Comparison Table
| Reaction Type | Description | Activation | Purpose |
|---|---|---|---|
| Righting Reactions | Automatic responses that help maintain the body’s upright posture and alignment in space | Initiated by changes in head position or displacement of the body | To maintain postural stability and alignment |
| Equilibrium Reactions | Automatic responses that help maintain balance when the body’s center of mass is displaced | Initiated by external forces or perturbations that shift the center of mass | To restore and maintain balance |
| Protective Reactions | Automatic responses to protect the body from potential harm or injury | Triggered by a threat to stability, such as a loss of balance or an impending fall | To prevent falls and minimize injury |
Outcome Measures
- Clinical Test of Sensory Interaction on Balance (CTSIB): evaluates a person’s ability to maintain balance under different sensory conditions, such as standing with eyes open or closed, on a firm or foam surface. It assesses the integration of sensory inputs and the individual’s ability to make postural adjustments.
- Berg Balance Scale (BBS): evaluates balance and functional mobility. It includes tasks such as sitting balance, standing balance, reaching, and transfers, which indirectly assess components of righting reactions and equilibrium reactions.
- Functional Reach Test (FRT): measures an individual’s ability to maintain stability while reaching forward in standing. It indirectly assesses the ability to maintain balance and righting reactions during an anterior reach.
- Timed Up and Go (TUG): assesses an individual’s mobility and balance during a specific functional task. It measures the time taken for a person to stand up from a chair, walk a short distance, turn, return, and sit back down. While not directly assessing righting or equilibrium reactions, it provides insight into functional mobility and balance.
- Four Square Step Test (FSST): assesses an individual’s ability to step in multiple directions quickly and accurately. It challenges balance, dynamic postural control, and the ability to adjust movement based on changing environmental demands.
Protective Reaction Testing
Remember, safety first to prevent injury and falls. Consider performing this on a mat or soft surface. Reactive Balance Measures:
- Forward Protective Reaction: The OT creates a forward destabilizing force by gently pushing the patient’s shoulder or chest. The patient should react by taking a step or reaching forward with their leg to prevent a fall.
- Sideways Protective Reaction: The OT creates a lateral destabilizing force by gently pushing the patient’s side. The patient should react by stepping or reaching sideways with their leg on the same side as the push to regain balance.
- Backward Protective Reaction: The OT creates a backward destabilizing force by gently pushing the patient’s shoulder or chest. The patient should react by stepping or reaching backward with their leg to avoid falling.
Occupation
While outcome measures and protective reaction testing are nice, it tests patients in isolation from functional and/or meaningful activities.
By focusing on actual occupations, therapists can gather valuable information about an individual’s abilities, limitations, and adaptations in real-life contexts. Here are some ways to incorporate occupations into the assessment process:
- Activity analysis and breakking down an occupation into smaller components and observing the individual’s performance at each step, specifically paying attention to their righting reactions, equilibrium reactions, and protective reactions. For example, if the occupation is getting dressed, observe their ability to maintain balance while shifting weight, reaching for clothes, and maintaining stability during movements.
- Set up a mock kitchen and observe their ability to maintain balance and react appropriately while reaching for objects, turning to access utensils, and adjusting their posture during cooking tasks.
- Observe the individual engaging in their daily activities or routines within their natural environment, focusing on their righting reactions, equilibrium reactions, and protective reactions. This can include observing their ability to recover balance when reaching for items on a high shelf, maintaining stability while transferring from a seated to standing position, or adjusting their posture to prevent falls during walking.
- Self-report: ask questions about their experiences with maintaining balance, their strategies for recovering balance, and any difficulties they face in reacting to challenges. Their input can provide valuable subjective information about their reactions in different occupations.
Conclusion
Understanding and assessing righting reactions, equilibrium reactions, and protective reactions are crucial for occupational therapists in evaluating a person’s postural stability, balance, and safety during functional activities. While specific outcome measures and protective reaction tests provide valuable information, incorporating occupations into the assessment process allows therapists to observe individuals in real-life contexts, engaging in meaningful activities.
By breaking down occupations, creating simulated environments, observing daily routines, and gathering subjective input, occupational therapists can gain a comprehensive understanding of an individual’s abilities, limitations, and adaptations related to these motor responses. This patient-centered approach enables OTPs to develop targeted interventions and strategies to enhance functional performance and promote safety in everyday activities, ultimately improving the individual’s overall quality of life.