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Postural Control
DongDong-Eui Medical Center Rehab. Therapy Center PT. SEO SUNG WOO
Definition
The terms balance balance,equilibrium equilibrium and postural control control are used as synonyms for the same concept of the mechanism by which the human body prevents itself from falling or loosing balance
(Ragnarsdottir 1996)
POSTURAL CONTROL
controlling the body bodys position in space for the dual purposes of stability and orientation orientation
(Shumway-Cook and Woollacott 1995)
POSTURAL ORIENTATION
This involves The ability to maintain the appropriate alignment between body segments The appropriate relationship between the body and the environment. environment. Requires establishing a vertical orientation to counteract the forces of gravity. Creates a reference frame for perception and action with respect to the external world.
POSTURAL STABILITY
This involves Maintaining the body bodys centre of mass within boundaries of space, referred to as stability limits. Stability limits are boundaries of an area of space in which the body can maintain it its position without changing it its base of support.
(McCollum & Leen, 1989)
Stability Limits
Stability limits are not fixed but change according to
CORE
1.The core has been described as a box with the abdominals in the front, paraspinals and gluteals in the back, the diaphragm as the root, and the pelvic floor and hip girdle musculature as the bottom.
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The task
The individual The environment
Postural control
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Individual
(Richardson, 1999)
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2. The core has been referred to as the powerhouse the foundation or engine of all limb movement
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Appropriate alignment of body segments Appropriate muscle activation Orientate in midline Interactive with BOS Linear acceleration against gravity
Core stability
Core Stability is the coco-activation of the deep muscles of the lower trunk to control displacement during - Weight transfer - Functional activities of the limbs (reaching and stepping) - Stability limits.
Kapandji 1974
Normal
Inefficient
Systems Model
Maintain a variety of positions / postures Loose and regain midline - displacements Provide a reference frame and stability to selectively move our eyes, head or limbs Move from one position to another Carry out cognitive tasks whilst moving i.e. dual tasks Function independently within a changing environment
Neuromuscular Synergies Individual Sensory Systems
Musculoskeletal Components
Balance Strategies
Internal Representation
Musculoskeletal
Neuromuscular
Normal tone Reciprocal innervation Patterns of movement / coordination Appropriate level of activation / timing / force
Sensory Systems
Lawes 2000
Internal representation
It is thought that an internal representation of body posture exists within the CNS.
Anticipatory Mechanisms
Predictive strategy PrePre-programmed muscle groups / force Minimises postural displacements Central stability Prerequisite of selective movement Experience Movement / task specific
Postural Body Schema. Body Schema incorporates body geometry, kinetics, orientation with respect to gravity.
Motor,Sensory Homunculus
Anticipatory Mechanisms
TrA IO EO RA MF -100 -50 0 50
Hodges & Richardson 1997 Extension Flexion Abduction
Adaptive Mechanisms
Reactive strategy Feedback / regulation of movement Based on current experiences Updates body schema Motor / balance strategies
EMG activity of each of the trunk muscles relative to that of the prime mover.
SUMMARY
Control of posture and movement requires initiation and planning at the highest level, control and updating from the middle level, and execution and regulation of the task at the lowest level. However it must be stressed that interaction between these levels is constant and ongoing, providing information in both directions.
Edwards 1996
Central Command
reticular
Limb Movement
cerebellum
Unexpected Displacement