1. Balance Wael Alasaq PT. Ph.D. PT Department Kuwait University

2. Wael Alasaq PT.Ph.D Balance What is Balance?  Balance involves the regulation of movement of linked body segments over supporting joints & base of support (Mackinnon & Winter 1993) What is postural control? The regulation of the body ’ s position in space for the dual purposes of stability & orientation. (Shumway-Cook & Woollacott).

3. Wael Alasaq PT.Ph.D Balance Cont. Postural adjustments have 3 goals: 1.Support body against gravity & other external forces. 2.Maintain the center of body mass (CBM) within the base of support (BOS). 3.To stabilize parts of the body while moving other parts.

4. Wael Alasaq PT.Ph.D Balance Cont.  How balance is regained (postural adjustments)? 1.Muscle activation 2.Segments movement

5. Wael Alasaq PT.Ph.D Systems participating in postural control are: 1- Sensory System –Vision: Provide information about our orientation to the environment & help in predicting upcoming perturbation. –Somatosensory including joints receptors, muscle proprioceptors, cutaneous, & pressure receptors –Vestibular 2- Musculoskeletal 3-

6. Wael Alasaq PT.Ph.D Old vs. new terms & their effects on ttt It was often referred to postural adjustments as: – postural reaction – postural reflexes or – equilibrium reactions.

7. Wael Alasaq PT.Ph.D Biomechanical Description 1. Balancing during motor action in standing 2. Balancing during motor action in sitting 3. Balancing during body transport

8. Wael Alasaq PT.Ph.D Balancing during motor action in standing  Postural sway: Postural sway  Balance is affected by the task & environment  Postural responses to unexpected perturbation

9. Wael Alasaq PT.Ph.D Balancing during motor action in setting Balancing during motor action in setting  BOS  CBM is closer to the BOS  Moving or reaching in setting requires postural adjustments as well.  Lower limb muscles are involved in anticipatory, ongoing and reactive postural adjustments.

10. Wael Alasaq PT.Ph.D Balancing during motor action in setting Cont. Balancing during motor action in setting Cont.  Trunk muscles act as postural stabilizers, especially when upper limbs are used and for reaching.  When reaching side ways destabilization occurs faster than forward reach.  When feet are unsupported the limits of stability is reached much earlier, such as setting over the side of the bed

11. Wael Alasaq PT.Ph.D Balancing during body transport  Walking  Standing up & Sitting down

12. Wael Alasaq PT.Ph.D Walking  Balance is affected by both task & environment.  Control of balance in walking vs. in standing.  Loss of balance may occur due to many factors: Find them in your book

13. Wael Alasaq PT.Ph.D Standing up & sitting down  The movt. in the sagital plane  Demands control of linear momentum & Muscle activations  Healthy elderly decrease speed of standing up  Falls in these activities are common in elderly

14. Wael Alasaq PT.Ph.D Standing up & sitting down Cont.  Stroke pts experience difficulties with balance throughout standing.  Muscles which are important in controlling the standing up are …………. & those controlling sitting down are ………. 

15. Wael Alasaq PT.Ph.D Age-related changes  Postural instability in elderly and tendency to fall can be attributed to many factors. Go and find them!  Are @ high risk of pathologies accelerating degeneration in neuromusculoskeletal systems  Biomechanical factors (musculoskeletal flexibility & MM strength)  30-80 yrs decrease of 40% UL & 30% LL strength

16. Wael Alasaq PT.Ph.D Age-related changes

17. Wael Alasaq PT.Ph.D Observational analysis & Guidelines for balance training  In trios read and practice the activities in Carr & Shepard book pp50-71.

18. Wael Alasaq PT.Ph.D Functional Tests  Functional reach test  Step Test  TUGT  BBS