Balance consists of both static and dynamic components. Static balance refers to maintaining a static position against gravity, while dynamic balance refers to maintaining control during movement. Balance is achieved through integration of inputs from the visual, vestibular, and somatosensory systems. Good balance control allows safe and controlled movement. Posture is maintained through modulation between global organization to regulate equilibrium and modular organization to orient body segments for perception and action.
Balance consists of both static and dynamic components. Static balance refers to maintaining a static position against gravity, while dynamic balance refers to maintaining control during movement. Balance is achieved through integration of inputs from the visual, vestibular, and somatosensory systems. Good balance control allows safe and controlled movement. Posture is maintained through modulation between global organization to regulate equilibrium and modular organization to orient body segments for perception and action.
Balance consists of both static and dynamic components. Static balance refers to maintaining a static position against gravity, while dynamic balance refers to maintaining control during movement. Balance is achieved through integration of inputs from the visual, vestibular, and somatosensory systems. Good balance control allows safe and controlled movement. Posture is maintained through modulation between global organization to regulate equilibrium and modular organization to orient body segments for perception and action.
Balance consists of both static and dynamic components. Static balance refers to maintaining a static position against gravity, while dynamic balance refers to maintaining control during movement. Balance is achieved through integration of inputs from the visual, vestibular, and somatosensory systems. Good balance control allows safe and controlled movement. Posture is maintained through modulation between global organization to regulate equilibrium and modular organization to orient body segments for perception and action.
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Richi HW ;
Neurodiv PMR Dept.,
BALANCE Balance consists o !oth static and d"na#ic co#ponents.$tatic !alance is de%ned as the status o the !od" in &hich all orces actin' on the !od" are !alanced, &here the !od" re#ains static in an intended position or orientation; d"na#ic !alance is reerred to as the status in &hich the su##ed orces on the !od" allo& the !od" to #ove in a controlled #anner. Accordin' to this de%nition, !alance control a!ilities are unda#ental to a &ide ran'e o dail" activities ran'in' ro# static to d"na#ic ones. (ood !alance control a!ilities &ould indicate that successul posture)voluntar" #ove#ent inte'ration is achieved so that a person is a!le to ul%ll the 'oal o a voluntar" tas* in a sae #anner. +his de%nition also i#plies that the nature o !alance control #echanis#s is tas*,speci%c. People that have !etter static !alance control do not necessaril" sho& !etter d"na#ic !alance control, and vice versa. Balance, postural control or e-uili!riu# are de%nitions used to descri!e ho& &e *eep our !od" in an upri'ht position and, &hen necessar", ad.ust this position. /t has !een descri!ed as 0sensin' the position o the !od"1s centre o #ass and #ovin' the !od" to ad.ust the position o the centre o #ass over the !ase o support provided !" the eet2. /n order to #aintain !alance, vision, the so#atosensor" s"ste# and the vesti!ular or'an interact and re'ister inputs ro# the surroundin's, &hich are inte'rated and processed in the central nervous s"ste#. +he vesti!ulo,ocular re3e4 567R8 coordinates e"e and head #ove#ents, #a*in' it possi!le, or e4a#ple, to &al* and read si'ns at the sa#e ti#e. +he cervico,ocular re3e4 interacts &ith the 67R, providin' inor#ation a!out head #ove#ents in relation to the trun*. $ensor" receptors in the s*in as &ell as #echanoreceptors in the #uscles provide input as to ho& 'ravit" a9ects the !od" :or the preservation o !alance, input ro# the di9erent parts o the !alance s"ste# is constantl" reconsidered and response ro# the #otor corte4 is sent !ac*. +his #eans that the !od" is constantl" in #otion, &hich is called postural s&a" . +hree #a.or sensor" s"ste#s are involved in !alance and posture. 6ision is the s"ste# pri#aril" involved in plannin' our loco#otion and in avoidin' o!stacles alon' the &a". +he vesti!ular s"ste# is our ;'"ro1, &hich senses linear and an'ular accelerations. +he so#atosensor" s"ste# is a #ultitude o sensors that sense the position and velocit" o all !od" se'#ents, their contact 5i#pact8 < &ith e4ternal o!.ects 5includin' the 'round8, and the orientation o 'ravit". Neuro, ph"siolo'ists have devised a &ide ran'e o e4peri#ents to tease out the contri!ution o each o these s"ste#s and even to conuse the s"ste# !" providin' con3ictin' or alse sensor" inputs. +he so#atosensor", visual, and vesti!ular s"ste#s are the three #ain !alance senses. +he so#atosensor" s"ste# provides inor#ation on the position or #otion o the !od" &ith respect to the supportin' surace and the position or #otion o !od" se'#ents &ith respect to each other. +he visual s"ste# provides inor#ation on the orientation and #otion o the !od" &ith respect to 'lo!al space. +he vesti!ular s"ste# senses the linear and an'ular acceleration o the head as &ell as the head position relative to 'ravit". Nor#all", these three senses &or* to'ether to detect relevant peripheral sensor" inor#ation ro# the environ#ent, to develop an internal representation o the !od" in 'lo!al space, and to tri''er proactive or reactive !alance ad.ust#ents, in an atte#pt to #aintain static and d"na#ic !alance under certain tas* and environ#ental conte4ts. = P7$+>RAL C7N+R7L D>R/N( ?