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Chapter 7

Chapter 7. Balance and Coordination. Exercise in Orthopedic Disorders. Rehab after acute injury, surgery, immobilization, or chronic orthopedic condition Must address all components of normal function regaining strength Reducing pain Reducing swelling Improving flexibility

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Chapter 7

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  1. Chapter 7 Balance and Coordination

  2. Exercise in Orthopedic Disorders • Rehab after acute injury, surgery, immobilization, or chronic orthopedic condition • Must address all components of normal function • regaining strength • Reducing pain • Reducing swelling • Improving flexibility • Increasing local muscular endurance • Increasing CV fitness • Optimal recovery • Requires • Normalizing of sequence • Normalizing patterns of movement

  3. Balance • “Ability to maintain equilibrium; that is, it is the ability to maintain the center of body mass over the base of support” • 2 types • Static • Ability to maintain posture during non-movement activities • Dynamic • Ability to maintain body mass over BOS while in motion • Component of Coordination

  4. Coordination • Ability to perform • Fine motor skills • Tasks requiring postural control • Reciprocal motions • Examples?

  5. Terms related to Balance and Coordination • Position sense • Static balance • “awareness of static position” • Kinesthesia (kinesthetic sense) • Deals with sensory receptor signals from muscle, tendons, and joints • Relates to awarenessof joint motion • Example • To know arm is moving • Proprioception • Function of joint receptors (sensory and mechanoreceptors) • Delivers input concerning • Joint position • Movement • Direction • Speed • Amplitude • Example • To know arm is moving into flexion

  6. Mechanoreceptor System • Regulates adaptive changes to joint movement and body position. • Provide CNS info. Concerning • Joint displacement • Velocity of joint motion • Amplitude of joint motion • Pressure • Stretch • Pain • What type of neural input comes from the mechanoreceptor system? Afferent or Efferent?

  7. Mechanoreceptors • Gogi Tendon Organs (GTO) • Located at myotendinous junction • Inhibitory function • Spinal reflex arc • Activated by continuous or prolonged stretch • Inhibits muscle contraction by reflex relaxation • Muscle Spindle • Located in muscle • Excitatory nature • Spinal reflex arc • Activated when muscle is stretched to quickly

  8. Mechanoreceptors (cont) • 4 other types • Type I (Ruffini mechanoreceptors) • Respond slowly to static joint position • Type II (Pacinian mechanoreceptors) • Adapt quickly to changes in joint position • Detect ligament tension • Detect velocity of motion • Type III • Active at extremes of joint motion (motions that produce joint injury) • Type IV (Free Nerve Endings) • Transmit info. Regarding pain and inflammation

  9. Balance and Coordination Tests • Test and treatment are often the same • May be modification of test • Progressive battery of tasks with incremental difficulty (duh!) • Can be static or dynamic • Examples (balance) • Double Leg Stance Test (DLST) • Single Leg Stance Test (SLST) • Tandem Walking (straight line, heel-to-toe sequencing) • Reach Test • Change in surfaces • Change in directions (go from A to B; must negotiate away around obstacles) • Would the above be more difficult with eyes open or closed? Why? • WARNING! Close observation is needed to insure patient safety! • Must master previous level before moving to next • Outline progression from least difficult test to most difficult test (balance)

  10. Balance and Coordination Tests • Coordination • See Shankman box 7-1 p.108 • Can be performed in sequence from basic balance positions to advanced.

  11. Functional Balance Training in Orthopedics • Factors that contribute to balance dysfunction • Perception • Behavior • Range of motion • Biomechanical alignment • Weakness • Sensory • Synergistic organization strategy • Coordination • adaptability

  12. Functional Balance Training in Orthopedics • Studies indicate how injury, surgery, and immobilization effect proprioception (negative) • Rehab programs should address proprioception • CKC activities good for proprioception • LE • UE • Examples? • Examples of devices that could be used?

  13. Aspects of a good Rehab program • regaining strength • Reducing pain • Reducing swelling • Improving flexibility • Increasing local muscular endurance • Increasing CV fitness • Proprioception • Patient education (Bill’s)

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