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HOW DO WE BALANCE
& HOW TO MEASURE
IT? MARY DANOUDIS
Physiotherapist Fall and Balance Clinic
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Function of the balance system
Maintains steady posture
and
allows functional movement
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Systems involved with balance
Neural and musculoskeletal systems that interact to select and adjust required movements and posture
Postural and movement responses are organized around the task
Responses are modified by environmental restraints Horak F 1989 , Shumway-cook A 1990
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Neural system
• Cognition / attentional
• Recognition of potential threats to balance
• Past experience to help plan best response
• Adjust and regulate attention
• ‘Automatic’ activity before voluntary movement
• Basal ganglia interacts with supplementary motor cortex to position COM before voluntary movement
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Neural systems active during
movement
Sensory systems – vision, vestibular and
somatosensory – input systems
Central nervous system – integrates, regulates
and modifies input and output
Central and peripheral neural connections to
muscular system – output systems
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Reactive system
Back up system
Ankle strategy
Step strategy
Grasp strategy- reaching out for support
• Centrally programmed
• Modifiable - not hard wired
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How to assess balance systems
• Mini BESTest
• Assesses 4 interacting interdependent systems
contributing to balance
• Preparation phase pre voluntary movement
• Sensory orientation
• Stability in gait – adaptability with various tasks
• Postural responses
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Preparation system
• 3 tasks
• Sit to stand
• Rise on toes
• Stand on one leg
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Sensory system
• 2 tasks
• CTSIB
• On firm surface, feet together (FT), eyes open (EO)
• On foam , feet together (FT), eyes closed (EC)
• Incline 100 toes up feet apart, eyes closed
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Stability in gait
• 5 tasks
• Change in gait speed – fast and slow
• Change in speed walking with head turns
• Pivot turns
• Step over obstacles
• GUG with dual task
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Reactive postural responses
Forwards
Back
To left
To right
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Task Score 2,1,0
Sit to stand
Rise on toes
Stand on 1 leg
Firm surface FTEO
Foam FTEC
Incline EC
Change speed 10m
Change speed head
turns
Pivot turn
Step over obstacle
GUG dual task
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Postural reaction Score
2,1,0
Forwards
Backwards
To left
To right