BALANCE Balance consists o !oth static and d"na#ic co#ponents.$tatic !alance is de%ned as the status o the !od" in &hich all orces actin' on the !od" are !alanced, &here the !od" re#ains static in an intended position or orientation; d"na#ic !alance is reerred to as the status in &hich the su##ed orces on the !od" allo& the !od" to #ove in a controlled #anner. Accordin' to this de%nition, !alance control a!ilities are unda#ental to a &ide ran'e o dail" activities ran'in' ro# static to d"na#ic ones. (ood !alance control a!ilities &ould indicate that successul posture)voluntar" #ove#ent inte'ration is achieved so that a person is a!le to ul%ll the 'oal o a voluntar" tas* in a sae #anner. +his de%nition also i#plies that the nature o !alance control #echanis#s is tas*,speci%c. People that have !etter static !alance control do not necessaril" sho& !etter d"na#ic !alance control, and vice versa. Balance, postural control or e-uili!riu# are de%nitions used to descri!e ho& &e *eep our !od" in an upri'ht position and, &hen necessar", ad.ust this position. /t has !een descri!ed as 0sensin' the position o the !od"1s centre o #ass and #ovin' the !od" to ad.ust the position o the centre o #ass over the !ase o support provided !" the eet2. /n order to #aintain !alance, vision, the so#atosensor" s"ste# and the vesti!ular or'an interact and re'ister inputs ro# the surroundin's, &hich are inte'rated and processed in the central nervous s"ste#. +he vesti!ulo,ocular re3e4 567R8 coordinates e"e and head #ove#ents, #a*in' it possi!le, or e4a#ple, to &al* and read si'ns at the sa#e ti#e. +he cervico,ocular re3e4 interacts &ith the 67R, providin' inor#ation a!out head #ove#ents in relation to the trun*. $ensor" receptors in the s*in as &ell as #echanoreceptors in the #uscles provide input as to ho& 'ravit" a9ects the !od" :or the preservation o !alance, input ro# the di9erent parts o the !alance s"ste# is constantl" reconsidered and response ro# the #otor corte4 is sent !ac*. +his #eans that the !od" is constantl" in #otion, &hich is called postural s&a" . +hree #a.or sensor" s"ste#s are involved in !alance and posture. 6ision is the s"ste# pri#aril" involved in plannin' our loco#otion and in avoidin' o!stacles alon' the &a". +he vesti!ular s"ste# is our ;'"ro1, &hich senses linear and an'ular accelerations. +he so#atosensor" s"ste# is a #ultitude o sensors that sense the position and velocit" o all !od" se'#ents, their contact 5i#pact8 < &ith e4ternal o!.ects 5includin' the 'round8, and the orientation o 'ravit". Neuro, ph"siolo'ists have devised a &ide ran'e o e4peri#ents to tease out the contri!ution o each o these s"ste#s and even to conuse the s"ste# !" providin' con3ictin' or alse sensor" inputs. +he so#atosensor", visual, and vesti!ular s"ste#s are the three #ain !alance senses. +he so#atosensor" s"ste# provides inor#ation on the position or #otion o the !od" &ith respect to the supportin' surace and the position or #otion o !od" se'#ents &ith respect to each other. +he visual s"ste# provides inor#ation on the orientation and #otion o the !od" &ith respect to 'lo!al space. +he vesti!ular s"ste# senses the linear and an'ular acceleration o the head as &ell as the head position relative to 'ravit". Nor#all", these three senses &or* to'ether to detect relevant peripheral sensor" inor#ation ro# the environ#ent, to develop an internal representation o the !od" in 'lo!al space, and to tri''er proactive or reactive !alance ad.ust#ents, in an atte#pt to #aintain static and d"na#ic !alance under certain tas* and environ#ental conte4ts. = P7$+>RAL C7N+R7L D>R/N( ?>/E+ $+ANCE Erect posture in hu#ans is achieved !" the superposition o !od" se'#ents 5head, trun* and le's8 alon' the lon'itudinal a4is. +his superposition is such that it should ul%l the t&o unctions o posture. +he %rst is the anti'ravit" unction. +he superposition o se'#ents is peror#ed a'ainst the orce o 'ravit" and the associated 'round reaction orces. +he postural tone, &hich is predo#inantl" distri!uted a#on' the e4tensor #uscles, pla"s an i#portant role in this anti'ravit" unction. +here is an additional constraint, &hich is e-uili!riu# #aintenance. +his #eans that the positionin' o !od" se'#ents 5&hich is onl" restricted !" the #echanical li#its o .oint #ove#ent8 should !e such that the pro.ection o the center o 'ravit" 5C(8 re#ains inside the support !ase under static conditions. A second unction o posture is to serve as an interace &ith the e4ternal &orld or perception and action. /t #eans that the orientation &ith respect to space o 'iven !od" se'#ents such as the head, the