Compensatory mechanisms

SUBMITTED TO DR. SHAKIR ULLAH PT

 Compensatory mechanisms
▪ Every functional task have essential components which
are series of moments or sub moments
when the patient is unable to perform the
normal moment or misses essential
component then the patient perform
the moment by compensatory
mechanisms.
▪ These are abnormal moments which the
patient need to avoid.
Sitting up from supine

Essential components
>Rotation and flexion of the neck
>Hip and knee flexion
>Flexion of the shoulder and
Protraction of the Shoulder girdle
>Rotation with in the trunk
▪ Sitting of over side of the bed.
▪ Lateral flexion of the neck.
▪ Lateral flexion of the trunk (abduction of the lower arm occur as these two moments
are performed).
▪ Leg lowered over the side of the bed.
▪ In rolling on to the intact side the patient may
demonstrate particular difficulty in:
▪ Flexion of the hip and knee on effected side
▪ Flexion of the shoulder and protraction of the
shoulder girdle
▪ These problems will result in:

inappropriate compensatory moment of the Intact side, e.g. he may try

to wriggle or to pull himself over using his intact hand.
In addition:
Failure to move the effected arm passively across his body may
indicate that he is neglecting the effected side.
 Sitting up of over the side of the bed

▪ The following problems may occur:

▪ Patient rotates neck and flexes it forward instead of
flexing it laterally. This usually occurs because of poor
lateral trunk moment
▪ Patient pulls with intact hand ( at bedclothes or side
of bed ) instead of laterally flexing neck and trunk
▪ Patient hooks intact leg under affected leg in order to
get legs over side of the bed. This will shift his weight
back as he attempts to sit up
Balance sitting
Essentials of sitting alignment

▪ Feet and knee are close together

▪ Symmetrical sitting
▪ Flexion of hip with extension of trunk (i.e. shoulder over hips)
▪ Head balance on level shoulders.
Compensatory mechanisms in sitting

▪ Wide base of support i.e. feet and/ or knees apart

▪ Voluntary restriction of moment, i.e. patient hold himself stiffly and hold his
breath.
▪ Patient shuffles feet instead of making adjustment with appropriate body
segments.
▪ Protective support on hand or arm or grabbing for support with minimal
moment. This patient may lose balance on any slight moment, even on taking
deep breath. He uses his hands to give himself a wider base and increase his
stability
▪ Patient lean forwards or backwards when weight should be shifting sideways this
mean lateral flexion of the trunk is poor
Standing up and sitting down
Essential components

▪ Standing up
▪ Foot placement.
▪ Inclination of trunk forward by flexion at hips with
extended neck and spine.
▪ Extension of hips for final standing alignment.
▪ Sitting down
▪ Inclination of the trunk forward by flexion at
hips with extended neck and spine
▪ Flexion of knees
Compensatory mechanisms

▪ Weights is borne principally through the intact side.

▪ inability to shift center of gravity sufficiently forward.
▪ Patient tries to shift weight forward by flexing trunk and head instead
of hips or by wriggling forward to the edge of the chair.
▪ Failure to place the effected foot ensures that the patient, who
already has this tendency, will stand up and sit down with all weight
taken through the intact side.
Balance standing

▪ Essential component
▪ Feet are few inches apart
▪ Symmetrical weight bearing
▪ Extended hips
▪ Extended knees
▪ Hips over feet
▪ Shoulder over hips
▪ Head balance on level shoulders
▪ Erect trunk
Compensatory mechanisms

▪ Wide base of support i.e. feet too far apart

or one or both hips externally rotated
▪ Voluntary restriction of movement i.e. patient holds himself stiffly
and holds his breath
▪ Patient shuffles feet instead of making adjustment with the
appropriate body segments.
▪ Patient takes a step sideways or backwards as soon as center of
gravity moves. This mean that balance is lost to soon
▪ Patient lean backwards when center of gravity shifts sideways this
mean that lateral flexion of the trunk is poor.
▪ Use of arms i.e grabbing for support, holding arms sideways or
forward, on minimal shift of center of gravity.
Walking
Essential component of walking

▪ Stance phase
▪ Extension of hip throughout
▪ Lateral horizontal shifts of the pelvis and trunk (normally
approximately 4 to 5 cm )
▪ Flexion of the knee ( approximately 15 degree ) initiated on
heel strike, followed by extension, then flexion prior to
toe_off.
▪ Swing phase
▪ Flexion of the knee
▪ Lateral pelvic tilt downward ( approximately 5 degree) in the
horizontal phase of toe off.
▪ Flexion of the hip
▪ Rotation of the pelvis forward on the side of the swinging leg (3
to 4 degree on either side of the central axis)
▪ Extension of the knee plus dorsiflexion of the ankle immediately
prior to the heel strike
Compensatory mechanisms in walking
Compensation is best
way to avoid your
problems but the worst
way to solve your
problems.