General Characteristics of Standing
Examination and Evaluation
Early Interventions in Modified Standing
Modified Standing, Stability
Modified Standing, Weight Shifting
Interventions in Standing
Strategies to Improve Motor Learning
Flexibility and Strengthening Exercises
Standing; Steady State Control
Standing, Weight Shifting
Standing, Limb Movements
Interventions to Improve Postural Synergies
Practicing Ankle Strategies
Practicing Hip Strategies
Practicing Stepping Strategies
Interventions to Improve Sensory Integration
Interventions to Reduce Reliance on Visual Information (Enhance Somatosensory)
Interventions to Reduce Surface Dependency (Enhance Vision)
Interventions to Improve Use of Vestibular Inputs
Using Force Platforms, Gaming and Virtual Reality Progressing Interventions
Interventions for High Level (Adaptive) Balance Control
Student Practice Activities
This chapter focuses on standing postural control and interventions that can be used to improve standing balance skills. Careful examination of the patient’s impairments and activity limitations that affect standing control is necessary and should include musculoskeletal alignment, range of motion (ROM), and muscle performance (strength, power, endurance). Examination of motor function (motor control and motor learning) focuses on determining the patient’s weight-bearing status, postural control, and use of neuromuscular synergies required for static and dynamic control. Examination of sensory function includes using sensory (somatosensory, visual, and vestibular) cues for standing balance control and central nervous system (CNS) sensory integration mechanisms. Finally, the patient must be able to safely perform functional activities (e.g., activities of daily living [ADL]) in standing position while in various environments (clinic, home, work, community [job/school/play]) to participate in a meaningful life.
GENERAL CHARACTERISTICS OF STANDING
Standing is a relatively stable posture with a high center of mass (COM) and a small base of support (BOS) that includes contact of the feet with the support surface. During normal symmetrical standing, weight is equally distributed over both feet (Fig. 10.1). From a lateral view, the line of gravity (LoG) falls close to most joint axes: slightly anterior to the ankle and knee joints, slightly posterior to the hip joint and posterior to the cervical and lumbar vertebrae, and anterior to the thoracic vertebrae and atlanto-occipital joint (Fig. 10.2). Natural spinal curves (i.e., normal lumbar and cervical lordosis and normal thoracic kyphosis) are present but flattened in upright stance depending on the level of postural tone. The pelvis is in neutral position, with no anterior or posterior tilt. Normal alignment minimizes the need for muscle activity during erect stance.
Normal postural alignment—frontal plane In optimal alignment, the line of gravity (LoG) passes through the identified anatomical structures, dividing the body into two symmetrical parts.
Normal postural alignment—sagittal plane In optimal alignment, the LoG passes ...