平衡性的机制和训练

平衡性的机制和训练平衡的定义以及几个重要概念Balance:Controlofcenterofmassoverbaseofsupport(Shumway–Cook,2001)Centerofmass:thepointthatisatthecenterofthetotalbodymassBaseofsupport:Areaofobjectthatisincontactwiththeground平衡的定义以及几个重要概念Centerofmass:CenterpointofeachbodysegmentcombinedCOM平衡的定义以及几个重要概念Baseofsupport:Areaofobjectthatisincontactwiththeground平衡的定义以及几个重要概念Balance:Controlofcenterofmassoverbaseofsupport平衡的分类Steadystate(static)balance:MaintainstablepositioninstandingorsittingReactivebalance:RecoveringfromanunexpectedperturbationProactive(anticipatory)balance:Activatingbalanceinadvance平衡的分类Steadystate(static)balance:Maintainstablepositioninstandingorsitting平衡的分类Reactivebalanceabilitytorecoverfromanunexpectedperturbation(beingnudgedbysomeone)平衡的分类Proactive(Anticipatory)Balance：Abilitytoactivatemusclesforbalanceinadvanceofapotentiallydestabilizingmovementinordertoavoidinstability.Reaching,leaning,pulling平衡的分类BalanceisacomplexcompositeofmultiplebodysystemsMotorSensoryCognitionMotorSystemsMusculoskeletalsystem:strengthandflexibilityNeuromuscularsystem:coordinationofmovementSensorySystemsPeripheralinput:Visual,vestibular(innerear),somatosensory(inputfromjointandmusclereceptors,auditory(hearing)Centralprocessing:Receivesinformationfromperipheryinterpretsit,andsendscommandstomotorsystemsCognitionMultitaskingandfilteringoutdistractionswhilemaintainingbalance平衡的系统模型平衡性的评定平衡性的评定平衡性的评定平衡性的评定

TheTUGwasfoundtohave:87%sensitivityforpredictingfallswithascore>14seconds

TheBergBalanceTest:83%ofsubjectswerecorrectlyidentifiedasfallers(thegoldstandard)baseduponthedichotomousruletoclassifyfallersatacut-offpointof<40(BBTScore).

平衡性的评定Timedupandgotest(TUG)Getupfromseatedposition,walk3meters,turnaround,walkbacktochairAdultswhotook>30secweredependentinactivitiesofdailyliving平衡性的评定BergBalancescale:DiscriminatesolderadultsatriskforfallsSinglebestpredictoroffallstatusincommunitydwellingadultsSoundtestwithgoodreliabilityMainlytestsstaticandanticipatorybalance平衡性的评定BergBalancescale:SittingtostandingStandingunsupportedStandingtosittingStandingunsupportedwitheyesclosedStandingunsupportedwithfeettogetherReachingforwardwithoutstretchedarmPickupobjectfromfloorTurningtolookoverrightandleftshoulderTurn360dgSteponstepstool(#timesin20seconds)Tandemstance;Standingononefoot平衡性的评定14itemscaleforpossible56pointstotalDecreaseinBergscore=increasedfallriskScoreof56-54,1pointdrop=3-4%inc.fallriskEachpointdropfrom54-46,=6-8%increaseBelow36,fallrisk=100%Limitations:doesnottestreactivebalance;ceilingeffect平衡性的训练平衡性的训练EXERCISE!!!!Standing-ontwo

feetandoneStandincornerandmoveshoulders/hipsWalkandturnhead平衡性的训练Walkheeltotoe,walkontoes,walkonheelsWalkbackwards,walksidewaysStandupandsitdownwithouthandsFocusonLE,Core,TricepsUE-scapularretraction,rowing平衡性的训练Improveflexibility-stretching,TaiChi,YogaDeepbreathingFloortransfersImprovepostureMedicationreview-4+meds,sideeffectsVisionscreening平衡性的训练AquaticprogramsStrategies-ankle,hip,stepEyesopenandclosedReaching/bending/weightshifts/lifting/carryingBalls/BAPSboard平衡性的训练ObstaclecoursesJointmobilizationstothespineDancingDoADLsononefootBeginwalkingprogramsElectricalstimulationConsiderDME/AE-hipprotectors,walkers,canes,etc平衡性的训练Dothingsduringbalanceexercises:AddmusicChangesurface-unlevelChangefootwearAdjustlighting-includelowlightingDomathCategorize平衡性的训练NintendoWiiFitSystemFallUnintentionalinjuriesExternalcausesoftheinjuryMultifactorialcauses e.g.fallsduetointrinsicfactorsvs.extrinsicfactors

Intrinsic(Personal)factorsforFallsAged(over65years)FemaleLowmobilityorfragility–lowerextremityweakness,andpoorgripstrengthFunctionalimpairments-limitedActivitiesofDailyliving(ADL)PoorgaitandbalanceLowbodyweightIntrinsic(Personal)factorsforFalls

CognitiveimpairmentordementiaChronicillness-Parkinsondisease,visualdifficulties,stroke,hypertension,orurinaryincontinencePsychoactivemedication-tranquilizersorantidepressantsPreviousfallsHeavydrinkingExtrinsicorEnvironmentalFactorsPerson’senvironment:UnevensurfacesObstacles,stairs,curbsPoorlighting,suddenchangesinlightingSlipperysurfacesPoorfootwearPoorlyfittedassistivedevicesforwalkingIncidenceratesofFallsinU.S.Oneofeverythreeadultsover65yearsfallineveryyear

Mostcommoncauseofinjurydeathfor65+90%ofhipfracturesinolderadultsMostcommoncauseofnon-fatalinjuries恶性循环Fall↗

↘Imbalance

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Inactive

Wherearepeoplelikelytofall?

Forpeople65yearsoldorolder…..NursingHome10%Home60%

PublicPlaces30%ConsequencesofFallsMortalityMorbidityFractures

SofttissueinjuriesHeadtraumaJointdistortionsanddislocationsLossofconfidence-fearoffallingRestrictedactivityIn1994,estimatedfall-relatedinjurycostwas$20.2billion.ConsequencesofFallsFractures3%ofallfallscausefractures.Approx.95%ofhipfracturesinolderpeopleagedover65yearsaretheresultofafallPeoplewhohaveahipfactureare5~20%morelikelytodieinthefirstyearfollowingtheinjurythananyotherreasoninthesameagegroupsConsequencesofFalls

Forearm(Wrist)FractureSpineFractureHipFracture(pelvis,hip,femur)AnkleFractureUpperarm,forearms,handHowtoPreventFallsCDCPreventionPlanFallPreventionstrategies:Exerciseregularly,TaiChi(strength/balance)Medicationreview-sideeffectsandinteractionsYear