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1、平衡性的机制和训练,唐戎 PT，DPT，PhDDOCTOR OF PHYSICAL THERAPYREHABCARE INC,自我介绍,出生和成长于四川省江油市临床医学专科 广元职工医学院运动人体科学硕士 成都体育学院生物医学工程学博士 华西医科大学DPT（Doctor of Physical Therapy）临床康复物理治疗学博士Concordia University Wisconsin(美国协和大学威斯康辛分校)Postdoctoral Research Associate（博士后助理研究员）University of Minnesota（美国明尼苏达大学）Supervising Phy
2、sical Therapist（主管物理治疗师）Aegis Therapies（美国易捷康复集团）Supervising Physical Therapist（主管物理治疗师）RehabCare（美国RehabCare 康复集团）医学总监 上海医知网络科技有限公司,平衡的定义以及几个重要概念,Balance:Control of center of mass over base of support(ShumwayCook,2001)Center of mass:the point that is at the center of the total body mass Base of sup
3、port:Area of object that is in contact with the ground,平衡的定义以及几个重要概念,Center of mass:Center point of each body segment combined,COM,平衡的定义以及几个重要概念,Base of support:Area of object that is in contact with the ground,平衡的定义以及几个重要概念,Balance:Control of center of mass over base of support,平衡的分类,Steady state(s
4、tatic)balance:Maintain stable position in standing or sitting Reactive balance:Recovering from an unexpected perturbationProactive(anticipatory)balance:Activating balance in advance,平衡的分类,Steady state(static)balance:Maintain stable position in standing or sitting,平衡的分类,Reactive balance ability to re
5、cover from an unexpected perturbation(being nudged by someone),平衡的分类,Proactive(Anticipatory)Balance：Ability to activate muscles for balance in advance of a potentially destabilizing movement in order to avoid instability.Reaching,leaning,pulling,平衡的分类,Balance is a complex composite of multiple body
6、systemsMotorSensoryCognition,Motor Systems,Musculoskeletal system:strength and flexibilityNeuromuscular system:coordination of movement,Sensory Systems,Peripheral input:Visual,vestibular(inner ear),somatosensory(input from joint and muscle receptors,auditory(hearing)Central processing:Receives infor
7、mation from periphery interprets it,and sends commands to motor systems,Cognition,Multitasking and filtering out distractions while maintaining balance,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,The TUG was found to have:87%sensitivity for predicting falls with a score 14 secondsThe Berg Balance Test:83%of
8、 subjects were correctly identified as fallers(the gold standard)based upon the dichotomous rule to classify fallers at a cut-off point of 40(BBT Score).,平衡性的评定,Timed up and go test(TUG)Get up from seated position,walk 3 meters,turn around,walk back to chairAdults who took 30 sec were dependent in a
9、ctivities of daily living,平衡性的评定,Berg Balance scale:Discriminates older adults at risk for falls Single best predictor of fall status in community dwelling adults Sound test with good reliabilityMainly tests static and anticipatory balance,平衡性的评定,Berg Balance scale:Sitting to standingStanding unsupp
10、ortedStanding to sittingStanding unsupported with eyes closedStanding unsupported with feet togetherReaching forward with outstretched armPick up object from floorTurning to look over right and left shoulderTurn 360 dgStep on step stool(#times in 20 seconds)Tandem stance;Standing on one foot,平衡性的评定,
11、14 item scale for possible 56 points totalDecrease in Berg score=increased fall riskScore of 56-54,1 point drop=3-4%inc.fall riskEach point drop from 54-46,=6-8%increaseBelow 36,fall risk=100%Limitations:does not test reactive balance;ceiling effect,平衡性的训练,平衡性的训练,EXERCISE!Standing-on two feet and on
12、eStand in corner and move shoulders/hipsWalk and turn head,平衡性的训练,Walk heel to toe,walk on toes,walk on heelsWalk backwards,walk sidewaysStand up and sit down without handsFocus on LE,Core,TricepsUE-scapular retraction,rowing,平衡性的训练,Improve flexibility-stretching,Tai Chi,YogaDeep breathingFloor tran
13、sfersImprove postureMedication review-4+meds,side effectsVision screening,平衡性的训练,Aquatic programsStrategies-ankle,hip,stepEyes open and closedReaching/bending/weight shifts/lifting/carryingBalls/BAPS board,平衡性的训练,Obstacle coursesJoint mobilizations to the spineDancingDo ADLs on one footBegin walking
14、 programsElectrical stimulationConsider DME/AE-hip protectors,walkers,canes,etc,平衡性的训练,Do things during balance exercises:Add musicChange surface-unlevelChange footwearAdjust lighting-include low lightingDo mathCategorize,平衡性的训练,Nintendo Wii Fit System,Fall,Unintentional injuries External causes of
15、the injury Multifactorial causese.g.falls due to intrinsic factors vs.extrinsic factors,Intrinsic(Personal)factors for Falls,Aged(over 65 years)FemaleLow mobility or fragility lower extremity weakness,and poor grip strength Functional impairments-limited Activities of Daily living(ADL)Poor gait and
16、balance Low body weight,Intrinsic(Personal)factors for Falls,Cognitive impairment or dementia Chronic illness-Parkinson disease,visual difficulties,stroke,hypertension,or urinary incontinence Psychoactive medication-tranquilizers or antidepressants Previous falls Heavy drinking,Extrinsic or Environm
17、ental Factors,Persons environment:Uneven surfacesObstacles,stairs,curbsPoor lighting,sudden changes in lightingSlippery surfacesPoor footwearPoorly fitted assistive devices for walking,Incidence rates of Falls in U.S.,One of every three adults over 65 years fall in every year Most common cause of in
18、jury death for 65+90%of hip fractures in older adultsMost common cause of non-fatal injuries,恶性循环,Fall ImbalanceInactive,Where are people likely to fall?,For people 65 years old or older.,Nursing Home 10%,Home 60%,Public Places 30%,Consequences of Falls,Mortality Morbidity Fractures Soft tissue inju
19、ries Head traumaJoint distortions and dislocations Loss of confidence-fear of fallingRestricted activity In 1994,estimated fall-related injury cost was$20.2 billion.,Consequences of Falls,Fractures,3%of all falls cause fractures.Approx.95%of hip fractures in older people aged over 65 years are the r
20、esult of a fall People who have a hip facture are 5 20%more likely to die in the first year following the injury than any other reason in the same age groups,Consequences of Falls,Forearm(Wrist)Fracture Spine Fracture Hip Fracture(pelvis,hip,femur)Ankle Fracture Upper arm,forearms,hand,How to Preven
21、t Falls,CDC Prevention Plan,Fall Prevention strategies:Exercise regularly,Tai Chi(strength/balance)Medication review-side effects and interactionsYearly eye examsReduce fall hazards in the homeImprove lighting throughout the home,How to Prevent Falls,Physical activity programs,particularly thoseemph
22、asizing balance and lower extremity strengthening,are associated with a 10-20 percent reduction in falls,How to Prevent Falls,Walkers:improve balance relieve or reduce weight bearingprovide 4-way stabilityCanes:improve balance provide support for one side of the body,How to Prevent Falls,ReachersPortable seat lift,How to Prevent Falls,Kitchenkeep items within easy reachBathroomgrab bars for toilet and bathtub；Raised toilet seats；Grab bars Bedroomnightlightsbed and nightstand at proper height,谢谢大家,联系方式,电话：15021183516 电子邮件：微信：ront511,
