Richi HW ;
Neurodiv PMR Dept.,
BALANCE
Balance consists o !oth static and d"na#ic co#ponents.$tatic
!alance is de%ned as the status o the !od" in &hich all orces actin' on
the !od" are !alanced, &here the !od" re#ains static in an intended
position or orientation; d"na#ic !alance is reerred to as the status in
&hich the su##ed orces on the !od" allo& the !od" to #ove in a
controlled #anner. Accordin' to this de%nition, !alance control a!ilities
are unda#ental to a &ide ran'e o dail" activities ran'in' ro# static to
d"na#ic ones. (ood !alance control a!ilities &ould indicate that
successul posture)voluntar" #ove#ent inte'ration is achieved so that a
person is a!le to ul%ll the 'oal o a voluntar" tas* in a sae #anner. +his
de%nition also i#plies that the nature o !alance control #echanis#s is
tas*,speci%c. People that have !etter static !alance control do not
necessaril" sho& !etter d"na#ic !alance control, and vice versa.
Balance, postural control or e-uili!riu# are de%nitions used to
descri!e ho& &e *eep our !od" in an upri'ht position and, &hen
necessar", ad.ust this position. /t has !een descri!ed as 0sensin' the
position o the !od"1s centre o #ass and #ovin' the !od" to ad.ust the
position o the centre o #ass over the !ase o support provided !" the
eet2. /n order to #aintain !alance, vision, the so#atosensor" s"ste# and
the vesti!ular or'an interact and re'ister inputs ro# the surroundin's,
&hich are inte'rated and processed in the central nervous s"ste#. +he
vesti!ulo,ocular re3e4 567R8 coordinates e"e and head #ove#ents,
#a*in' it possi!le, or e4a#ple, to &al* and read si'ns at the sa#e ti#e.
+he cervico,ocular re3e4 interacts &ith the 67R, providin' inor#ation
a!out head #ove#ents in relation to the trun*. $ensor" receptors in the
s*in as &ell as #echanoreceptors in the #uscles provide input as to ho&
'ravit" a9ects the !od" :or the preservation o !alance, input ro# the
di9erent parts o the !alance s"ste# is constantl" reconsidered and
response ro# the #otor corte4 is sent !ac*. +his #eans that the !od" is
constantl" in #otion, &hich is called postural s&a" .
+hree #a.or sensor" s"ste#s are involved in !alance and
posture. 6ision is the s"ste# pri#aril" involved in plannin' our
loco#otion and in avoidin' o!stacles alon' the &a". +he vesti!ular
s"ste# is our ;'"ro1, &hich senses linear and an'ular accelerations.
+he so#atosensor" s"ste# is a #ultitude o sensors that sense the
position and velocit" o all !od" se'#ents, their contact 5i#pact8
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&ith e4ternal o!.ects 5includin' the 'round8, and the orientation o
'ravit". Neuro, ph"siolo'ists have devised a &ide ran'e o
e4peri#ents to tease out the contri!ution o each o these s"ste#s
and even to conuse the s"ste# !" providin' con3ictin' or alse
sensor" inputs.
+he so#atosensor", visual, and vesti!ular s"ste#s are the three
#ain !alance senses. +he so#atosensor" s"ste# provides inor#ation on
the position or #otion o the !od" &ith respect to the supportin' surace
and the position or #otion o !od" se'#ents &ith respect to each other.
+he visual s"ste# provides inor#ation on the orientation and #otion o
the !od" &ith respect to 'lo!al space. +he vesti!ular s"ste# senses the
linear and an'ular acceleration o the head as &ell as the head position
relative to 'ravit". Nor#all", these three senses &or* to'ether to detect
relevant peripheral sensor" inor#ation ro# the environ#ent, to develop
an internal representation o the !od" in 'lo!al space, and to tri''er
proactive or reactive !alance ad.ust#ents, in an atte#pt to #aintain
static and d"na#ic !alance under certain tas* and environ#ental
conte4ts.
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P7$+>RAL C7N+R7L D>R/N( ?>/E+ $+ANCE
Erect posture in hu#ans is achieved !" the superposition o !od"
se'#ents 5head, trun* and le's8 alon' the lon'itudinal a4is. +his
superposition is such that it should ul%l the t&o unctions o posture. +he
%rst is the anti'ravit" unction. +he superposition o se'#ents is
peror#ed a'ainst the orce o 'ravit" and the associated 'round reaction
orces. +he postural tone, &hich is predo#inantl" distri!uted a#on' the
e4tensor #uscles, pla"s an i#portant role in this anti'ravit" unction.
+here is an additional constraint, &hich is e-uili!riu# #aintenance. +his
#eans that the positionin' o !od" se'#ents 5&hich is onl" restricted !"
the #echanical li#its o .oint #ove#ent8 should !e such that the
pro.ection o the center o 'ravit" 5C(8 re#ains inside the support !ase
under static conditions.
