Balance
Statistics
• Geriatric most at risk for falling
• Frail bones, weaker
• Neural system not firing as quick
• Muscles losing strength
• Comorbidities leading to impairments
• More likely to fall after falling once/they are scared and timid and can cause them to be
more off balance
• Cognitive impairments-not aware of something that could put them at high risk of falling
• Fear of falling common in elderly-can lead to depression, decreased function/other
impairments -decreased strength and ROM
• Females have higher risk of falling-especially with incontinence-running to bathroom-
higher risk of falling
Balance
• Body is controlling the body’s center of gravity over the base of support
• Center of mass
• Essential for movement and function
• Body is aware and can react
Static balance
• No active/voluntary movement that goes out past our limits of stability
• Quiet balance
• Standing still-can move arms but still static balance is occurring of rest of body
Limits of stability
• Like a cone-cone of stability p 265
• Greatest distance that a person can lean away from base of support without altering the
base of support
• Normal adult- 12 degrees anterior and posterior and 16 degrees lateral
• Standing-top of body-can lean forward, but bottom will stay standing
Dynamic balance
• Ability to balance while movement is occurring
• Involves muscular activity that responds based on us going outside of base of
support/outside limits of stability
, Proactive balance
• Within our body that we will anticipate or prepare for some type of disturbance
• Disturbances with balance (force)-perturbations. Challenge how we maintain balance
• Tossing water bottle-person knows water bottle is coming and can prepare for it
• Natural motor response will anticipate it/tensing or bracing
Reactive balance
• How we react to disturbances that we are not prepared for
• Walking and something bumps into you
• Have to quickly react to something- have a motor response
Base of support
• Any surfaces that experiences pressure as a result of body weight and gravity
• Usually ground/chair-accepting weight downward
• Encompasses perimeter around all surfaces accepting body weight
Center of gravity
• Is slightly anterior to s2
• Weight on all sides is equal
• Cog is not fixed, postural changes
• All planes intersect within body
• Equal distribution of mass throughout body
• Is not fixed, moves based on how we move
• Hands in front, goes slightly anterior
• Hands above, goes slightly superior
• Should maintain cog over bos
• Within limits of stability-may not require cog to change
Sensory components of balance
• Sensory input from proprioceptive/somatosensory, visual, and vestibular
• All work together to maintain upright position
Proprioception/somatosensory
• Sensory input- goes to CNS-integration-motor output in response-step 1
• Proprioception-ability to sense position in space: don’t have to look to see if arm is bent,
mechanoreceptors- sensory organ within our joints, are responsible for joint position, if
there is movement at joint, or stress on joint
• Somatosensory- Golgi tendon organs-senses changes in tension, muscle spindle-changes
in length or velocity
• Skin mechanoreceptors: detect changes with potential vibrations, light touch, deep
pressure, or if skin stretches, any changes could potentially lead to disturbance in balance
Statistics
• Geriatric most at risk for falling
• Frail bones, weaker
• Neural system not firing as quick
• Muscles losing strength
• Comorbidities leading to impairments
• More likely to fall after falling once/they are scared and timid and can cause them to be
more off balance
• Cognitive impairments-not aware of something that could put them at high risk of falling
• Fear of falling common in elderly-can lead to depression, decreased function/other
impairments -decreased strength and ROM
• Females have higher risk of falling-especially with incontinence-running to bathroom-
higher risk of falling
Balance
• Body is controlling the body’s center of gravity over the base of support
• Center of mass
• Essential for movement and function
• Body is aware and can react
Static balance
• No active/voluntary movement that goes out past our limits of stability
• Quiet balance
• Standing still-can move arms but still static balance is occurring of rest of body
Limits of stability
• Like a cone-cone of stability p 265
• Greatest distance that a person can lean away from base of support without altering the
base of support
• Normal adult- 12 degrees anterior and posterior and 16 degrees lateral
• Standing-top of body-can lean forward, but bottom will stay standing
Dynamic balance
• Ability to balance while movement is occurring
• Involves muscular activity that responds based on us going outside of base of
support/outside limits of stability
, Proactive balance
• Within our body that we will anticipate or prepare for some type of disturbance
• Disturbances with balance (force)-perturbations. Challenge how we maintain balance
• Tossing water bottle-person knows water bottle is coming and can prepare for it
• Natural motor response will anticipate it/tensing or bracing
Reactive balance
• How we react to disturbances that we are not prepared for
• Walking and something bumps into you
• Have to quickly react to something- have a motor response
Base of support
• Any surfaces that experiences pressure as a result of body weight and gravity
• Usually ground/chair-accepting weight downward
• Encompasses perimeter around all surfaces accepting body weight
Center of gravity
• Is slightly anterior to s2
• Weight on all sides is equal
• Cog is not fixed, postural changes
• All planes intersect within body
• Equal distribution of mass throughout body
• Is not fixed, moves based on how we move
• Hands in front, goes slightly anterior
• Hands above, goes slightly superior
• Should maintain cog over bos
• Within limits of stability-may not require cog to change
Sensory components of balance
• Sensory input from proprioceptive/somatosensory, visual, and vestibular
• All work together to maintain upright position
Proprioception/somatosensory
• Sensory input- goes to CNS-integration-motor output in response-step 1
• Proprioception-ability to sense position in space: don’t have to look to see if arm is bent,
mechanoreceptors- sensory organ within our joints, are responsible for joint position, if
there is movement at joint, or stress on joint
• Somatosensory- Golgi tendon organs-senses changes in tension, muscle spindle-changes
in length or velocity
• Skin mechanoreceptors: detect changes with potential vibrations, light touch, deep
pressure, or if skin stretches, any changes could potentially lead to disturbance in balance
