Chapter 10: Interventions to Improve Standing and Standing Balance Skills

INTRODUCTION

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.