A second unction o posture is to serve as an interace &ith the
e4ternal &orld or perception and action. /t #eans that the orientation
&ith respect to space o 'iven !od" se'#ents such as the head, the trun*
or the ar# are used as a reerence ra#e. +he reerence ra#e #a" !e
used either to perceive the position o the !od"1s #ove#ent &ith respect
to the e4ternal &orld or to or'ani@e#ove#ents to&ard a tar'et in e4ternal
space.
+a*in' into account the unctions o posture accordin' to the conte4t
and the tas*, t&o #odes o posturalor'ani@ation have !een proposed.
:irst, a 'lo!al or'ani@ation o posture is #ainl" related to e-uili!riu#
control. /t is represented !" the inverted pendulu# #odel descri!ed !"
Nashner and McCollu#. +he reerence value to !e re'ulated or
e-uili!riu# control is still a #atter o discussion. Balance,stricto sensu, is
preserved &hen the center o pressure 5CP8 re#ains inside the support
!ase 5i.e. the surace under the eet8. >nder static conditions this
corresponds to the pro.ection o the C(. Ho&ever, under d"na#ic
conditions, as, or e4a#ple,initiation o 'ait, the C( is accelerated !" a
tor-ue at the level o the an*le .oint created !" activatin' #uscles
controllin' that .oint;this causes a shit othe CP,&hich #oves a&a" ro#
the C( pro.ection. +hus, !oth CP position and C( pro.ection onto the
support !ase should !e ta*en into account or e-uili!riu# control in
d"na#ic conditions.
Accordin' to the #odelin' o PaA and Patton,the !order o the
sta!ilit" li#its can !e predicted in d"na#ic conditions !" a co#!ination o
three para#etersB the CP position, the C( hori@ontal position and the C(
velocit". /n order to re'ulate the C( position, &hich is located at the level
o the pelvis, the &hole !od" can !e #oved as an inverted pendulu#
C
around the an*le .oint. Ho&ever, as &ill !e co##ented on later, these
oscillations are ver" slo& 5re-uenc" around D.= H@8 !ecause o the hi'h
inertia o the !od". /n case o ast pertur!ations, ast corrections are
re-uired. 7ther !od" se'#ents &ith lo&er inertia 5trun* around the hip,
thi'h around the *nee8 are then #oved or ast corrections. /nterestin'l",
the constraints related to !od" inertia are not onl" i#portant or
e-uili!riu# control. +he" are also a *e" characteristic or the or'ani@ation
o #ove#ents. :or e4a#ple, it is possi!le to couple a set o .oints !"
increasin' the correspondin' .oint sti9ness. +his results in creatin' a ne&
ense#!le &ith an increased inertia correspondin' to that o the &hole set
o se'#ents coupled to'ether.
Droule@ and Bertho@ introduced the concept o topolo'ical
or'ani@ation o posture in order to descri!e this reor'ani@ation o !od"
inertia. +he" provided t&o e4a#ples. When readin' a paper &hile &al*in',
sti9ness o the ar#, trun* and head is increased in order to create a ne&
hi'h inertial ense#!le that &ill reduce the #ove#ents o the ar#s &ith
respect to the head. Conversel", unloc*in' the ar# ro# the trun* occurs
in tas*s &here the sta!ilit" o the hand position in space should !e
preserved independentl" ro# the trun* oscillations, as &hen the su!.ect
is &al*in' holdin' a ull 'lass in the hand. A second #ode o or'ani@ation
is #odular or'ani@ation, &hich is used or orientin' se'#ents such as the
head and trun* 5&hich serve as a reerence ra#e or perception and
action8 &ith respect to space. +he various se'#ents o the *ine#atic
chain ro# the eet to the head are not controlled as a sin'le unctional
unit, !ut as a superposition o individual ;#odules1. Each #odule is tied to
the ne4t one !" a set o #uscles &hich has its o&n central and peripheral
control, ai#ed at #aintainin' the reerence position o the #odule.
+he head is the site o di9erent cate'ories o sensors, such as the
retina, the la!"rinthine a9erents and the nec* #uscle proprioceptors.
Each cate'or" o receptors has !een sho&n to !e a!le to sta!ili@e the
head. +he head can !e sta!ili@ed &ith respect to 'a@e,verticalit" and to
the trun*. 7rientation and sta!ili@ation o the trun* a4is, &hich is the
lar'est a4is o an" !od" se'#ent, is critical. /nterestin'l", #aintainin'
e-uili!riu# throu'h the 'lo!al or'ani@ation o posture and preservin' the
orientation o !od" se'#ents &ith respect to space #a" !e con3ictin' in
'iven #otor acts throu'h the #odular control o posture. :or e4a#ple,
there &ill !e a con3ict !et&een e-uili!riu# #aintenance and holdin' a ull
'lass o &ine !" the hand 5local posture8 &hen a postural distur!ance
occurs that endan'ers !alance. +he sta!ili@ation o the head in space
durin' loco#otion is used as a navi'ational inertial plator# or the
evaluation o the visual or la!"rinthine inputs. +hese inputs si'nal
chan'es o !od" position &ith respect to the e4ternal &orld.
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Another i#portant role o this #odular or'ani@ation o posture is to
serve as an e'ocentric reerence ra#e or the or'ani@ation o #ove#ent.
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