Postural kontrol

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 Postural Kontrol

Istilah dari balance, equilibrium,

dan postural kontrol merupakan
sinonim yang berarti mekanisme
tubuh untuk mempertahankan
dirinya agar tidak jatuh dan tetap
seimbang (ragnarsdottir 1996)

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 Skilled movement

• “Skilled movement has both,

postural and voluntary components:
• the postural component provides a
stabilising DYNAMIC frame for
• the second component, the primary
movement.“
(Shumway-Cook und Woollacott 1995,2002, 2007)
 Prenatal Development

• In Uterus the fetus experiences movement in a

spaceless environment

– The fetus is „floating“ in the amnion fluid

– He can make a lot of changes in his position
– Many adaptations of different muscle lenghts
– Activation and stimulation of centres in the CNS, for
antigravity activity in later days

(Prechtl,1985,1989, de Vries et al.1985,1986)

Usg bayi

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 Postnatal Development
• The geneticly predispotioned movement patterns
• are experienced, learnt, trained and used in all
different positions
• For
• Exporation of the body-feeling within gravity
 Postural control
• The ability to control our body’s position
against and within the forces of gravity is
fundamental to everything we do. (massion
woolacott 1996)
• Postural control is complex motor skill derived
from the interaction of multiple sensorimotor
processes.(F.B Horak 2006)

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 Gravity………
• “We can conclude, that any posture in itself is acceptable, as
long it is not in conflict with the law of nature. Which means
that the skeleton is working against the gravitational pull, to let
the muscles work for the movement.

• The Nervous System and the skeleton develop jointly under the
influence of gravity in such a way, that the skeleton is holding
he body upright without wasting a lot of energy, only the
energy needed against the antigravitational force.

• If the muscles are carrying out the job of the skeleton it is not
only a waste of energy but it prevents the muscles to do their
main function,
To change positions in space and carry out functions.“
(Moshe Feldenkrais 1972)
Gravitasi

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 Gravitasi

Merupakan input Afferent yaitu berupa

kekuatan konstan kearah bawah dimana kita
harus selalu berinteraksi dengannya untuk
dapat melakukan gerakan secara selektif.

Balance dan Agonistic Activity dibangun

karena adanya gravitasi

BBTA 2002

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Postural Kontrol

Postural
Control

T
Task

PC
E
I
Environment
Individual

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Postural control

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 Postural Kontrol
• Mengontrol posisi badan agar tetap dalam
keseimbangan dengan tujuan untuk
stabilisasi dan orientasi. (shumway-cook
and woolacott 1995)

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 Postural Orientasi
Meliputi :
- Kemampuan untuk memelihara keselurusan / alignment
diantara segment tubuh
- Menciptakan hubungan yang tepat antara tubuh dan
lingkungannya
- Memerlukan orientasi vertical yang stabil untuk melawan
gravitasi
- Membuat format acuan untuk persepsi dan aksi untuk
merespon terhadap dunia luar

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 Postural stabilisasi
Meliputi :
- Kemampuan untuk mempertahankan pusat berat
tubuh / COM / COG pada ruang batas yang disebut
stability limit

- Stability Limit adalah batasan area dimana tubuh

bisa mempertahankan posisi tanpa merubah base
of support / BOS

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 Proyeksi COG Pada BOS

Cog Projected within BOS Cog Projected Outside

of BOS

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 Stability Limit
• Batas stabilisasi tidak selalu tetap tetapi
dapat berubah sesuai dengan
• Tugas
• Individu
• Lingkungan
• Postural action dapat dilihat dari
kemampuan motorik yang timbul dari
interaksi antara individu, tugas dan
lingkungannya
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Stability Limit

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 Kontrol Postural Membuat Kita Mampu
Untuk :
- Mempertahankan berbagai macam posisi tubuh /
postur
- Trasnfer Weight Bearing dan kembali ke posisi
semula
- Menyediakan pola acuan dan stabilitas untuk
gerakan selectively dari mata, kepala atau organ
tubuh kita
- Bergerak dari satu posisi ke posisi lainnya
- Memberikan tugas kognitif disaat bergerak ( dual
task )
- Melakukan kegiatan secara mandiri dalam lingkungan
yang selalu berubah
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 Postural Kontrol

Musculo
Internal
Skeletal Representations
Components

Neuro Muscular
Adaptive
Synergies
Postural Mechanism

Kontrol
Individual
Sensory Anticipatory
Systems Mechanisms
Snsory
Strategies

Conceptual model representing the many components of

postural control that have been studied by a single system, but
emerges from the interaction of many sistems.

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musculoskeletal neuromuscular
• Muscle length • Normal tone
• Joint range of • Reciprocal innervation
movement • Pattern
• Compliance movement/coordination
• Alignment • Appropriate level of
• strength activation/timing/force

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 Anticipatory Mechanism
• Strategy prediksi / awalan
• Pre-Programmed muscle group / force
• Meminimalkan perubahan postural
• Pusat stabilisasi / core stability
• Dasar melakukan gerakan selektif
• Pengalaman
• Gerakan atau tugas spesifik

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 Anticipatory Mechanisms

EMG Activity of each of the trunk muscles relative to that of the prime mover
Hodges & Richardson 1997

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 Core Stability

• Keseluruhan segment
tubuh
• Kesesuaian aktifitas otot
• Berorientasi pada garis
tengah
• Interaksi dengan BOS
• Linear Acceleration
agains gravity

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 APA
Proactive postural control

pAPA aAPA
(preparatory APA) (accompanying APA)

100 ms before accompanying the

the initiation of movement movement
 Ilustration of posible origins and
Global planning Projection of the signals respon
Sible for obserserved activity
movement and posture In reticular neurons in the cat

Signal for pAPA’s Signal for execution of

movement motor
cortex (area 4)

Signal for aAPA’s

Ponto medullary Reticular Formation

pAPA’s pAPA’s/aAPAs aAPAs

Signal for execution of movement and posture

Dual control hypothesis Adapted from Schepens and Drew 2004

 Adaptive mechanisms
• Reactive strategy
• Feedback/regulation of movement
• Based on current experience
• Updates body schema
• Motor/balance strategies

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 Balance Strategies

Ankle Hip Stepping

Strategy Strategy Strategy
Shumway-Cook & Horak 1989
 Balance Strategies

Stepping strategy

Hip strategy

Ankle strategy

Firm flat Narrow

surface surface
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Sensory
Input

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 Sensory strategi
• Pada permukaan yang datar dan keras(firm)
somato sensori 70 %
vision 10%
vestibular 20%
• Pada permukaan yang tidak stabil akan terjadi
peningkatan pada vision dan vestibular,dan
secara bersamaan terjadi penurunan pada
somatosensori input untuk mempertahankan
postural orientation. (paterka RJ)
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 Cognitive processing
• Many cognitive resourses are required in
postural control (teasdale N.et al 2001)
• Even quiet standing requires cognitive
processing,as can be seen by increasing
reaction times in person standing compered
with those in person who are sitting with
support.
• The more difficult the postural task ,the more
cognitive processing is required. (horak 2006)
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Descending tract

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Rangkuman

 Kontrol postural dan gerakan

memerlukan inisiatif dan perencanaan
pada tingkat yang tertinggi, kontrol dan
pembaharuan pada tingkat pertengahan
pelaksanaan dan pengaturan tugas pada
tingkat terbawah.
 Bagaimanapun kontrol postural harus
ditekankan pada interaksi antara setiap
level secara konstan dan tetap, serta
menyediakan informasi kedua arah pada
setiap level
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