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THEORETICAL BACKGROUND OF POSTURAL CONTROL
Postural Control – Role In The Human Movement
대전 보람병원
이기훈
2015 한국보바스 소아학술대회
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Key word
• Postural control : 중력에 대응공갂에서 자세를 유지어떤 동작을 수행이 가능하도록 하는 배경보행이나 manual skill 발달의 기초
• 중추신경계- 공갂에서의 신체의 위치와 움직임에 대한 정보를 제
공하는 많은 감각 정보를 받아들임.- 통합- 여러 조절단계- 몸통 및 사지의 귺육에 적절한 수축과 이완 유도
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Key word
• Vestibular system
• Muscles which locate around the neck are most important, which is the basis for the postural control of human movement
• The top is the head which is the keystone of the central line
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Gravity
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Human Movement
• The same way to move against gravity
• Normal postural control mechanism
• All of these are all generated postural control, without conscious control
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Terminology
• Postural control: the ability to control the body’s position in space for the dual purposes of orientation and stability
1) Orientation: the ability to maintain appropriate task-specific relationships between the body segments and between the body and the environment
2) Stability: the ability to control the center of mass relative to the base of support
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3 components of postural control mechanism
- Normal postural tone
- Reciprocal innervations
- Common movement pattern (learned pattern)
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Human movement – postural tone
• Postural tone generated by changes in the
location of the head
- move on the same axis against the BOS
- activate the neural system of the brain
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Human movement – reciprocal innervations
• Reciprocal innervations
- Agonist, antagonist, synergist
- Proximal stability, distal mobility
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Human movement- common movement pattern
• Previous information, current information
• Adaptive, anticipatory
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Postural tone
• In daily life, human keep working against
gravity to maintain the head in the axis
• Postural tone starts to work from the moment
the head in space
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Terminology
• Tone : resistance of muscle to stretch
phasic and postural
• Phasic tone – rapid contraction in response to a high- intensity
stretch, as in tendon reflex response
• Postural tone – prolonged contraction of antigravity muscles in
response to the low-intensity stretch of gravity. When postural
tone is depressed, the trunk and limbs cannot maintain
themselves against gravity
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Postural tone
• An appropriate activation of muscle of the
body to maintain the head & body on midline
against gravity
• Information tools which are the vestibular
network of eye, inner ear, muscle spindles of
the neck and trunk
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Mechanisms for modulation of postural tone
• Postural tone automatically works to
allow head movement in space in order
to do something with volition
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Mechanisms for modulation of postural tone
• Standing
• Soldier – military standing at attention
• Lying down in bed
• Initial wakefulness with opening of eye
• Sitting
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Mechanisms for modulation of postural tone
• Straightened neck with 2 columns of upper trapezius
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The Neck
• Muscles which locate around the neck are most important, which
is the basis for the postural control of human movement
• It works with vestibulospinal reflex, vestibulocollic reflex,
vestibuloocullar reflex
• For connecting with vestibular neural network, neck muscles are
composed of highest density of muscle spindle then other
muscles
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Mechanisms for modulation of postural tone
• Hemiplegia – muscle weakness, hypertonus SCM, upper
trapezius column weakness or disappearance
• Premature diplegia – low proximal tone
• Weak or shortened neck
-inability to watch with two eyes and to straighten the neck
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Basis of neural network for the modulation of postural tone
• Otolith, the utricle and saccule.
- LVN
- ipsilaterally extensor m. in the cervical & lower lumbar
segment of spinal cord
• Semicircular canal
- MVN
- bilaterally cervical or upper thoracic of spinal cord
- extensor m. facilitation, flexor m. inhibition
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Netter ‘97
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Basis of neural network for the modulation of postural tone
• Vestibular nuclei
1. Sensory information about head movement &
head position relative to gravity
2. Gaze stabilization
3. Postural adjustment
4. Autonomic function and consciousness
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Model ComponentsSensory Organization
• Balance/postural control via
three systems:
– Somatosensory
– Visual
– Vestibular
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Somatosensory System
• Dominant sensory
system
• Provides fast input
• Reports information
– Self-to-(supporting)
surface
– Relation of one
limb/segment to another
• Components
– Muscle spindle
• Muscle length
• Rate of change
– GTOs
• Monitor tension
– Joint receptors
• Mechanoreceptors
– Cutaneous receptors
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Vestibular System
• Not under conscious
control
• Assesses movements of
head and body relative to
gravity and the horizon
(with visual system)
• Resolves inter-sensory
system conflicts
• Gaze stabilization
• Components
– Cerebellum
– Projections to:
• Brain stem
• Ear
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Sensory-Motor Integration
Somatosensory
Vestibular
Visual
Eye Movements
Postural Movements
10 Processor
20 ProcessorCerebellum
Motoneurons
Sensory Input Processing Motor Response
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Normal Postural ControlSensory System
• The somatosensory system provides information
about the body with reference to supporting
surfaces.
