Postural Control - Nbcot Registered Occupational Therapists Otr

1. Which sensory system provides joint position and pressure input for postural stability?

   Somatosensory (proprioceptive) system. Delivers tactile and kinesthetic feedback from skin, muscles, and joints, enabling adjustments for surface contact and body position.

2. Identify the best cue to increase stability in standing ADLs for a patient with sway.

   Increase BOS by widening stance or staggering feet. Enhances postural stability by expanding the support area, counteracting excessive sway in functional activities.

3. What is the righting reaction in postural control during functional tasks?

   Automatic response to align head and trunk with gravity. Triggers reflexive adjustments to reorient the body vertically, supporting recovery and maintenance of upright posture.

4. What is the hip strategy for balance recovery, and when is it primarily used?

   Rapid hip/trunk motion; used for larger or faster perturbations. Employs quick hip flexion or extension to counteract forces, effective when ankle strategy is insufficient for greater challenges.

5. What is reactive postural control in response to an external perturbation?

   Feedback-driven balance responses after a disturbance occurs. Utilizes sensory feedback to trigger corrective muscle responses, restoring equilibrium following unexpected balance threats.

6. Which change most increases stability: widen BOS, narrow BOS, or raise COM?

   Widen the BOS. Expands the stability area, allowing greater tolerance for COM shifts without losing balance.

7. Which cane instruction best improves stability: cane on stronger side or weaker side?

   Cane on the stronger side (opposite the weaker/painful leg). Allows weight offloading to the unaffected side, enhancing gait symmetry and overall balance during walking.

8. Which sensory system is most relied upon for balance when the support surface is unstable?

   Vestibular system. Compensates for unreliable somatosensory cues on uneven surfaces by providing head orientation data relative to gravity.

9. Which option best describes optimal lifting mechanics to reduce spinal load?

   Keep load close, neutral spine, bend hips/knees, avoid trunk rotation. Minimizes compressive forces on the spine by distributing load through larger joints and maintaining alignment.

10. What is the base of support (BOS) in postural control during functional tasks?

    The area of contact between the body and the supporting surface. Defines the stability boundary by including all points where the body touches the support, crucial for maintaining balance in tasks.

11. Which device most increases BOS during ambulation: single-point cane or rolling walker?

    Rolling walker. Provides a broader, four-point contact area that enlarges the BOS more effectively than a single-point device.

12. Which option best reduces fall risk when standing from a chair: feet under knees or feet forward?

    Feet under knees with forward trunk lean before lift-off. Positions the COM optimally over the BOS, allowing efficient weight shift and reduced effort to achieve standing.

13. What is the center of mass (COM) in relation to balance during activity?

    The point where total body mass is concentrated; affects stability. Represents the balance point of the body's weight distribution, influencing how easily posture is maintained or disrupted during movement.

14. What is the stepping strategy for balance recovery during functional mobility?

    A step is taken to create a new BOS when COM moves beyond BOS. Reestablishes stability by enlarging or repositioning the BOS to recapture the displaced COM during dynamic activities.

15. Which relationship between LOG and BOS indicates stable static balance?

    LOG falls within the BOS. Ensures gravitational forces act within the stability limits, preventing tipping or loss of balance in static positions.

16. What is the protective extension reaction in sitting or standing balance loss?

    Automatic arm/leg extension to prevent a fall and protect the body. Activates limb outreach reflexively to widen BOS or absorb impact, enhancing safety during imminent falls.

17. What is the ankle strategy for balance recovery, and when is it primarily used?

    Distal-to-proximal sway control; used for small, slow perturbations. Initiates correction from the ankles upward to realign COM over BOS efficiently for minor disturbances on stable surfaces.

18. What is anticipatory postural adjustment (APA) during reaching or lifting?

    Feedforward muscle activation to stabilize posture before movement. Prepares the body proactively through muscle pre-activation, minimizing disruptions to balance during voluntary actions.

19. Which change most decreases stability: lower COM, widen BOS, or raise COM?

    Raise the COM. Elevates the balance point, making the system more susceptible to perturbations and reducing overall stability.

20. What is the line of gravity (LOG) as used in balance and posture training?

    The vertical line projecting from the COM toward the support surface. Indicates the direction of gravitational pull from the COM, essential for assessing alignment and stability in therapeutic interventions.

21. Which sensory system provides information about head position and motion for balance?

    Vestibular system. Detects angular and linear head movements, integrating with other systems to maintain orientation and equilibrium.

22. Which instruction best reduces shoulder strain during a lift: elbows away or elbows tucked?

    Elbows tucked close to the body. Reduces moment arm and torque on the shoulder joint, promoting safer load handling and less muscle strain.

23. Identify the safest transfer setup: wheelchair at $90^\circ$ or $30^\circ$ to the bed?

    $30^\circ$ to the bed (shorter pivot and less rotation). Facilitates a smoother transfer with reduced spinal torsion and better biomechanical advantage for patients with limited mobility.

24. Find the safer body mechanics choice: pivot with feet or twist the trunk while carrying a load?

    Pivot with the feet; avoid trunk twisting. Distributes forces evenly and prevents shear stress on the spine by using lower body movement for directional changes.

25. Identify the safest reach technique for a high shelf: stand on toes or use a step stool?

    Use a stable step stool; avoid reaching on toes. Maintains a lower COM and stable BOS, reducing risk of overreaching-induced falls or strains.

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