Exercise for Impaired Balance

Wijianto, SST.FT., Ftr., M.OR

Siti Khadijah, S.Ftr., M.Biomed

Program Studi Fisioterapi FIK UMS

Balance: Key Terms and Definitions

• Balance, or postural stability, is a generic term used to describe the

dynamic process by which the body’s position is maintained in
equilibrium.
• Equilibrium means that the body is either at rest (static equilibrium) or in
steady-state motion (dynamic equilibrium).
• Balance is greatest when the body’s center of mass (COM) or center of
gravity (COG) is maintained over its base of support (BOS)

Program Studi Fisioterapi FIK UMS

Center of mass. Titik yang sesuai Center of gravity. proyeksi
dengan vertikal dari pusat massa ke
Base of support. Area kontak
pusat dari total massa tubuh dan tanah. Letak COG ialah di
antara tubuh dan permukaan
merupakan titik di mana tubuh anterior vertebra sakrum 2 atau
berada dalam keseimbangan 55% dari TB.
sempurna.
Limits of stability. mengacu pada perubahan/perpindahan keseimbangan tanpa
mengubah BOS-nya.
 Balance Control

• Integration of sensory information

to assess the position and motion
of the body in space and the
execution of appropriate
musculoskeletal responses to
control body position within the
context of the environment and
task.
• Thus, balance control requires the
interaction of the nervous and
musculoskeletal systems and
contextual effect
Motor Strategies for Balance Control

• To maintain balance, the body

must continually adjust its
position in space to keep the
COM of an individual over the
BOS or to bring the COM back
to that position after a
perturbation.
Muscle activity evoked following perturbations to the support surface
 Impaired Balance
• Impaired balance can be caused by injury or disease to any structures involved in the three
stages of information processing—sensory input, sensorimotor integration, and motor
output generation.

• Sensory Input Impairments. Decreased joint position sense has been reported in individuals
with recurrent ankle sprains, knee ligamentous injuries, degenerative joint disease, and low
back pain.
• Sensorimotor Integration Impairments. Damage to the basal ganglia, cerebellum, or
supplementary motor area impair processing of incoming sensory information, resulting in
difficulty adapting sensory information in response to environmental changes and in
disruption of anticipatory and reactive postural adjustments.
• Biomechanical and Motor Output Impairments. In individuals with neurological conditions
(e.g., stroke, TBI, Parkinson’s disease), failure to generate adequate muscle forces due to
abnormal tone or impaired coordination of motor strategies may limit the person’s ability to
recruit muscles required for balance.
Deficits with Aging and balance test
Static Balance Tests (Sharpened Romberg Test)

• Tes Romberg adalah suatu metode untuk mengevaluasi

gangguan sensoris seseorang, dimana terjadi gangguan
postur dan keseimbangan, misalkan dalam kondisi vertigo
dan cedera kepala.
No Jenis Pemeriksaan Negatif Positif
1 Kedua kaki rapat, mata
terbuka selama 30s
2 Kedua kaki rapat, mata
tertutup selama 30s
3 Kaki posisi tandem mata
terbuka selama 30s
4 Kaki posisi tandem mata
tertutp selama 30s

Hasil
Balance Training
Dynamic Balance Control
Balance program for reducing the incidence of ankle sprains in
athletes using a wobble board
Studi Kasus:
seorang pasien usia 58 tahun datang ke fisioterapi dengan perjalanan penyakit
seperti berikut:
• adanya gangguan sistem saraf pusat yang menyebabkan kadar dopamine dalam
otak turun akibat kematian sel saraf di dalam substantia nigra. Dalam substantia
nigra terkandung sel saraf yang membuat neurotransmitter (zat kimia otak)
menjadi dopamin, yang juga berperan untuk mengendalikan gerakan.
• Adanya kerusakan SSP menyebabkan gangguan gerakan, dimana gerakan yang
dihasilkan akan menjadi lebih lambat (bradikinesia), tremor, kekakuan sendi
(rigiditas), serta hilangnya keseimbangan.

Exercise apa yang akan diberikan?

Referensi