For 3rd year Physiotherapy students.

1. Suvarna Ganvir
Professor,
DVVPF’s College of Physiotherapy,
Ahmednagar

2.  Definition of balance, Postural control
 Adaptive, Reactive and Proactive
 Motor responses
 Sensory system
 CNS integration
 Functional Balance tests

3.  Postural Orientation
 Control of relative positions of body parts by
skeletal muscles with respect to each other and
gravity.
 Balance: all the forces acting on the body are
balanced such that the center of mass (COM) is
within the stability limits , the boundaries of
the Base of Support (BOS).

4.  Reactive Postural Control-
external forces acting on the body, displacing the
COM or moving the BOS- pertubations or
movable platform.

5.  Proactive Postural Control:
 Occurs in response of internally generated,
destabilising forces imposed on the body’s own
movements- catching a weighted ball

6.  Adaptive Postural Control:
 Allows the individual to appropriately modify
sensory and motor systems in response to
changing task and environmental demands.

7. Complex interaction of
Motor responses
Sensory systems
CNS integration process

8.  Limits of stability LOS
 Maximum distance an individual is able to or
willing to lean in any direction without loss of
balance or changing the BOS.
 Forward and backward (AP) or side to side(ML)
 AP LOS in standing- 12 degrees
 ML LOS in standing- 16 degrees

9.  Steadiness- ability to maintain a given posture
with minimum movement
 Sway Envelope- refers to the path of body’s
movement during standing.

10.  Postural Sway-visual inspection with patient
standing against the postural grid.
 Posturography-

11.  Posturography- forceplate to measure ground
reaction forces
 Center of force measures –COF – calculated
using only vertical forces
 Center of pressure measures – COP- calculated
using vertical and horizontal shear forces

12.  Measures of the initial stance position, mean
sway path, total excursion, and zone of
stability
 Patient’s postural symmetry- reflection of
amount of weight placed on each foot.
 Patients sway path-postural un steadiness

13.  Ataxia- hypermetric responses- excessive sway,
uncoordinated movements, limited postural
steadiness
 Parkinson’s disease- hypometric responses –
diminished sway, excessive stabilisation

14.  Vision ,
 Somatosensory,
 vestibular

15.  Important source of information
 For our ability to perceive our movements and
detect the relative orientation of body parts and
orientation of body in space
 Visual proprioception
 Focal vision
 Ambient vision

16.  Focal – cognitive or explicit
 Major role in localising features in the
environment
 Conscious reaction to visual events

17.  Ambient vision – sensorymotor or implicit
 utilises the entire visual field
 To provide information on localising features
about the environment and to guide the
movements using largely non conscious
awareness.

18.  Somatosensory inputs- cutaneous and pressure
sensations, proprioceptors.
 Provide relative information about relative
orientation and movement of the body in
relation to the support surface.

19.  Semicircular canals (SCC)- detect angular
acceleration and deceleration forces acting on
the head –sensitive to fast movements.
 Otolith organs – detect linear deceleration and
orientation of head – sensitive to slow
movements.
 Functions to stabilise gaze during head
movements , to assist in regulation of postural
tone, and postural muscle activation.

20.  Quite stance- all inputs contributes to the
maintenance of posture.
 CNS places greater weight on somatosensory
inputs.
 Somatosensory inputs plays a major role –
during platform perturbations

21.  Absence of somatosensory inputs- vision
assumes a greater role.
 In the absence of vision and somatosensory
inputs- vestibular systems takes over.

22.  Assessment of balance

23.  To determine the effectiveness of an individual
to utilize different sensory inputs.
 Examines body sway during quite standing
under six different sensory test conditions.
 Dynamic posturography- provides moving
platform

25.  Condition 1- Eyes open, stable surface,
 Condition 2- Eyes close, stable surface,
 Condition 3- visual conflict with moving
sorround, stable surface
 Condition 4- eyes open , moving surface
 Condition 5- eyes closed moving surface
 Condition 6- visual conflict with moving
sorround, moving platform

26.  Numerical scoring system
 1-minimal sway
 2-mild sway
 3- moderate sway
 4- fall.

27.  Ankle strategy
 Hip strategy
 Stepping strategy

29.  1. Present And Normal
 2. Present But Limited Or Delayed
 3. Present But Inappropriate For The Particular
Context Or Situation
 4. Abnormal
 5. Absent.

30.  Focus on –
 Maintenance of posture –static
 Balance during weight shifting or voluntary
movement
 balance responses to manual perturbations -
dynamic

31.  To Determine proprioceptive contribution to
upright balance
 Stand with feet together , eyes open unaided
for 20-30 sec
 With minimal sway- test is negative
 Test is positive- increased instability or fall
with EC
 Positive Romberg test- loss of proprioceptive
sensation

32.  Objective measure of static and dynamic
balance
 14 functional tasks commonly performed in
day to day life.
 Scoring on five point ordinal scale, 0-4
 A maximum score -56
 Score 45 or below – high fall risk

33.  Types of balance – Adaptive, reactive, postural
 Static and dynamic
 Motor responses, sensory system, CNS
integration
 Functional balance tests- Romberg test, BBS

34.  Define balance and describe types 3M
 Motor strategies 7M
 Balance Control – 7M
 Functional Balance tests- 7M
 BBS- 7M

35.  Thank You