This document defines balance and its components, types, evaluation, and training. It states that balance is the ability to control the center of mass in relation to the base of support. The main components of balance are the sensory systems (visual, somatosensory, vestibular), sensory integration, feedback and feedforward mechanisms, and motor components. There are three types of balance: static, dynamic, and automatic. Balance is evaluated through tests like Romberg tests and functional reach tests. Balance training focuses on static, dynamic, and anticipatory postural control through exercises involving stable and unstable surfaces, narrow stances, and additional tasks.

1. “Balance”
or
“Postural Stability”
Dr.Preeti Ghodge(M.P.T)

2. Contents:
• Introduction
• Definition
• Components
• Types
• Evaluation
• Training

3. Introduction
 Important when rehabilitating patients with variety of
disorder’s :-
 Balance training is increasingly being integrated into clinical
practice.
 Rehabilitation plan of care for each of these patients should
include a balance components.
 Reduce risk of fall

4. Definition:
Balance is the ability to maintain equilibrium or the ability to
control the center of mass(COM) relative to the base of
support (BOS).

5. Orientation(Posture):-
Ability to maintain appropriate
relationship between the body
segments, and between the
body and the environment.
Stability(Balance):-
Ability to control the center of
mass(COM) in relationship to
the base of support (BOS).

6. Components :

7. Sensory Components :
Visual
Somatosensory Vestibular

8. Sensory Integration:
Information from somatosensory, visual and vestibular systems
are constantly integrated to interpret the environment.

9. Feedback Mechanisms
• Feedback control refers to postural control that occurs in
response to sensory feedback (visual,vestibular &/or
somatosensory) from an external pertubation
• Support surface moves
• Trips and slips
• Reactive Control

10. Neuromuscular Synergies:
Automatic Postural Responses(APRs)
Ankle strategy

11. Feed forward Mechanisms
• Feed forward control refers to postural response that are made
in anticipation of a voluntary movement that is potentially
destabilizing in order to maintain stability during the
movement.
• Proactive control

12. Motor Components:
• Postural motor mechanisms primarily engage in voluntary
motor pathways to maintain balance.
• 2 main goals :
Proactive Response:- Predict disturbances that occur during
voluntary movement, and thus maintain balance during active
or planned movement.
Reactive Response:- React to outside or unplanned
disturbances and recover balance.

13. Reactive Postural Response use:
• Movement Strategies to restore
the COM over the BOS after a
disturbance.
• 3 main Strategies:-
• Ankle
• Hip
• Stepping
Ankle Hip Stepping

14. Ankle Strategy:
The body moves at the ankle
 Used when:
• Balance disturbance is small
• Standing surface is wide and
firm
 Head moves in unison with
hips, like and inverted
pendulum
 Muscles are recruited from
distal to proximal

15. Hip Strategy:
The body moves at the hip
 Used when:
• Balance disturbance is
moderate or fast
• Surface is narrow or
compliant
 Head movement is opposite
in direction to hips
 Muscles are recruited
proximal to distal

16. Stepping Strategy:
One or more steps are taken
 Used when :
• Balance disturbance is strong
or fast
• BOS needs to move quickly
 Commonly used during
walking
 BOS moves quickly to catch
up with COM

17. Suspensory Strategy:
 Trunk bends forward
with hip and knee
flexion --> squatting
position
 Quickly lowers
COM over BOS,
immediately making
you more stable

18. Types:
1)Static :balance control to maintain a stable antigravity position
while at rest.
eg.Sitting or Standing.
2)Dynamic :balance control to stabilize the body when the
supporting surface is moving or the body is moving on astable
surface.
eg.Sit to stand transfers or walking.

19. 3) Automatic : postural reactions to maintain balance in response
to unexpected external pertubations.
eg. standing on a bus that suddenly accelerates forward.

20. Balance Evaluation:
Static Balance Test:
Romberg test
Sharpened Romberg or tandem Romberg
Single_Leg Balance Stance Test(SLB)
Stork Stand Test
Dynamic Balance Test:
Five-times-sit-to-stand test

21. Anticipatory Postural Control Tests:
Functional Reach Test
Balance Error Scoring System (BESS) :

22. Balance Training:
• Static Balance Control:
Maintain Sitting ,Half –Kneeling,Tall kneeling and standing on
a firm surface.
Challenging Activities:
Tandem and single –leg stance,lunge and squat positions.
Progression:
Soft Surfaces(eg.foam,sand,grass),Narrow base of support,
Moving arms, Closing eyes.
Resistance via handheld weights or elastic resistance
Add secondary task (catch ball or mental calculations)

23. • Dynamic Balance Control:
Maintain equal weight distribution and upright trunk postural
alignment on moving surface. Eg. Sitting on therapeutic
ball,standing on wobble boards or bouncing on mini-trampoline.
Progression :
body weight shifting ,rotating the trunk, moving head or arms.
Practice stepping exercises :small steps,mini lunges to full lunges.
Hopping,Skipping,Rope jumping and hopping down from small
stool while maintaining balance.
Arm leg exercises while standing with normal stance, tandem
stance,ans single leg stance.

27. References:
• Kisner,C.& Colby,L.(2012).Therapeutic Exercise Foundations
and Techniques,6th ed.,F.A.Davis.
• Carrie M.Hall &Lori Thein Brody (2011). Therapeutic
Exercise Moving Toward Function,3rd ed.,Wolter Kluwer.

28. Thank You