>/E+ $+ANCE Erect posture in hu#ans is achieved !" the superposition o !od" se'#ents 5head, trun* and le's8 alon' the lon'itudinal a4is. +his superposition is such that it should ul%l the t&o unctions o posture. +he %rst is the anti'ravit" unction. +he superposition o se'#ents is peror#ed a'ainst the orce o 'ravit" and the associated 'round reaction orces. +he postural tone, &hich is predo#inantl" distri!uted a#on' the e4tensor #uscles, pla"s an i#portant role in this anti'ravit" unction. +here is an additional constraint, &hich is e-uili!riu# #aintenance. +his #eans that the positionin' o !od" se'#ents 5&hich is onl" restricted !" the #echanical li#its o .oint #ove#ent8 should !e such that the pro.ection o the center o 'ravit" 5C(8 re#ains inside the support !ase under static conditions. A second unction o posture is to serve as an interace &ith the e4ternal &orld or perception and action. /t #eans that the orientation &ith respect to space o 'iven !od" se'#ents such as the head, the trun* or the ar# are used as a reerence ra#e. +he reerence ra#e #a" !e used either to perceive the position o the !od"1s #ove#ent &ith respect to the e4ternal &orld or to or'ani@e#ove#ents to&ard a tar'et in e4ternal space. +a*in' into account the unctions o posture accordin' to the conte4t and the tas*, t&o #odes o posturalor'ani@ation have !een proposed. :irst, a 'lo!al or'ani@ation o posture is #ainl" related to e-uili!riu# control. /t is represented !" the inverted pendulu# #odel descri!ed !" Nashner and McCollu#. +he reerence value to !e re'ulated or e-uili!riu# control is still a #atter o discussion. Balance,stricto sensu, is preserved &hen the center o pressure 5CP8 re#ains inside the support !ase 5i.e. the surace under the eet8. >nder static conditions this corresponds to the pro.ection o the C(. Ho&ever, under d"na#ic conditions, as, or e4a#ple,initiation o 'ait, the C( is accelerated !" a tor-ue at the level o the an*le .oint created !" activatin' #uscles controllin' that .oint;this causes a shit othe CP,&hich #oves a&a" ro# the C( pro.ection. +hus, !oth CP position and C( pro.ection onto the support !ase should !e ta*en into account or e-uili!riu# control in d"na#ic conditions. Accordin' to the #odelin' o PaA and Patton,the !order o the sta!ilit" li#its can !e predicted in d"na#ic conditions !" a co#!ination o three para#etersB the CP position, the C( hori@ontal position and the C( velocit". /n order to re'ulate the C( position, &hich is located at the level o the pelvis, the &hole !od" can !e #oved as an inverted pendulu# C around the an*le .oint. Ho&ever, as &ill !e co##ented on later, these oscillations are ver" slo& 5re-uenc" around D.= H@8 !ecause o the hi'h inertia o the !od". /n case o ast pertur!ations, ast corrections are re-uired. 7ther !od" se'#ents &ith lo&er inertia 5trun* around the hip, thi'h around the *nee8 are then #oved or ast corrections. /nterestin'l", the constraints related to !od" inertia are not onl" i#portant or e-uili!riu# control. +he" are also a *e" characteristic or the or'ani@ation o #ove#ents. :or e4a#ple, it is possi!le to couple a set o .oints !" increasin' the correspondin' .oint sti9ness. +his results in creatin' a ne& ense#!le &ith an increased inertia correspondin' to that o the &hole set o se'#ents coupled to'ether. Droule@ and Bertho@ introduced the concept o topolo'ical or'ani@ation o posture in order to descri!e this reor'ani@ation o !od" inertia. +he" provided t&o e4a#ples. When readin' a paper &hile &al*in', sti9ness o the ar#, trun* and head is increased in order to create a ne& hi'h inertial ense#!le that &ill reduce the #ove#ents o the ar#s &ith respect to the head. Conversel", unloc*in' the ar# ro# the trun* occurs in tas*s &here the sta!ilit" o the hand position in space should !e preserved independentl" ro# the trun* oscillations, as &hen the su!.ect is &al*in' holdin' a ull 'lass in the hand. A second #ode o or'ani@ation is #odular or'ani@ation, &hich is used or orientin' se'#ents such as the head and trun* 5&hich serve as a reerence ra#e or perception and action8 &ith respect to space. +he various se'#ents o the *ine#atic chain ro# the eet to the head are not controlled as a sin'le unctional unit, !ut as a superposition o individual ;#odules1. Each #odule is tied to the ne4t one !" a set o #uscles &hich has its o&n central and peripheral control, ai#ed at #aintainin' the reerence position o the #odule. +he head is the site o di9erent cate'ories o sensors, such as the retina, the la!"rinthine a9erents and the nec* #uscle proprioceptors. Each cate'or" o receptors has !een sho&n to !e a!le to sta!ili@e the head. +he head can !e sta!ili@ed &ith respect to 'a@e,verticalit" and to the trun*. 7rientation and sta!ili@ation o the trun* a4is, &hich is the lar'est a4is o an" !od" se'#ent, is critical. /nterestin'l", #aintainin' e-uili!riu# throu'h the 'lo!al or'ani@ation o posture and preservin' the orientation o !od" se'#ents &ith respect to space #a" !e con3ictin' in 'iven #otor acts throu'h the #odular control o posture. :or e4a#ple, there &ill !e a con3ict !et&een e-uili!riu# #aintenance and holdin' a ull 'lass o &ine !" the hand 5local posture8 &hen a postural distur!ance occurs that endan'ers !alance. +he sta!ili@ation o the head in space durin' loco#otion is used as a navi'ational inertial plator# or the evaluation o the visual or la!"rinthine inputs. +hese inputs si'nal chan'es o !od" position &ith respect to the e4ternal &orld. E Another i#portant role o this #odular or'ani@ation o posture is to serve as an e'ocentric reerence ra#e or the or'ani@ation o #ove#ent. F