The document provides a comprehensive assessment of balance, including evaluations of static and dynamic balance, sensory interaction tests, and motor strategies. It outlines various functional balance tests and grading systems to assess a patient's balance capabilities and the underlying sensory strategies utilized. Additionally, it details limits of stability testing parameters to measure a patient's ability to maintain balance during various perturbations.

1. ASSESSMENT OF BALANCE
DEVENDRA SINGH
MPT NEUROLOGY
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2. ASSESSMENT OF BALANCE
Static balance
Dynamic balance
……………………… CNS integration
Balance Reactions
Postural strategies
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3. FUNCTIONAL BALANCE TESTS
Static balance
Maintenance of posture
Dynamic balance
During weight shifting and movement
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4. STATIC CONTROL
(30 SEC)
Double limb stance
Single limb stance
Tandem stance
Romberg test
Sharpened Romberg test
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5. DYNAMIC BALANCE
Standing up
Walking
Turning
Stopping
starting
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6. FUNCTIONAL BALANCE GRADES
Normal Patient is able to maintain balance
without support. Accepts
maximal challenge and can shift
weight in all directions.
Good Accepts moderate challenge and can
shift weight, although limitations are
evident.
Fair Patient is able to maintain balance
without support. Cannot tolerate
challenge. Cannot
maintain balance while shifting
weight.
Poor Patient requires support to maintain
balance
Zero Patient requires maximal assistance
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7. THE CLINICAL TEST FOR SENSORY
INTERACTION AND BALANCE (CTSIB) (FOAM –
DOME TEST)
Alternative test for the SOT of CDP
How patient use somatosensory ,visual, vestibular inputs for
balance
Subjects standing on six different conditions
 Varied sensory input
 Varied supporting surface
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8. SENSORY STRATEGIES
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9. SIX DIFFERENT SENSORY
CONDITIONS
1 - Normal vision fixed support
2 - Absent vision fixed support
3 - Sway referenced vision, fixed support
4 - Normal vision, sway referenced support
5 - Absent vision sway referenced support
6 - Sway referenced vision and support
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10. condition surface vision Sensory input
available
Abnormal score indicates
1 Firm Eyes open Accurate vision
Accurate SS
2 Firm Eyes closed Absent vision
Accurate SS
Visually dependent
Impaired Proprioception
3 Firm Visual conflict dome Inaccurate vision
Accurate SS
Visually dependent
Impaired Proprioception
4 compliant Eyes open Accurate vision
Inaccurate SS
Surface dependent
Impaired vision
Impaired vestibular
5 Compliant Eyes closed Absent vision
Inaccurate SS
6 Compliant Visual conflict dome Inaccurate vision
Inaccurate SS
Impaired vestibular
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11. SCORE
1 - Minimal sway
2 - Mild sway
3 - Moderate sway
4 - Fall
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12. MODIFIED CLINICAL TEST OF SENSORY INTERACTION ON BALANCE
(mCTSIB)
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14. MODIFIED CLINICAL TEST OF SENSORY INTERACTION ON
BALANCE (MCTSIB)
Simplified derivative of the SOT ("Foam and Dome")
Document the presence of sensory dysfunction
To establish objective baselines for treatment planning and outcome
measurement.
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15. The mCTSIB eliminates the "dome"
To quantify postural sway velocity during the four sensory conditions
1. Eyes open firm surface
2. Eyes closed firm surface
3. Eyes open unstable surface (foam)
4. Eyes closed unstable surface (foam)
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16. MOTOR STRATEGIES
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17. BALANCE STRATEGIES
Ankle
 Perturb the patient at the shoulder with small, slow perturbation
 Slow standing sway
 Romberg test
Hip
 Faster, larger perturbation at the shoulders or hips
 Stand on narrow surface (2x4 or hemiroll)
 Single-limb stance, tandem stance
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18. THANK YOU
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19. Stepping
 Any balance activity is difficult for the patient and moves the COG outside the BOS so that the patient
must step to avoid falling
 Larger and /or faster perturbations that perturb the COG outside the BOS
SCORE
 1 - Present and normal
 2 - present but limited or delayed
 3 - present but inappropriate for the particular context or situation
 4 - Abnormal
 5 - Absent
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20. LIMITS OF STABILITY (LOS)
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21. LIMITS OF STABILITY TESTING
Measure the person ability to shift the COG with in the
BOS
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23. Quantifies the maximum distance a person
can intentionally displace their Center of
Gravity (COG)
( lean their body in a given direction without losing balance,
stepping, or reaching for assistance)
The measured parameters are:
Reaction time,
COG movement velocity,
Directional control,
End point excursion,
Maximum excursion.
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24. LIMITS OF STABILITY
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25. Reaction Time (RT) : time in seconds between the
command to move and the patient's first movement.
Movement Velocity (MVL) : average speed of COG
movement in degrees per second.
Endpoint Excursion (EPE) : is the distance of the first
movement toward the designated target, expressed
as a percentage of maximum LOS distance.
The endpoint is considered to be the point at which
the initial movement toward the target ceases.
Maximum Excursion (MXE) : maximum distance
achieved during the trial.
Directional Control (DCL): comparison of the amount
of movement in the intended direction (towards the
target) to the amount of extraneous movement (away
from the target).
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26. POMA
Two components
Balance and gait portion
 Balance portion – 9 items
 Gait portion – 7 items
Increased risk of falling
 Less than 10/16 of balance portion
 Less than 9/12 of gait portion
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