• The somatosensory system receives information
from muscle spindles, joint receptors, tendon
organs, and mechanoreceptors.
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Basis of neural network for the modulation of postural tone
• Modulation Of Postural Tone
• Higher Position
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Basis of neural network for movement of the body
• Standing
• The top is the head which is the keystone of the central line
• Vestibular system contributes to the generation of postural
tone regarding to the location of the head for maintaining
posture and for preparing the body movement
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Basis of neural network for movement of the body
• In sitting: gluteus maximus initiator of respond the change
of head location
• Rest a sofa
- head flexed, body lean backward
• Sacrum sitting
• When intend to do something
- head higher, pelvis upright, gluteus maximus, back m
extension
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Basis of neural network for movement of the body
• The most important consideration is the
adequate & right activation of the head
• Gluteus maximus
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Basis of neural network for movement of the body
• For another instance
- human stand up
• Head flexion, proximal m. flexion
• Pelvis automatically ant. tilting
- leg flexion – for supporting the weight of the head & the
body
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Special consideration body parthuman movement
1. Eye with the head
2. Neck dynamic stability
3. Shoulder joint
4. Hand
5. Proximal dynamic stability
6. 3-dimensional pelvic movement
7. Ankle, foot
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CERVICAL AND THORACIC
SPINE
HAND MOVEMENT
PROXIMAL DYNAMIC STABILITY
3 – DIMENSIONAL PELVIC MOVEMENT WITHOUT or WITH BOS
THE PELVIS MOVES ONTO THE HIP JOINT
FOOT /ANKLE, TOE AS A BOS
NECK DYNAMIC STABILITY
HEAD / EYE
POSTURAL TONEAXIS
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Altered vestibular system
• Eyes
- connecting signals from the vestibular network
- helping modulation of postural tone
• VOR
• Neck collarboration
• Vestibular network of the eye and head
- axis에 대해 몸의 위치변화 감지- 머리의 조절
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VESTIBULO-OCCULAR REFLEXES
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Altered vestibular system
• Sub- occipital spine (atlas- axis complex)
• Trapezius, SCM
• Deep m.
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Altered vestibular system
• Hyperextended and asymmetric posture-typical hypertonic pattern
• Insufficient sensorimotor experience
• Womb
- flexed posture, connective movement
• Neck m. (flexor part)
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Altered Vestibular System Spastic Diplegia
• Hyperextended neck and eye
which leads extended body.
• Different head Location
mainly activate special
muscles group of extension
for maintain axis.
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The eye
• Hyperextended neck, both eye not stable
- alteration of axis
- lead to change muscle, body alignment
• C1,C2 segment fixed
• Neutralization of altered vestibular system
- therapist correct the altered vestibular system, normal axis,
bring the eyes back to the middle
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Altered Vestibular System Extended Child
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The neck
• Muscles which locate around the neck are most important, which
is the basis for the postural control of human movement
• It works with vestibulospinal reflex, vestibulocollic reflex,
vestibuloocullar reflex
• For connecting with vestibular neural network, neck muscles are
composed of highest density of muscle spindle then other
muscles
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The neck
• Spastic quadriplegia, dystonic athetosis
- Activated mainly extensor group
- Caused by dysfunction of the brain
- Hyperextended neck
- Hyperextended body d/t maintain the body axis
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The neck
• Hyperextension inhibit C1-C2 complex movement-
altered vestibular system
Spastic diplegia
- Hyperextended neck
- Short neck,
- Disappearance of the SCM, Upper part of trapezius, C7
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The neck
• Cannot function optimally
- lead to shortness of trapezius, deep capital
extensor m.
- Strong axis & information center의 기능을 할
수 없게 됨
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The neck
• Head – sense its location & movement
• Neck- rotation, flexion, extension
• Vestibular information을 적절히 할 수가 없음
• C.P에서 postural tone 유지가 불가능하면 움직
일 수 없다
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The neck
• Lack of rotation from cervical to thoracic
spine
- Unable scapular movement dissociation
- Unable shoulder joint movement
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The neck
• Hemiplegia- low proximal tone
• Less movement on more affected side
• Hypertonus
• Poor body scheme
• Less weight bearing
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The weakness of the neck
• Weak neck – proximal m. tone low
• Premature diplegia- insufficient postural tone, vestibular information
• Build up muscle of neck c proximal
• Activate two-eye watching
• Spinal rotation
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The weakness of the neck
• Hyperkinetic athetosis
• Fluctuating postural tone
- poor head movement
• Neck brace - move axis
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The weakness of the neck
• Hemiplegia
- Asymmetry in posture and movement
• SCM, upper trapezius
- activate weak & inactive m.
