Submitted by: Jeremy Nelson PT
11.0 Turn 360°.
Turning around is a difficult task to complete as it requires multiple bases of support and control of the COG to produce weight shifts in different directions. The goal of this component is to be “able to turn 360 degrees safely in 4 seconds or less”. This component includes weight shifts to establish a new base of support while maintaining the center of gravity over that new base of support and also unloading and extremity order to move that extremity. A s discussed in the Component 9 – Picking up from the floor, the Berg is not sequenced in the way that reflects increasing difficulty. As this motions includes the tasks of attaining, maintaining and controlling the COG over the single limb BOS, it would most likely be near the difficulty scale. Ideally the capacity to stand on the single limb, measured in the last component 14 would precede the turning test.
For the practicing clinician its beneficial to understand the critical tasks in each component and how they relate to other functional activities. Included in the turning is the task of stepping posteriorly to establish a new BOS and then accepting the weight shift in a posterior lateral direction. No easy task for the performer with asymmetrical strength or a hypo active inner ear.
Similar to the turning and looking over the shoulder test, the vestibular system and its contribution to control rotations in space is included. During the closing of the eyes test in symmetrical stance examined in component 5, the dependency on the vestibular and sensory system was identified. As a result the rehab professional with an abundance of caution would want to review the test result for that component before testing this component. Although the eyes remain open, the rotational component of the test could provoke a loss of balance.
When the performer “needs assistance while turning” further inquiry is helpful to determine why the assistance is required. Are the signs and symptoms of vertigo present? When does the loss of balance requiring assistance occur? To what degree is the assistance required? All questions that will help to identity the entry point into the change effort. Depending on what critical task requires the assistance, this would be the place to return to. In other words if standing in symmetrical stances requires help, then go to the critical tasks for this position and begin to explore which requires change. If the beginning goes well, and further weight shifts are impaired, go to those critical tasks for further evaluation. When the performer “needs close supervision or verbal cuing” the critical task identified as inadequate will provide the appropriate verbal cuing.
As the performer demonstrates to be “able to turn 360 degrees safely but slowly” the rehab professional will comment on the reason for the deliberate nature of the turn. Often this is due to lack of power to control the weight shifts and provide the emphasis for the quick deceleration of a weight shift and then rapid acceleration of the weight shift to the other lower extremity.
Symmetry between the sides as a goal is examined. If the performer is “able to turn 360 degrees safely one side only 4 seconds or less”, then the asymmetry is investigated. Single limb testing on each extremity will demonstrate the capacity to accept the weight shift. It may also be cause for examination of the vestibular system even if vertigo is not obvious. With a balanced system capable of performing the full turn in the time desired, the performer is well positioned to be involved in their life as they desire.