POSTURAL CONTROL

Ability to do postural adjustments for the dual purpose of orientation and stability

Postural Control

Ability to maintain an appropriate relationship

• Between the body segments

• Between the body and the environment for a task

Postural Orientation: Posture

• Gravity  (vestibular system)

• Support surface (somatosensory system)

• Relation to objects in the environment (visual system)

Ability to maintain the body in equilibrium at rest (static) or in steady state motion (dynamic)

Postural Stability : Balance

Center of Mass is in front of ______

S2

• COM in maintained over its BOS

vertical projection of body weight

COG

boundary where we are able to balance ourselves in any position

Limit of stability

Muscle activation patterns and segmental movements that enable us to control the body segmental linkages in relation to the BOS

Postural Adjustments

Activation patterns of muscles and segments that happen prior to action (ready)

• Focus on this during acute rehab phase

Anticipatory Adjustment

• Breathing exercises when standing

• Neck, trunk movements  

• “Look up, look up at the ceiling ”

Patient must maintain postural control with the necessary adjustments needed when changing direction or movement

on going Adjustment

Ability to maintain postural control even with external forces

Reactive Adjustment

Order of Treatment for Postural Adjustments

Anticipatory → ongoing → reactive

Ability to do postural adjustments for the dual purpose of orientation and stability

Postural Control

• day-to-day activities; not just posture and balance alone

Postural Control: CRITICAL COMPONENTS

• Head balanced on level ______

  • Head should not be on ___

• Upper body _____

• Shoulders ______ of the hips in sitting

• Shoulders over _____ in standing

• Feet and knees are a few cm apart (___ cm)

• Weight evenly distributed

• Head balanced on level shoulders

  • Head should not be on list

  • Dominant shoulder is usually lower

• Upper body erect

  • Vertically erect, not listed to the side or rotated

• Shoulders in front of the hips in sitting

• Shoulders over hips in standing

• Feet and knees are a few cm apart (10 cm)

• Even WB

Postural Control: UNDERLYING IMPAIRMENTS

• Weakness: Inability to produce or maintain muscle contraction or control

  • Generating force

  • Fierce initiation timing and sequencing

  • Sustain force

  • Generating force fast enough

  • Abnormal motor control

• Sensory impairments

• Decreased soft tissue flexibility

POSTURAL CONTROL: MALADAPTIVE BEHAVIOR

• _____ of the BOS

• Shifting on to the _____ side 

• _____ the body

  • compensation to prevent fall

• Moving ____

• _____ motions instead of distal joint movements

• Avoiding the threat of balance

• Disuse of ____ side

• ____ posture

• Using the ____ for support

• Widening of the BOS

• Shifting on to the less affected side 

• Stiffening the body

  • compensation to prevent fall

• Moving slowly

• Trunk motions instead of distal joint movements

• Avoiding the threat of balance

• Disuse of paretic side

• Improper posture

• Using the hands for support

POSTURAL CONTROL REHAB GOALS (READ)

• Control of COG over BOS in a given activity within or beyond LOS

• Develop necessary and quick strategies to known and unknown external perturbations

• Prevent or reduce impairments that are important to balance

• Increase LE muscle strength and coordination to support body mass

• Retrain functional tasks with varying postural control demands

POSTURAL CONTROL TRAINING GUIDELINES

• Provide appropriate instructions and use apt feedback.

• Manipulate the attributes of the individual, task, and environment to facilitate the action.

  • Increase the difficulty 

• Recognize the contributions of the sensory and motor systems in retraining PC.

• Balance training should be task-specific because PC cannot be trained in isolation from the actions that must be relearned in a given context.

  • To improve standing due to weak muscles, strengthen the muscles in standing 

• Practice reaching beyond arm’s length.

T/F: If the patient has poor PC in standing due to weakness of LE. As a PT, you would perform MRE in supine to address the weakness.

False → MRE in Standing

• Be task specific

T/F: Postural control can be trained in isolation

False

Document the picture

Standing exercises in front of a mirror c vertical tape to improve standing postural control 

1. Proper alignment in standing X 5 mins 

2. Self-initiated movements of the head and trunk in AP X 10 reps X 1 set each 

3. Deep breathing exercise X 3 reps X 1 set

Document the picture

Stepping exercises in various directions using visual cues for 10 mins c emphasis on quick response to improve dynamic standing balance

In stepping exercise, limb loading is performed when _____ foot is moving

Unaffected

In stepping exercise, strengthening & ↑ reaction time & mobility is performed when _____ is moving.

Affected foot

Document this

analyze the progression

L side-reaching a cup on a box while short-sitting, c emphasis on side trunk flexion X 10 reps X 1 set to facilitate correct posture when reaching objects on the side 

Progression of Postural Control Exercises

• Changing the shape of the base of support

  • Use of wobble board 

• Requiring increased LE flexion and extension

  • Reaching side to side to up & down 

• Increasing the object’s distance from the body

  • Beyond arms length or cross opposite side of body

• Increasing and varying the object’s weight

• Increasing the object’s size

• Changing the location of the object

• Increasing speed demands

• Requiring a quick response

• Requiring that movement occur in directions that are difficult for the individual

Document This

Reaching diagonally to the L using the L hand c tactile cues on L knee x 10 reps x 2 sets to facilitate limb loading on L LE. (facilitates limb loading)

How do you progress this?

• 1st  photo: limb loading forward

• 2nd photo:  limb loading on the side

• 3rd photo: limb loading using both hands 

• Progression:

  • Reaching laterally to the side

  • Transferring a tray with a cup, spoon & fork using B hands from R side on the high mat to a box diagonally placed in front on L

basta masmahirap

Treatment for Postural Control in Sitting

Postural Re-education

• Promote proper alignment of posture

• Active correction of alignment with verbal of visual cues

• Promote symmetrical weight distribution (buttocks)

Treatment for Postural Control in Sitting & STANDING

Head & Trunk Movements

• Breathing exercises

• Self-initiated head and trunk rotation

• Looking up at the ceiling and down at the floor

Treatment for Postural Control in Sitting & STANDING

Reaching actions

• Reaching to touch an object

  • Done in various directions

  • May place affected side on table initially

  • Ipsilateral then contralateral reach

• Reaching to pick-up objects from the floor

  • Forward and sideways

  • One hand to two hand

Progression (standing) : change BOS, INC flex & ext of legs

Treatment for Postural Control in STANDING

Postural Re-education

• Proper alignment of posture

• Active correction of alignment with verbal or visual cues

• May Initially use

  • light splint for the affected lower limb

  • harness to reduce body weight

• Promote symmetrical weight distribution or limb loading on the affected foot

Treatment for Postural Control in STANDING

Single Leg Support

• With or without splint or body harness

• Stepping forward of the unaffected foot

• Standing with one foot a step with reaching action

• Stepping exercises "Dance revo"

Treatment for Postural Control in STANDING

Functional strength training

• Walking sideways

• Wall slides

• Step-ups

• Lunges

• Open-chain strengthening exercises

• Tai-chi

Treatment for Postural Control in STANDING

Soft tissue Stretching

• Calf muscles (positional stretch)

• Hip flexors