Professional Documents
Culture Documents
Prepared by:
Dr.misbaH waris
BSPT,PP-DPT,MS-NMPT, PGD-TM
Objectives of the lecture
• At the end of the lecture students will be able to
– Define balance and other key terms
– Describe limits of stability and its boundaries
– Describe the process of balance control
– Describe different sensory systems
– Define and describe sensory organization for
balance control
– Define different types of balance control
– Describe motor strategies for balance control
– Describe impaired balance and its causes
– Describe deficits with aging
– Enlist risk factors for falls in elders
– Perform examination and evaluation of
impaired balance
– Describe exercise for static balance control,
dynamic balance control, anticipatory balance
control, reactive balance control and balance
during functional activities
– Describe different factors affecting balance
– Describe Tai Chi for balance control
Background and
concepts
Balance and key terms definitions
• Balance
– 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).
• Center of mass
– The COM is a point that corresponds to the center
of the total body mass and is the point where the
body is in perfect equilibrium.
• Center of gravity
– The COG refers to the vertical projection of the
center of mass to the ground.
– In the anatomical position, the COG of most adult
humans is located slightly anterior to the second
sacral vertebra or approximately 55% of a
person’s height.
• Momentum
– Momentum is the product of mass times velocity.
– Linear momentum relates to the velocity of the
body along a straight path.
– Angular momentum relates to the rotational
velocity of the body.
• Base of support
– The BOS is defined as the perimeter of the
contact area between the body and its support
surface; foot placement alters the BOS and
changes a person’s postural stability.
• Limits of stability
– “Limits of stability” refers to the sway
boundaries in which an individual can maintain
equilibrium without changing his or her BOS
– Changing depending on the tasks
– For normal adults, the anteroposterior sway
limit is approximately 12⁰from the most
posterior to most anterior position.
– Lateral stability varies with foot spacing and
height; adults standing with 4 inches between
the feet can sway approximately 16⁰from side
to side.
Boundaries of the limits of stability
while standing, walking, and sitting.
• Ground reaction force
– the contact between our bodies and the ground due
to gravity (action forces) is always accompanied by
a reaction from it, the so-called ground reaction
force.
• Center of pressure
– The center of pressure (COP) is the location of the
vertical projection of the ground reaction force.
– It is equal and opposite to the weighted average of
all the downward forces acting on the area in
contact with the ground.
– COP is a reflection of the body’s neuromuscular
responses to imbalances of the COG.
Balance Control
• Balance is a complex motor control task
involving
– the detection and 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.
• Balance control requires the interaction of
the nervous and musculoskeletal systems
and contextual effects
Interactions of the musculoskeletal and nervous systems
and contextual effects for balance control
Sensory Systems and Balance Control
• Visual System
• Somatosensory system
• Vestibular system
Visual System
• Three strategies
– Ankle Strategy (Anteroposterior Plane)
– Hip Strategy
– Stepping Strategy
Ankle Strategy
(Anteroposterior Plane)
• In quiet stance and during small perturbations
movements at the ankle act to
– restore a person’s COM to a stable position.
• Low Vision
• Sensory Loss
• Medications
• Low Vision
– encourage regular eye examinations
– Wearing a hat and sunglasses in bright
sunlight
– making sure lights are on when walking about
the house at night
– avoid using bifocal glasses when walking
because
• Single lens glasses are safest for improving depth
perception and contrast sensitivity, especially on
stairs
• Sensory Loss
– For individuals with sensory loss in the legs
• caution them to take extra care
– when walking on soft carpet or uneven ground
• use a cane or other device if necessary
– wear firm rubber shoes with low heels
– Regular medical examinations
• blood glucose levels
– Seek medical attention if they experience any
symptoms of dizziness.
• Medications
– Patients should be educated about the
influence of certain medications
• such as sedatives and antidepressants