balance wael alasaq pt. ph.d. pt department kuwait university

BalanceBalance

Wael Alasaq PT. Ph.DWael Alasaq PT. Ph.D..

PT DepartmentPT Department

Kuwait UniversityKuwait University

Wael Alasaq PT.Ph.DWael Alasaq PT.Ph.D

BalanceBalance

What is Balance?What is Balance? Balance involves the regulation of Balance involves the regulation of

movement of linked body segments over movement of linked body segments over supporting joints & base of support supporting joints & base of support

(Mackinnon & Winter (Mackinnon & Winter 1993)1993)

What is postural control?What is postural control?

The regulation of the bodyThe regulation of the body’’s position in s position in space for the dual purposes of stability & space for the dual purposes of stability & orientation. orientation. (Shumway-Cook & (Shumway-Cook &

Woollacott)Woollacott)..


Balance Balance ContCont..

Postural adjustments have 3 Postural adjustments have 3 goals:goals:

1.1. Support body against gravity & other Support body against gravity & other external forces.external forces.

2.2. Maintain the center of body mass Maintain the center of body mass (CBM) within the base of support (CBM) within the base of support (BOS).(BOS).

3.3. To stabilize parts of the body while To stabilize parts of the body while moving other parts.moving other parts.


Balance ContBalance Cont..

How balance is regained (postural How balance is regained (postural adjustments)?adjustments)?1.1.Muscle activationMuscle activation

2.2.Segments movementSegments movement


Systems participating in postural control Systems participating in postural control are:are:

1- Sensory System1- Sensory System– Vision: Provide information about our Vision: Provide information about our

orientation to the environment & help in orientation to the environment & help in predicting upcoming perturbation.predicting upcoming perturbation.

– Somatosensory including joints receptors, Somatosensory including joints receptors, muscle proprioceptors, cutaneous, & pressure muscle proprioceptors, cutaneous, & pressure receptors receptors

– VestibularVestibular2- Musculoskeletal2- Musculoskeletal3-3-


Old vs. new terms Old vs. new terms & their effects on ttt& their effects on ttt

It was often referred to postural It was often referred to postural adjustments as:adjustments as:

– postural reactionpostural reaction– postural reflexes orpostural reflexes or– equilibrium reactions. equilibrium reactions.


Biomechanical DescriptionBiomechanical Description

1.1. Balancing during motor action in Balancing during motor action in standingstanding

2.2. Balancing during motor action in Balancing during motor action in sittingsitting

3.3. Balancing during body transportBalancing during body transport


Balancing during motor action in Balancing during motor action in standingstanding

Postural sway: Postural swayPostural sway: Postural sway Balance is affected by the task & Balance is affected by the task &

environmentenvironment Postural responses to unexpected Postural responses to unexpected

perturbationperturbation


Balancing during motor action Balancing during motor action in settingin setting

BOS BOS CBM is closer to the BOSCBM is closer to the BOS Moving or reaching in setting Moving or reaching in setting

requires postural adjustments as requires postural adjustments as well. well.

Lower limb muscles are involved in Lower limb muscles are involved in anticipatory, ongoing and reactive anticipatory, ongoing and reactive postural adjustments.postural adjustments.


Balancing during motor action Balancing during motor action in settingin setting Cont Cont..

Trunk muscles act as postural Trunk muscles act as postural stabilizers, especially when upper stabilizers, especially when upper limbs are used and for reaching.limbs are used and for reaching.

When reaching side ways When reaching side ways destabilization occurs faster than destabilization occurs faster than forward reach.forward reach.

When feet are unsupported the limits When feet are unsupported the limits of stability is reached much earlier, of stability is reached much earlier, such as setting over the side of the bedsuch as setting over the side of the bed


Balancing during body transportBalancing during body transport

WalkingWalking Standing up & Sitting down Standing up & Sitting down


WalkingWalking

Balance is affected by both task & Balance is affected by both task & environment.environment.

Control of balance in walking vs. in Control of balance in walking vs. in standing. standing.

Loss of balance may occur due to Loss of balance may occur due to many factors: many factors:

Find them in your bookFind them in your book


Standing up & sitting downStanding up & sitting down

The movt. in the sagital planeThe movt. in the sagital plane Demands control of linear Demands control of linear

momentum & Muscle activationsmomentum & Muscle activations Healthy elderly decrease speed of Healthy elderly decrease speed of

standing upstanding up Falls in these activities are common Falls in these activities are common

in elderlyin elderly


Standing up & sitting downStanding up & sitting down Cont. Cont.

Stroke pts experience difficulties with Stroke pts experience difficulties with balance throughout standing.balance throughout standing.

Muscles which are important in Muscles which are important in controlling the standing up controlling the standing up areare……………………. & those controlling . & those controlling sitting down are sitting down are ………………..


Age-related changesAge-related changes

Postural instability in elderly and tendency Postural instability in elderly and tendency to fall can be attributed to many factors. to fall can be attributed to many factors.

Go and find them!Go and find them! Are @ high risk of pathologies accelerating Are @ high risk of pathologies accelerating

degeneration in neuromusculoskeletal degeneration in neuromusculoskeletal systemssystems

Biomechanical factors (musculoskeletal Biomechanical factors (musculoskeletal flexibility & MM strength)flexibility & MM strength)

30-80 yrs decrease of 40% UL & 30% LL 30-80 yrs decrease of 40% UL & 30% LL strengthstrength


Age-related changesAge-related changes


Observational analysis & Observational analysis & Guidelines for balance trainingGuidelines for balance training

In trios read and practice the In trios read and practice the activities in Carr & Shepard book activities in Carr & Shepard book pp50-71.pp50-71.


Functional TestsFunctional Tests

Functional reach testFunctional reach test Step TestStep Test TUGTTUGT BBSBBS

balance wael alasaq pt. ph.d. pt department kuwait university

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