Background

Balance is our body’s ability to distribute our weight so that we can stand and move without falling and recover if we trip. Our body must integrate complex sensory input from multiple systems to achieve balance. These systems include our somatosensory—muscles and joints, visual—eyes, and vestibular—inner ear. These balancing components can all be affected by various deficits and environmental factors.

This video explains to the OT practitioner two key concepts relating to balance, which are base of support and center of mass. The video also addresses four different balance types, including static sitting balance, dynamic sitting balance, static standing balance, and dynamic standing balance.

In adults with physical dysfunction, their balance is often affected. Some diagnoses that affect balance are cerebrovascular accident (CVA) or stroke, incomplete spinal cord injury (SCI), Parkinson’s disease, Huntington’s disease, hip fracture, etc. As OT practitioners, we must be aware of our clients’ ability to balance and the level of assistance they need as this can affect their independence measures, safety, and well-being.

Balance

This video defines what balance is and its different components.

Balance Video Transcript

Concept 1: Key Concepts of Balance Tips

• Base of Support: These are contact points with the floor that support your client, which can be feet, chair, etc.
• Center of Mass: This is the point on which the weight of your client is balanced.

Concept 2: Four Areas of Balance Tips

• Static Sitting: This is a seated position with no movement.
• Dynamic Sitting: This is a seated position with movement. For example, bending down to tie your shoes while seated.
• Static Standing: This is a standing position with no movement.
• Dynamic Standing: This is a standing position with movement. For example, catching a ball while standing.
• Functional Balance Grades: Each balance type mentioned above can be graded as normal, good, fair, or poor.
  • Normal: Your client can accept a maximal balance challenge and needs no assistance.
  • Good: Your client can accept a moderate balance challenge and needs minimal assistance.
  • Fair: Your client can accept a minimal balance challenge and needs moderate assistance.
  • Poor: Your client cannot accept any balance challenge and needs maximum assistance.

Concept 3: Components of Balance Tips

• Visual Sense: This is visual input from the environment—you have 10 percent reliance when on a firm surface with the eyes open.
• Vestibular Sense: This is your sense of gravity and movement based on the semicircular canals in the ear—you have 20 percent reliance when on a firm surface with the eyes open.
• Somatosensory Input: This is feeling your feet against the ground and proprioception, or the awareness of your body in space, based on muscle and joint feedback—you have 70 percent reliance when on a firm surface with the eyes open.
• If you are on an unstable surface, your vestibular sense increases to a 60 percent reliance, your vision sense increases to a 30 percent reliance, and your somatosensory decreases to about a 10 percent reliance.

Resources

• Balance by Physiopedia
• The Role of Occupational Therapy in Balance by The Practical Occupational Therapist
• Occupation-Based Balance Interventions For Your OT Practice by my OT Spot

References

• Peterka, R. J. (2002). Sensorimotor integration in human postural control. Journal of neurophysiology, 88(3), 1097-1118.
• Prost EL. & Willis BW. (2021). Functional Balance Grades – Geriatric Examination Tool Kit. https://geriatrictoolkit.missouri.edu/Balance_functional_grades–static–dynamic.doc