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Chapter Objectives

Upon completion of this chapter, the learner should be able to:

  1. Distinguish between static and dynamic forms of balance with examples of each that may be identified on the problem list in patients with neurological disorders.

  2. Identify safety issues that can affect the examination of balance and equilibrium.

  3. Describe the critical aspects of anatomy and physiology related to motor and sensory systems that contribute to balance and equilibrium.

  4. Synthesize knowledge of balance impairment with understanding of functional activity performance to determine examples of how decreased balance can contribute to functional activity limitation.

  5. Analyze information from patient history in a specific patient scenario to select appropriate balance tests/measures.

  6. Explain the significance and implications of specific balance test/measure results.

  7. Record thorough, meaningful, and accurate documentation of balance examination results, patient problems related to balance, and goals/prognosis for recovery in a given patient scenario.

Introduction

Mr. McMurray, a 75 year-old man, was a fairly active golfer until 6 months ago when he was diagnosed with peripheral neuropathy related to diabetes mellitus. He now reports he has fallen three times in the past week. He and his wife report that his balance is “off ” and has gradually worsened over the past couple of months. Because of his falls, now combined with significant fear of falling, Mr. McMurray even avoids many of the simple community activities he frequently enjoyed in the past, including attending the weekly Bingo game. It will be very important to determine the impact of his balance deficit on his functional activity and on his participation. Measures should be selected to optimally quantify his balance ability as a baseline and to help direct the development of the treatment plan.

Balance or equilibrium, sometimes referred to as postural stability, is the ability to maintain stability in an upright posture particularly keeping the body up against gravity. Balance is an essential component of all upright tasks involving both the ability to recover from episodes of instability and the ability to anticipate and move in ways to avoid instability and falling. From the standpoint of physics, for any upright object to be stable the center of mass must be maintained over the base of support. The center of mass (COM) is the single point at which all the mass of the object can be considered to lie. The base of support (BOS) includes all points of body contact with the supporting surface and can be described or visualized as the area enclosed within the perimeter of all these points of contact. For example, in sitting, the BOS includes the ischial tuberosities and buttocks, probably part of the posterior thighs (depending on how far back the person is sitting on the surface), the feet, and perhaps even an upper extremity or hand. The statement relating COM to BOS implies there must be a system of sensory input to monitor the ...

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