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 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

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.

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:

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

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.

SOMATOSENSORY
 Free Nerve Endings
 Ruffini Endings

 Paciniform Corpuscles

 Golgi-Mazzoni Corpuscles

 Golgi Ligament Endings

 Muscle Spindles

PROCESSING SENSORY
INFORMATION
 Itmeans 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.

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.

BIOMECHANICAL COMPONENTS
 Here3 main strategies used are ANKLE,
HIP & STEPPING PHENOMENA

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.

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.

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

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

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

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.

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

ACTIVITIES OF TREATING
IMPAIRED BALANCE
 Impaired balance can be treated by foll
ways:

 1. Gradual intervention (mode)
 2. Posture for COG control

 3. Movement

MODE-GRADUATED
INTERVENTION
 Begin with weight shifts on a stable
surface.
 Gradually increases sway

 Increase surface challenges (mini-tramp)

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.

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.

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.

CONTAINDICATONS
 Persons who are inheritently in balance-
challenged positions.
 Pain or muscle pain.

 Inflammatory neuromuscular disease.

 Severe cardio-pulmonary diseases.

TYPES OF IMPAIRMENTS
 Mainly 4 types-
 1. Musculoskeletal

 2. Neuromuscular

 3. Cardiovascular or Pulmonary

 4. Integumentary

 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.

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”.

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Balance

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