Postural control
controlling body position in space for stability and orientation
Balance
ability to hold center of mass in relation to base of support
Center of gravity
vertical projection of the COM (slightly anterior to L2 in standing)
Base of support
area of body in contact with a support surface
Postural orientation
ability to maintain an appropriate relation between body segment and between the body and the environment
Limits of stability
internal representation of how far the body can move over its base of support before changing the support or losing balance
Anticipatory postural responses
active movement of the body’s COM in anticipation of a postural transition from one body position to another
Reactionary postural responses
active response to an external perturbation
Sensory interaction/orientation
ability to maintain balance during altering sensory conditions
Balance Examination: Systems Review
Cardiovascular
Integumentary
Neuromuscular
Musculoskeletal
Balance Examination: Body Functions and Structure
ROM Muscle Strength Muscle Tone Coordination Cognition Posture Pain Sensory Systems -Somatosensory --Light touch --Proprioception/Vibration ---Pain -Vision -Vestibular Perception
Motor Strategies
Ankle
Hip
Stepping
Balance Examination:Motor Strategies: Ankle
- Control of postural sway from ankles and feet
- Head and hips travel in the same direction at the same time with the body moving as a unit over the feet
- When it is appropriate to use an ankle strategy?
- -Firm surface
- -Foot well supported
- -Slow moving with minimal displacement
Balance Examination:Motor Strategies: Hip
- Control of postural sway from pelvis and trunk
- Head and hips travel in opposite directions
- When is it appropriate to use a hip strategy?
- -Foot not completely supported
- -Quick and large displacements
Balance Examination: Motor Strategies: Stepping
- Steps with the feet to establish a new base of support when the center of gravity has exceeded the original base of support
- When is it appropriate to use a stepping strategy?
- -When the other strategies are not sufficient enough to maintain equilibrium
Balance Examination: Clinical Test for Sensory Interaction in Balance (CTSIB)
- Clinical version of the Sensory Organization Test that does not require computerized force plate
- Designed to assess the patient’s ability to select and combine sensory information in different environments
- Does not measure the integrity of the three sensory systems
Stages of Foam and Dome
Condition 1: Firm surface, eyes open Condition 2: Firm surface, eyes closed Condition 3: Firm surface, dome Condition 4: Foam surface, eyes open Condition 5: Foam surface, eyes closed Condition 6: Foam surface, dome
Where is somatosensory dominant?
Condition 1
Condition 2
Where is Vision dominant?
Condition 4
Where is vestibular dominant?
Condition 3
Condition 5
Condition 6
Balance Error Scoring System [Purpose and Population]
- Purpose: Objective measure of assessing static postural stability (designed for the mild head injury population-concussion, to assist in return to sports play decisions).
- Population tested: Concussion, mild TBI, ankle instability, vestibular disorders
Balance Error Scoring System Conditions
- 6 conditions each tested barefoot, eyes closed for 20 seconds each:
- Double leg stance (feet together): Firm & Foam
- Single leg stance (non-dominant foot): Firm& Foam
- Tandem stance (non-dominant foot in back): Firm & Foam
Scoring Balance Error Scoring System
Count number of errors (deviations) from proper stance:
- Moving hands off the hips
- Opening the eyes
- Step, stumble or fall
- Abduction or flexion of the hip beyond 30°
- Lifting the forefoot or heel off of the testing surface
- Remaining out of the proper testing position for greater than 5 seconds
What do the Balance Error Scoring System mean?
- Score of 0-60 (lower scores indicate better balance and less errors)
- MDC – 7 to 9 points
- BESS
