The document discusses postural control and balance, defining it as the ability to control body position in space. It describes static and dynamic postural control, and notes an intervention program should be based on an accurate evaluation. The summary provides exercises to improve postural alignment, control of movement, adaptation to tasks/environments, and fall prevention. A balance training program incorporates steady state, anticipatory and reactive exercises focusing on static and dynamic postural control.

1. Dr.Fatima Ejaz PT
MS Neurophysical therapy

2.  It is defined as:
 The ability to control body’s position in space
for stability and orientation .
 POSTURAL ORIENTATION: is the ability to
maintain normal alignment relationships
between the various body segments and
between the body and the environment.

3. 1. Static postural control
2. Dynamic postural control
 Static postural control(Static balance control,
stability): is the ability to maintain stability and
orientation with the COM over the BOS with the
body at rest.
 Dynamic Postural control (Dynamic balance
control , controlled mobility) : is the ability to
maintain stability and orientation with the COM
over the BOS while parts of the body are in
motion .

4.  An intervention program to improve postural
control must be based on an accurate
evaluation of data obtained during
examination of deficits.

5.  Training activities can be used to improve the
following:
 Postural alignment, body mechanics and static
postural control
 Dynamic postural control, including
musculoskeletal responses necessary for control
of movement and posture.
 Adaptation of balance skills for varying task and
environmental conditions.
 Use of sensory monitoring for postural control
 Safety awareness and compensatory strategies
for effective fall prevention.

6.  Balance is based on a developmental
perspective of reflex control:
 (i-e righting and equilibrium reactions)
 Organization of postural control strategies
must be viewed as flexible not rigid involving
multiple body segments and postural
strategies.

7.  Initial conditions
 Balance requirements and challenges
 Pertubation characteristics
 Learning and intention
 The patient needs to practice steady state,
anticipatory and reactive balance control
using activities that focus on both static and
dynamic postural control.

8.  Functional activities selected should be based
on an accurate evaluation of the patients
abilities and needs.
 The activities should include those required
for ADL,as well as those required for social
participation, recreation, and work if
appropriate.
 Sensory selection and organiation should be a
part of a balance training program.
 Recreation and practice are essential factors
in assisting CNS adaptation.

9.  Some balance training activities may cause
patient distress initially.the therapist will feel
threatened when placed in situations where
he or she is in jeaopardy of falling.
1. The therapist should ensure patience
confidence by providing a clear explanation
of the nature of the task,
2. that the challenges to balance are,
3. and the steps the therapist will take to
prevent falls in terms that are easy to
understand.

10.  The patient with unstability can wear a gait belt
or practice standing activities wearing an
overhead safety harness.
 The therapist needs stand close as to interfere
with the activity.
 For the very unstable patient, two spotters may
be necessary.
 The environment can be used to assist in keeping
the patient from falling. E.g: standing exercises
can be formed in parallel bars, between two
tables , near a wall or two walls (corner
standing)or in a pool with the patient standing in
waist high or chest high water).
 Support given early in training should be
withdrawn as soon as possible to allow focus on
active control

11.  It will direct the therapist in improving the
postural al polignment and body mechanics.
 Sitting is a relatively stable posture with
moderately high COM and a moderate BOS
that includes contact of buttocks, thighs and
feet with support surface.
 During normal sitting, weight is equally
distributed over both buttocks with pelvis in
neutral position or tilted slightly anterior.

12.  Patient who demonstrate impairements in static
postural control ( stability) are unable to maintain
or hold a steady position for a number of reasons
including :
 Decreased stength
 Tonal imbalances ( hypotonia, spasticity,
dystonia)
 Impaired voluntary control
 Hypermobility ( ataxia , athetosis)
 Sensory hypersensitivity(tactile avoidance
reaction)
 Or increased anxiety or arousal ( high sypathetic
fight of flight)

13.  Instability is associated with excessive
postural sway , Wide BOS , low or high guard
hand position, holding onto an object in the
environment ( handhold), and loss of balance
(falls).
 The therapist can select any number of
weight bearing ( antigravity) postures to
develop stability control.
 Typical training postures include sitting and
standing ( in modified plantigrade and full
standing) .

14.  Are selected on the basis of
1. Patient safely and level of control
2. Importance in terms of functional tasks
 The therapist varies the level of activities,
selecting activities activities that both allow
success and provide an appropriate challenge
for the patient.

15.  Therapist focus on symmetrical, balanced weight
bearing.
 Patient may present with specific directional
instabilities such as weight bearing more on one
side than the other .e.g: after a stroke the patient
keeps weight centered toward the less affected
side.
 Practice should focus on redirecting the patient
into a centerd position by moving towards the
more affected side.
 The patient is instructed to hold steady while
sitting or standing and maintaining a visual focus
on a target.
 Progression is to holding for longer and longer
duration.

16.  Patient who demonstrate impairements in
dynamic anticipatory postural control are unable
to control postural stability and orientation while
moving segments of the body.
 A number of impairements may be contributing
factors including :
 Tonal imbalances ( spasticity, rigidity, hypotonia),
ROM restrictions , impaired voluntary control,
hypermobility ( ataxia, athetosis, impaired
reciprocal actions of the antagonists( cerebellar
dysfunctions or improved proximal stabilization.

17.  Patient demonstrates difficulty in weight
shifting from side to side , forward-
backward, or diagonally.
 Difficulties are also apparent in moving one
or more limbs while maintaining a posture (
sometimes referred to as static dynamic
control). E.g one limb is moving (UE reaching
or LE stepping) while the patient maintains
the sitting or standing.