BALANCE
Balance refers to an individuals ability to maintain their line of gravity within their
Base of support (BOS). It can also be described as the ability to maintain equilibrium,
where equilibrium can be defined as any condition in which all acting forces are
cancelled by each other resulting in a stable balanced system.
Balance Test (Static)
The ability to maintain the body in some fixed posture. Static balance is the ability to
maintain postural stability and orientation with centre of mass over the base of
support and body at rest.
1) Sitting static balance test
Aims: To assess coordination and motor control balance in static position
Target population: Patient with vestibular disorder, Parkinson, Stroke
Procedure: Patient in sitting position on chair
Therapist sit in front of the patient
Instruction;
1) Therapist will make nudge from anterior, posterior and lateral to the patient
1) Patient try to keep the body to not fall or loss balance in sitting positon
2) If the patient can keep the body not loss balance it the static sitting balance is
good
2) Standing static balance test
Aims: To assess coordination and motor control balance in static position
Target population: Patient with vestibular disorder, Parkinson, Stroke
Procedure: Patient in standing position in hard flat surface
Therapist standing in front of the patient
Instruction;
1) Therapist will make nudge from anterior, posterior and lateral to the patient
3) Patient try to keep the body to not fall or loss balance in standing
4) If the patient can keep the body not loss balance it the static standing balance is
good
Dynamic balance (Test)
Dynamic balance is the ability to maintain postural stability and orientation with
centre of mass over the base of support while the body parts are in motion
1) Time up and go test
2) Four square step test
3) 8 feet up and go
4) Functional reach test
5) Romberg test
6) Tandem test
7) Dynamic sitting balance test
8) Dynamic standing balance test
1) Four square step test
Aims: Assessment coordination and motor control to maintain balance when in
motion
Target population: Patient with vestibular disorder, Parkinson’s, stroke
(Duncan, 2013)
Procedure; The subject is required to sequentially step over four canes set-up in a
cross configuration on the ground.
At the start of the test, the subject stands in Square 1 facing Square 2.
The aim is to step as fast as possible into each square with both feet in the following
sequence: Square 2, 3, 4, 1, 4, 3, 2, 1 (clockwise to counterclockwise)
Test procedure may be demonstrated, one practice trial is allowed prior to
administering the test.
Two trials are then performed, and the better time (in seconds) is taken as the score.
Timing starts when the first foot contacts the floor in Square 2 and finishes when the
last foot comes back to touch the floor in Square 1.
Instructions: Try to complete the sequence as fast and as safely as possible without
touching the sticks. Both feet must make contact with the floor in each square. If
possible, face forward during the entire sequence.
Normal can complete < 15 sec (GOOD)
Reduce balance usually complete > 15 sec (POOR)
(Zoe Langford Austin , 2015)
2) Dynamic sitting balance
Aims: Assessment coordination and motor control to maintain balance when in
motion or out from based of support (BOS)
Target population: Patient with vestibular disorder, Parkinson’s, stroke
Procedure;
1) Patient in sitting position without any support of back
2 ) Therapist sitting in front of patient
3 ) Instruction: Therapist command the patient try to reach therapist hand
Patient try to reach therapist hand without loss of the balance
4 ) If the patient can reach hand therapist from out of patient (BOS) the dynamic
balance in sitting considered as good
3) Dynamic standing balance
Aims: Assessment coordination and motor control to maintain balance when in
motion or out from based of support (BOS)
Target population: Patient with vestibular disorder, Parkinson’s, stroke
Procedure;
1) Patient in standing position without any support
2 ) Therapist standing in front of patient
3 ) Instruction: Therapist command the patient try to reach therapist hand
Patient try to reach therapist hand without loss of the balance
4 ) If the patient can reach hand therapist from out of patient (BOS) the dynamic
balance in standing considered as good
Reference
Duncan RP, Earhart GM. Four square step test performance in people with Parkinson
disease. Journal of Neurologic Physical Therapy. 2013 Mar 1;37(1):2-8.
(Zoe Langford Austin, Journal of Physiotherapy 61 (2015) 162)
Saumur TM, Gregor S, Mochizuki G, Mansfield A, Mathur S. The effect of bed rest on balance
control in healthy adults: A systematic scoping review. Journal of Musculoskeletal & Neuronal
Interactions. 2020;20(1):101.
