THE BASIS FOR NORMAL MOVEMENT AND POSTURAL CONTROL roan ! Control makes voluntary movement possible. Postural control makes voluntary jomechone ncient, fluid and pleasurable. Postural control relies on the proper ignment v2, alignment of the skeleton, with the pelvis acting as the comerstone. ‘Nt Of the skeleton relies on ‘adequate length of the muscles and soft tissue. Wh ae gravity ty body orients itself in the proper spatial plane in relationship to the center of body motige a ational forces are neutralized and motion becomes effortless. Full on then requires anti-gravity muscle control with some muscle groups working in a coneentric or shorter si : e ic Ortenatiened state, mf opPeing musi grvps working nan oocen POSTURAL REACTIONS Righting reactions bring the head and trunk in line wi i n Ink in line with the center of gravity. The develop gradually during childhood with much of the evolution taking place, ‘uring the first six months of life. They require anti-gravity muscle control. In PRONE the five month old ~, will activate a landau reaction | or prone extension posture. The! \ extensors shorten and are | counter-balanced by elongating | “sy — > flexors. The posterior aspect of | the body is shortened and the | anterior aspect of the body is lengthened. The shoulders | & ( expand and move posteriorly. rc } Figure 1 page 24In SUPINE the six month old exhibits postural flexion where the anterior aspect of the body shortens and the posterior aspect lengthens. The flexors shorten and are counter-balanced by elongating extensors. The shoulders move forward so that hands can reach feet. The pelvis moves posteriorly, rising off the weight bearing surface, allowing the lower extremities to move toward the hands. Figure 2 Sidelying requires unilateral control of flexors and extensors. This means that the flexors and extensors on each side of the body work together. The weight bearing side of the body lengthens while the unweighted side shortens or laterally flexes. These righting reactions in the lower positions allow the child to. move in and out of prone and supine through lateral weight shifting which will eventually lead to controlled rolling. Righting reactions become modified and integrated for upright postural control. \ oe Figure3f UPRIGHT control is 2 result of ‘e shifting one's weight and _ responding to the gravitational forces of the planet. When the weight is displaced anteriorly in sitting, SYMMETRICAL EXTENSION is the most efficient reaction. Symmetrical extension prevents us from falling on our ll face when the body moves in front of the center of gravity. With this forward movement, the spine extends or shortens in the back and the head extends on the neck. The shoulders move back with a visible broadening of the upper chest. A response in the arms depends on the degree of excursion used in the weight shift. When the weight shift is significant, the top of the pelvis will move forward over the hips. The front of the torso becomes longer. Through this postural reaction, the trunk flexors work eccentrically to prevent a response of excessive extension, As the body returns to the middle, flexors and extensors tte work tagether or co-contract to B maintain this efficient relationship with gravity. Figure 4 page 26With a posterior displacement of the weight, SYMMETRICAL FLEXION is used to bring the body in line with the center of gravity. The shoulders move forward and the spine lengthens the back as the head flexes on the neck. The abdominals contract to flex or shorten the torso in front. If the weight shift is significant, the abdonimals tilt the top of the pelvis posteriorly, behind the hips. This dynamic flexion response prevents a backward fall by moving the body forward. Throughout this automatic postural reaction the extensors are working eccentrically, or in a lengthened Figure 5 position, to prevent a response of excassive flexion. As the body nears the center of gravity, the extensors work concentrically or in a shortened position to straighten the spine and re-align the pelvis. Symmetrical postural control is limited, when the patient is unable to utilize full spinal mobility. For example, during symmetrically extension you may see the patient getting all of the mobility in the low back and cervical spine, while they hold onto thoracic flexion with a forward position of the shoulders. Patients who hold their shoulders forward are often protecting their heart. They feel vunerable as they expand their upper chest. The outside world feels like a scary place. Conversely, during symmetrical flexion, you may see the patient holding the spine rigidly straight, instead of allowing the spine to flex. Inthis Case the patient is choosing to control the body rather than trusting that the body can naturally and freely respond safely to outside forces. This type of patient may generally feo! that their world is only safe when "Im under control." Postural control in sitting relies on the hips being active against the weight bearing surface with the rest of the body “letting go" of holding or fixation pattems. When symmetrical postural control is poorly developed, the patient may utilize subtle pattems of torsion in the pelvis or trunk. Torsion or asymmetry is the pattern one chooses when he feels posturally insecure (fear). page 27 oOWith a lateral weight shift, the spine lengthens on the weight-bearing side and — shortens on the side that is unweighted. The torso uses concentric unilateral flexion and extension to shorten the unweighted side. Eccentric — 1 unilateral flexion and extension § allow active lengthening on the weighted side. Each side's U respective flexors and extensors have a specific job in controlling this weight shift, righting the head and body in space and A bringing the person back to the middle. Patients find lateral motion difficull when they lack hip . activity against the weight i bearing surface, especially hip abduction. The weight shift should originate at the pelvis and yet many people will weightshift by moving the upper body over the pelvis. Symmetrical flexion and extension are needed before the patient can combine unilateral flexion and extension. Again, watch for pelvic torsion in their motion, oo Figure 6 Page 28 scanEQUILIBRIUM reactions are more complex postural responses which utilize diagonal pattems for transitional movement patterns as well as ambulation. When a lateral weight shift takes a person farther than a straight plane reaction can control, diagonal or rotational reactions are needed. This means that the upper body can rotate over the lower body and visa versa. An individual can rotate with extension by orienting the upper body toward the weight bearing hip. This response is used for protection during a fall. Or the individual can rotate with flexion by orienting the upper body away from the weight bearing hip. This is a true equilibrium reaction and one that we use for gait. It requires activation of the abdominal obliques. Figure 8 page 29FACILITAT'ON DRAW'NGS page 30Quadruped . to stamad!