Balance, or postural stability, is the process of maintaining the body's position in equilibrium, which can be static or dynamic. Key concepts include the center of mass (COM), center of gravity (COG), and base of support (BOS), which influence stability and sway limits. The Berg Balance Scale is a tool used to assess balance and fall risk in older adults through a series of functional tasks.
Balance, or postural stability, is the process of maintaining the body's position in equilibrium, which can be static or dynamic. Key concepts include the center of mass (COM), center of gravity (COG), and base of support (BOS), which influence stability and sway limits. The Berg Balance Scale is a tool used to assess balance and fall risk in older adults through a series of functional tasks.
Balance, or postural stability, is the process of maintaining the body's position in equilibrium, which can be static or dynamic. Key concepts include the center of mass (COM), center of gravity (COG), and base of support (BOS), which influence stability and sway limits. The Berg Balance Scale is a tool used to assess balance and fall risk in older adults through a series of functional tasks.
Balance, or postural stability, is the process of maintaining the body's position in equilibrium, which can be static or dynamic. Key concepts include the center of mass (COM), center of gravity (COG), and base of support (BOS), which influence stability and sway limits. The Berg Balance Scale is a tool used to assess balance and fall risk in older adults through a series of functional tasks.
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BALANCE
• Balance, or postural stability, is a generic term
used to describe the dynamic process by which the body’s position is maintained in equilibrium. Equilibrium means that the body is either at rest (static equilibrium) or in steady-state motion (dynamic equilibrium). Balance is greatest when the body’s center of mass (COM) or center of gravity (COG) is maintained over its base of support (BOS) • Center of mass (COM) : is a point that corresponds to the center of the total body mass and is the point where the body is in perfect equilibrium. • COM of most adult humans is located slightly anterior to the second sacral vertebra or approximately 55% of a person’s height. • The position of the CoM is not fixed and changes in different postures such as sitting and kneeling, with movements of the extremities or trunk, and when a person is carrying something • Center of gravity. The COG refers to the vertical projection of the center of mass to the ground. • Base of support : defined as the perimeter of the contact area between the body and its support surface • foot placement alters the BOS and changes a person’s postural stability. • • A wide stance, such as seen with many elderly individuals, increases stability, whereas a narrow BOS, such as tandem stance or walking, reduces it. • So long as a person maintains the COG within the limits of the BOS, i.e. the “limits of stability”, he or she does not fall. • Limits of stability. “Limits of stability” refers to the sway boundaries in which an individual can maintain equilibrium without changing his or her BOS • These boundaries are constantly changing depending on the task, the individual’s biomechanics, and aspects of the environment. • Any deviations in the body’s COM position relative to this boundary are corrected intermittently, producing a random swaying motion. • For normal adults, the anteroposterior sway limit is approximately 12 degree from the most posterior to most anterior position. Boundaries of the limits of stability while standing, walking, and sitting • Lateral stability varies with foot spacing and height; adults standing with 4 inches between the feet can sway approximately 16degree from side to side. • A person sitting without trunk support has much greater limits of stability than when standing because the height of the COM above the BOS is less and the BOS is much larger (i.e., perimeter of the buttocks in contact with a surface). • Ground reaction force : In accordance with Newton’s law of reaction, the contact between our bodies and the ground due to gravity (action forces) is always accompanied by a reaction from it ,called ground reaction force. • Center of pressure is the location of the vertical projection of the ground reaction force. It is equal and opposite to the weighted average of all the downward forces acting on the area in contact with the ground • If one foot is on the ground, the net COP lies within that foot. When both feet are on the ground, the net COP lies somewhere between the two feet, depending on how much weight is taken by each foot. When both feet are in contact, the COP under each foot can be measured separately. • To maintain stability, a person produces muscular forces to continually control the position of the COG, which in turn changes the location of the COP. Thus the COP is a reflection of the body’s neuromuscular responses to imbalances of the COG. A force plate is traditionally used to measure ground reaction forces [in newtons (N)] and COP movements [in meters (m)]. • Balance is a complex motor control task involving the detection and integration of sensory information to assess the position and motion of the body in space and the execution of appropriate musculoskeletal responses to control body position within the context of the environment and task. Thus, balance control requires the interaction of the nervous and musculoskeletal systems and contextual effects Types of Balance Control • Functional tasks require different types of balance control • (1) static balance control to maintain a stable antigravity position while at rest such as when standing and sitting; • (2) dynamic balance control to stabilize the body when the support surface is moving or when the body is moving on a stable surface such as sit-to-stand transfers or walking; • (3) automatic postural reactions to maintain balance in response to unexpected external perturbations, such as standing on a bus that suddenly accelerates forward. Motor Strategies for Balance Control • To maintain balance, the body must continually adjust its position in space to keep the COM of an individual over the BOS or to bring the COM back to that position after a perturbation. • Three primary movement strategies used by healthy adults to recover balance in response to sudden perturbations of the supporting surface (i.e., brief anterior or posterior platform displacements) called ankle, hip, and stepping strategies Factors Influencing Selection of Balance Strategies • Speed and intensity of the displacing forces • Characteristics of the support surface • Magnitude of the displacement of the center of mass • Subject’s awareness of the disturbance • Subject’s posture at the time of perturbation • Subject’s prior experiences Berg’s balance test • Dynamic functional assessment of balance • The Berg Balance Scale (BBS) is a 56-point scale that evaluates 14 tasks. • The BBS is one of the earliest performance- based measures developed by Katherine Berg to assess balance status and falls risk in older adults Equipment needed: Ruler, 2 standard chairs (one with arm rests, one without), footstool or step, stopwatch or wristwatch, 15 ft walkway
Time needed: 15–20 minutes
Scoring: A five-point ordinal scale, ranging from 0–4. “0” indicates the lowest level of function and “4” the highest level of function. Total score = 28
Interpretation: 41–56 = low fall risk
21–40 = medium fall risk 0–20 = high fall risk <36 fall risk close to 100% Item description: SCORE (0–4)