- postural tone appropriate and correct axis the
body
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Connective movement of cervical, thoracic and lumbar spine
• Cervical spine rotation
- thoracic spine rotation
- lumbar spine rotation
• Vestibular network of CNS
- eye not midline, neck weakness
- low proximal tone
- poor connect movement of the spine
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Connective movement of cervical, thoracic and lumbar spine
• Diplegia
- connective movement difficult
• Dissociated movement of the scapular
d/t especially poor neck movement
- because hyperextension or flexion
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Power and speed: chin tuck
• Chin goes toward the spine – chin tuck
• Weak neck- power, speed not produce
• Hyperextension inhibit chin tuck
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Axis keeper
• Neck, hand, gluteus maximus, ankle, toe
• Most strongest stabilizer – chin tuck
• Facial muscle – masseter
• Hand- pushing, pulling
• Gluteus maximus- sever as posture of extension
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Axis keeper
• Landau reaction
- gluteus maximus strongly contract
• Upright sitting- highest head position, pelvic ant. Tilting
• In standing – maintaining axis from top to bottom
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Axis keeper
• Ankle, toe - strongly contribute
BOS bipedal stance, dynamic movement
• Head is suddenly displaced or lose correct
head alignment
- running, ballet
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Axis keeper
• Head is weak or altered vestibular
system
- all axis keeper will weaken or disappear
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Proximal dynamic stability
• Proximal, neck dynamic stability
- Stabilization body for distal part movement
- Stabilization of rib cage
• Start to postural tone upon alertness (eye opening)
• Automatic activation
• Initiation of any kind of movement
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Proximal dynamic stability
• Abdominalis, quadriceps, femoris, gluteals, diaphragm
• Proximal, pelvis conversely
- 3-dimensional pelvic movement
• Neural signal from the CNS
• Neuromuscular junction
• Enough number of muscle fiber
• Thus, activation and building up proximal m. are very
important
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Proximal dynamic stability
• 3-dimensional pelvic movement
- Forward, backward, diagonal
• Crawl – one leg flexion, other leg extension
• Greater flexion – opposite greater extension
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Proximal dynamic stability
• If weak- not generate postural tone
• Inactive trunk, muscle tone extensor
• Neck proximal stability – distal part move
• Rib cage & pelvis – arm, leg appropriate movement
• Proximal – neck, pelvis, core muscle
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Physiologic postural reflex response
• Head righting reaction
- 출생직후 출현
- 지면에 엎드려 눕히면 고개를 들어올리는 반응
- Landau 와 derotative righting reaction으로 통합
• Landau reaction
- 엎드린 상태에서 영아의 배를 손으로 받치고 들어올림.
- Neck extension, trunk extension
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Physiologic postural reflex response
• Derotative righting reaction
1) Head on body righting reaction
- 머리를 한쪽으로 돌리면 어깨, 몸통, 골반, 다리가 그 방향
으로 돌아감.
2) Body on body righting reaction
- 다리를 한쪽으로 꼬아 옆으로 돌리면 골반, 몸통, 어깨관절,
상지 순으로 꼬인 몸을 푼다.
• Optical righting reaction
- 몸을 한쪽으로 기울였을 때, 고개를 똑바로 위치하려고 하는
반응
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Physiologic postural reflex response
• Labyrinthine righting reaction
- 눈을 가리고 몸을 한쪽으로 기울이면 전정기관
의 수용체가 자극
→ 목 주위 귺육의 귺 긴장도가 변함.
→ 고개를 똑바로 정위 자세로 위치
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Physiologic postural reflex response
• Equilibrium reaction (평형 반응)
- 무게 중심이 몸의 중심에서 벗어났을 때 몸의 중심의 안정성을 다시 확보
ex) 앉은 자세에서 팔을 뻗어 물건을 잡으려 할 때
- Sitting, standing
• Protective reaction
- 무게중심의 이동이 너무 빠르고, 너무 커서 무게 중심을 유지하여 안정성
을 회복할 수 없을 때
ex) Parachute reaction
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Thank You for Your Attention.