Balance

1. BALANCE

2.  DEFINITION :: It is a condition in which
all the forces acting on the body are
balanced in such a way that the centre of
mass(COM) is within the stability limits ,
the boundries of base of support(BOS).
 The overall goals of balance is to control
system stability, functions and integrated
CNS control

3. Postural Stability
Ability to maintain the COG within the
stability limits.
Normal anterior/posterior sway-12
degrees from most posterior-anterior
position.
Lateral sway-16 degrees from side to
side.
If sway exceeds boundaries,
compensation is employed to regain
balance. A smaller envelope is created
and tolerated.

4. PHYSIOLOGY OF BALANCE
Means having described about what
should be the normal position in
balanced state and how its imbalaced in
improper adjustments of the COG line.
It can be illustrated by the foll. figure:

5. CONTRIBUTION OF SENSORY
SYSTEM
Sensory system has a major contribution
in the co-ordination of balance.
Three pairs of the sensory system have
a dominating part in the same. They are
VISUAL
SOMATOSENSORY
VESTIBULAR

6. VISUAL & VESTIBULAR
NEUROPHYSIOLOGY
VISUAL NEUROPHYSIOLOGY provides
information regarding the position of the
head, related to the environment and
orients the head to maintain the gaze
level.
VESTIBULAR NEUROPHYSIOLOGY
provides information regarding the
orientation of head in space &
acceleration.

7. SOMATOSENSORY
Free Nerve Endings
Ruffini Endings
Paciniform Corpuscles
Golgi-Mazzoni Corpuscles
Golgi Ligament Endings
Muscle Spindles

8. PROCESSING SENSORY
INFORMATION
It means how all the 3 components i.e
VISUAL SOMATOSENSORY &
VESTIBULAR of the sensory system
processes in order and from which
regions to gain proper motor output.

9. COMPONENTS OF BALANCE
There are 3 chief components:
(1) sensory system
(2) musculoskeletal system
(3) vestibular
 Sensory System: As described above
MSS: Helps to maintain the normal balance by
various processes of the system such as
muscle contractions, relaxations etc.
Vestibular System: It provides the info abt the
orientation of head in space & acceleration.

10. BIOMECHANICAL COMPONENTS
Here 3 main strategies used are ANKLE,
HIP & STEPPING PHENOMENA

11. ANKLE STRATEGY
Used when displacements are small.
Displaces COG by rotation abt the ankle
joint.
Eg. Posterior displacement of COG-
Dorsiflexion at ankle, contraction of
anterior tibialis, quadriceps, abdominalis.
Anterior COG displacement-
Plantarflexion at ankle, contraction of
gasterocnemius, hamstring, trunk
extensors.

12. HIP STRATEGY
Employed when ankle motion is limited,
displacement is greater, when standing on
unstable surface that disallows ankle strategy.
Preferred when perturbation is rapid and near
limits of stability.
Post. Displacement COG- backward sway,
activation of hamstring and paraspinalis
Ant. Displacement COG- forward sway,
activation abdominal and quadriceps muscles.

13. STEPPING STRATEGY
If displacement is large enough, a
forward or backward step is used to
regain postural control.

14. CAUSES FOR IMPAIRED
BALANCE
Patients may develop balance deficits
coz of impaired sensory input from joint
mechanoreceptors and altered muscle
spindle input. This particularly occurs in
weight bearing joints.

15. CAUSES FOR IMPAIRED BALANCE
Injury or disease of eyes, inner ear,
peripheral receptors, spinal cord,
cerebellum, basal ganglia, cerebrum etc.
Injury or damage to knee, ankle, hip and
back
CVAs, tumors, visual field loss
Age

16. EXAMINATION & EVALUATION OF
IMPAIRED BALANCE
(3 categories)
1. Balance during functional activities
with or without assistive devices.
2. Balance (static or dynamic) with or
without use of assistive devices.
3. Safety during gait, locomotion or
balance.

17. EXAMINATION & EVALUATION OF
IMPAIRED BALANCE
Standing with eyes open- Fixed platform
Standing blindfolded- Fixed platform
 Sway-refernced vision with fixed support
Normal vision with sway-referenced
support
Absent vision with sway-referenced
support
Sway referenced vision and support

18. ACTIVITIES OF TREATING
IMPAIRED BALANCE
Impaired balance can be treated by foll
ways:
1. Gradual intervention (mode)
2. Posture for COG control
3. Movement

19. MODE-GRADUATED
INTERVENTION
Begin with weight shifts on a stable
surface.
Gradually increases sway
Increase surface challenges (mini-tramp)

20. POSTURE
Often includes “core stability training” to
improve COG control and sense of trunk
posture.
 Begin in supine or seated position.
Over sessions, use a variety of arm
positions, unstable surfaces, single leg
stances etc.

21. MOVEMENT
Adding movement patterns to acquired stable
static postures increase balance challenge.
Add ant./post sway to increase stability limits.
Trunk rotations and altered head positions
alter vestibular input.
PNF Techniques during trunk rotation.
Stepping back/forward assists in re-
stabilization exercises.

22. PRECAUTIONS FOR IMBALANCE
Pain should not occur during exercises.
Donot initiate exercises at maximum level.
Avoid uncontrolled, ballistic movements as
they compromise safety & effectiveness.
Avoid exercises that creates stress on back.
Discontinues exercises if patient experiences
pain, dizziness or unusual shortness of breath.
Eliminate obstacles or unsafe instruments from
exercise area.

23. CONTAINDICATONS
Persons who are inheritently in balance-
challenged positions.
Pain or muscle pain.
Inflammatory neuromuscular disease.
Severe cardio-pulmonary diseases.

24. TYPES OF IMPAIRMENTS
Mainly 4 types-
1. Musculoskeletal
2. Neuromuscular
3. Cardiovascular or Pulmonary
4. Integumentary

25. MUSCULOSKLETAL-
Pain, muscle weakness, Jt. Hypermobility, Faulty posture,
muscle imbalances, limited ROM etc.
•NEUROMUSCULAR-
Pain, impaired balance, delayed motor development,
ineffective, abnormal tone.
•CARDIOVASCULAR-
↓ed aerobic capacity, impaired circulation, pain with
sustained physical activity (intermittent claudication).
•INTEGUMENTARY-
Skin hypomobility.

26. BALANCE RETRAINING
Retraining the lost co-ordination of
balance to the normal stable balanced
control through development of muscular
activity and generation of motor output is
called “BALANCE RETRAINIG”.