trun* or the ar# are used as a reerence ra#e. +he reerence ra#e #a" !e used either to perceive the position o the !od"1s #ove#ent &ith respect to the e4ternal &orld or to or'ani@e#ove#ents to&ard a tar'et in e4ternal space. +a*in' into account the unctions o posture accordin' to the conte4t and the tas*, t&o #odes o posturalor'ani@ation have !een proposed. :irst, a 'lo!al or'ani@ation o posture is #ainl" related to e-uili!riu# control. /t is represented !" the inverted pendulu# #odel descri!ed !" Nashner and McCollu#. +he reerence value to !e re'ulated or e-uili!riu# control is still a #atter o discussion. Balance,stricto sensu, is preserved &hen the center o pressure 5CP8 re#ains inside the support !ase 5i.e. the surace under the eet8. >nder static conditions this corresponds to the pro.ection o the C(. Ho&ever, under d"na#ic conditions, as, or e4a#ple,initiation o 'ait, the C( is accelerated !" a tor-ue at the level o the an*le .oint created !" activatin' #uscles controllin' that .oint;this causes a shit othe CP,&hich #oves a&a" ro# the C( pro.ection. +hus, !oth CP position and C( pro.ection onto the support !ase should !e ta*en into account or e-uili!riu# control in d"na#ic conditions. Accordin' to the #odelin' o PaA and Patton,the !order o the sta!ilit" li#its can !e predicted in d"na#ic conditions !" a co#!ination o three para#etersB the CP position, the C( hori@ontal position and the C( velocit". /n order to re'ulate the C( position, &hich is located at the level o the pelvis, the &hole !od" can !e #oved as an inverted pendulu# C around the an*le .oint. Ho&ever, as &ill !e co##ented on later, these oscillations are ver" slo& 5re-uenc" around D.= H@8 !ecause o the hi'h inertia o the !od". /n case o ast pertur!ations, ast corrections are re-uired. 7ther !od" se'#ents &ith lo&er inertia 5trun* around the hip, thi'h around the *nee8 are then #oved or ast corrections. /nterestin'l", the constraints related to !od" inertia are not onl" i#portant or e-uili!riu# control. +he" are also a *e" characteristic or the or'ani@ation o #ove#ents. :or e4a#ple, it is possi!le to couple a set o .oints !" increasin' the correspondin' .oint sti9ness. +his results in creatin' a ne& ense#!le &ith an increased inertia correspondin' to that o the &hole set o se'#ents coupled to'ether. Droule@ and Bertho@ introduced the concept o topolo'ical or'ani@ation o posture in order to descri!e this reor'ani@ation o !od" inertia. +he" provided t&o e4a#ples. When readin' a paper &hile &al*in', sti9ness o the ar#, trun* and head is increased in order to create a ne& hi'h inertial ense#!le that &ill reduce the #ove#ents o the ar#s &ith respect to the head. Conversel", unloc*in' the ar# ro# the trun* occurs in tas*s &here the sta!ilit" o the hand position in space should !e preserved independentl" ro# the trun* oscillations, as &hen the su!.ect is &al*in' holdin' a ull 'lass in the hand. A second #ode o or'ani@ation is #odular or'ani@ation, &hich is used or orientin' se'#ents such as the head and trun* 5&hich serve as a reerence ra#e or perception and action8 &ith respect to space. +he various se'#ents o the *ine#atic chain ro# the eet to the head are not controlled as a sin'le unctional unit, !ut as a superposition o individual ;#odules1. Each #odule is tied to the ne4t one !" a set o #uscles &hich has its o&n central and peripheral control, ai#ed at #aintainin' the reerence position o the #odule. +he head is the site o di9erent cate'ories o sensors, such as the retina, the la!"rinthine a9erents and the nec* #uscle proprioceptors. Each cate'or" o receptors has !een sho&n to !e a!le to sta!ili@e the head. +he head can !e sta!ili@ed &ith respect to 'a@e,verticalit" and to the trun*. 7rientation and sta!ili@ation o the trun* a4is, &hich is the lar'est a4is o an" !od" se'#ent, is critical. /nterestin'l", #aintainin' e-uili!riu# throu'h the 'lo!al or'ani@ation o posture and preservin' the orientation o !od" se'#ents &ith respect to space #a" !e con3ictin' in 'iven #otor acts throu'h the #odular control o posture. :or e4a#ple, there &ill !e a con3ict !et&een e-uili!riu# #aintenance and holdin' a ull 'lass o &ine !" the hand 5local posture8 &hen a postural distur!ance occurs that endan'ers !alance. +he sta!ili@ation o the head in space durin' loco#otion is used as a navi'ational inertial plator# or the evaluation o the visual or la!"rinthine inputs. +hese inputs si'nal chan'es o !od" position &ith respect to the e4ternal &orld. E Another i#portant role o this #odular or'ani@ation o posture is to serve as an e'ocentric reerence ra#e or the or'ani@ation o #ove#ent. F