postural assessment presentation_2010.pptx

postural assessment presentation_2010.pptx

1. ASSESSMENT OF POSTURE

2. POSTURE is defined as the composite alignment of all the joints of the body at any given moment in time Posture can be Static: body segments aligned and maintained Eg . Standing, sitting, lying, kneeling Dynamic: body or its segments are moving Eg . Walking, running, jumping

3. Basic terminologies Base of support ( BoS ) Center of gravity ( CoG / CoM ) - In sitting : located near the armpits - In standing : children >> at level of 12 th vertebra adult >> at level of second sacral segment

4. Postural control can be either static or dynamic refers to a persons ability to maintain stability of the body and its segments in response to forces that threaten to disturb the body’s equilibrium >> Depends on the integrity of the CNS, visual system, Vestibular system, and musculoskeletal system Reactive (compensatory) >> reaction to external forces Proactive (anticipatory) >> internally generated destabilizing forces

5. Goals of postural control >> to control body’s orientation in space >> maintain body’s CoM over the BoS >> stabilize the head with regard to vertical so that the eye gaze is appropriately oriented

6. Muscle synergies and strategies Muscle synergies are centrally occurring patterns of muscle activity that occur in response to perturbations of standing postures Perturbation is a sudden change in position that displaces body posture away from equilibrium Sensory perturbation >> altering of visual input Mechanical perturbation >> direct changes in relationship of CoM to BoS

7. Fixed support synergies are patterns of muscle activity in which BoS remains fixed during perturbations and recovery of equilibrium Stability is gained through movements of body parts but feet remain fixed on the BoS Eg . Ankle synergy >> discrete bursts of muscle activity >> on anterior or posterior aspects >> occur in distal to proximal pattern >> forward and backward movements of support platform Hip synergy >> discrete bursts of muscle activity >> on the side of the body >> opposite to ankle pattern >> in proximal to distal pattern of activation

8. Change-in-support strategies Moves or enlarges the body’s BoS so that the LoG remains under the CoM Stepping (forward, backward, sideways) Grasping (using one’s hand to grab a bar or a fixed support) Head stabilizing strategies U sed to maintain head during dynamic tasks like walking Head stabilization in space (HSS) Head stabilization on trunk (HST)

9. Basic principles for evaluating and treating postural problems relating to alignment, joints and muscles Faulty alignment results in undue stress and strain on bones, joints, ligaments and muscles Joint positions indicate which muscles appear to be elongated and which appear to be shortened A relationship exists between alignment and muscle test findings if posture is habitual Muscle shortness holds the origin and insertion of the muscle together

10. Adaptive shortening can develop in muscles that remain in shortened condition Muscle weakness allows separation of the origin and insertion of the muscle Stretch weakness can occur in one-joint muscles that remain in an elongated condition

11. Analysis of standing posture (sagittal view) A plumb line or line with weight, dropped from the ceiling passing through external auditory meatus of ear may be used to represent LoG Subject should be standing in good light and preferably wearing minimal clothing

12. Analysis of standing posture (anterior view) LoG bisects body in symmetrical halves Head straight with no tilting/ rotation Eyes, clavicles, shoulders at level parallel to ground Inferior angle of scapulae parallel to ground and equidistant to LoG Waist angles, gluteal fold should be equal ASIS and PSIS parallel to ground Joint axes of hip, knee and ankle equidistant from LoG

13. Analysis of posture in standing (posterior view)

14. Shoulders and scapulae, good position

15. Scapulae, abducted and slightly elevated

16. Shoulder elevated, scapulae adducted

17. Shoulders depressed, scapulae abducted

18. Scapulae, adducted and elevated

19. Scapulae abnormal appearance

20. Abducted and slightly winged scapulae

21. Abducted scapulae and forward shoulders

22. Thank you