the more unstable.
Definition
true
Term
what does a 40% loss in vestibular hair cells by age 70 tell us being that the vestibular system is an absolute reference system?
Definition
a decline in the vestibular system results in a reduced inability to resolve visual and somatosensory conflict
Term
what happens to the size of the visual field with aging?
Definition
decreases
Term
what are the rods and cones like in older individuals?
Definition
less sensitive
Term
what was Rosenhall's study?
Definition
dissected the vestibular apparatus of cadavers
Term
what happens to the size of the visual field with age?
Definition
it decreases
Term
explain the flow chart.
what is the flow chart?
Definition
sensory-> integration of information-> Motor Output-> Balance

sensory information from the vestibular system, vision and proprioception all contribute to postural control.
the information is transmitted to the cerebellum and the brain stem to innervate AMN.
The motor output is sent to the eyes to make eye movements and to musculature to make postural adjustments.
Term
explain how slipping and falling occurs.
Definition
moving into heel strike, the foot slips and loses the grip of the heel strike causing the foot to move forward

the center of gravity changes causing a loss of balance as the back foot is unable to properly support the individual

this causes posterior or lateral contact with the ground that could cause lasting trauma.
Term
T/F sway increases with fall history.
Definition
true
Term
T/F proprioceptive and cutaneous receptors are more in old stable and young adults.
Definition
true
Term
T/F more strength the better the balance.
Definition
true
Term
T/F latencies of postural sway muscles were greatest in young adults.
Definition
false
old impaired adults
Term
what is peripheral neuropathy?
Definition
the loss in number of receptors and fibers that innervate those receptors such as touch, pressure, and vibration sensation
Term
peripheral neuropathy increases/decreases with age.
Definition
increases
Term
explain the problems with the statement: "research has shown that older adults rely a great deal on vision for balance control."
Definition
aging also shows signs of cataracts, macular degeneration, ischemic retinal and brain damage

there is a general decline in vision with age
Term
what systems contribute to postural control?
Definition
vestibular system
vision
proprioception
Term
what is proprioception?
Definition
the sense from them muscle spindle or GTO
Term
during a slip what is activated first?
which is followed by what?
Definition
the stretched ankle muscles
ordered activation of ascending musculature
Term
what is the difference between young and old people when it comes to muscle activation and response to recovery?
Definition
older persons take longer to activate muscle
older persons can have as much as a 40% fiber loss between age 30 and 80
older persons have less flexibility of muscles
Term
Postural control is a head to foot then proximal to distal response. In older persons what can occur?
give examples that were found in a study.
Definition
some older adults show proximal muscle activation before distal

produce more hip rather than ankle dominant responses to instability

bend at the knees and use more arm activity than young

the greater the perturbation, older adults will uses stepping responses
Term
if you want to train an older adult, what system should you activate to increase balance?
Definition
vestibular system
Term
what does literature show about strength training and balance?
Definition
some show increases in strength, but some show increase in strength with no increase in balance
Term
why would strength training help with balance?
Definition
because it decreases muscle force output
Term
what type of balance training is better at increase balance?
Definition
dynamic balance training
Term
in a study done to implement a LiFE what happened?
what did the results show?
Definition
a LiFE program was implemented into a groups daily life, where the control group did not get.
the results showed that the LiFE program was effective in reducing falls
Term
in a study to test the effectiveness of strength training on standing balance, walking speed, and sit to stand performance, what happened?
what did the results show?
Definition
one group of 12 subjects did 10 reps of 6 difference lower body exercises, while 12 subjects acted as the control.
the results showed that the strength exercises did not enhance the standing balance or sit to stand performance, but may show improvements in walking speed
Term
in a study to use Tai-Chi as an intervention to improve balance, what did the results show?
Definition
tai-chi was an appropriate alternative treatment to imp roe balance as to reduce falls in older individuals.
Term
why would tai-chi improve balance?
Definition
it activates to vestibular system
Term
In a study to see the effects of Tai-Chi on muscular strength showed what?
Definition
the results on musculoskeletal health were modest and may not translate into better clinical outcomes
Term
in a study to see the effects of velocity training on older adults showed what?
Definition
the velocity training improved leg power and max strength sustainability but did not improve functional fast performance in either group
Term
what is RESS unit?
Definition
reactive enhancer slip stimulator
Term
what is the function of a RESS unit?
Definition
create a device to train and measure lower body movement speed in older persons.
Term
what are key points of a RESS unit?
Definition
it is safe
it is ADL sensitive
Term
what does a RESS unit stimulate?
Definition
brain centers associated with postural control
Term
what does a RESS unit promote?
Definition
ROM in movement specific context
Term
the RESS unit serves as a stimulus for what recruitment?
Definition
recruitment of FTF
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