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It is good to have an end to journey toward; but it is the journey that matters in the end.

Ursula Le Guin

Cornerstone Concepts

  • Balance: differentiation between postural control and balance

  • Theoretical models of postural control and balance:

    • Reflex-hierarchical

    • Systems approach

  • Components of postural control and balance:

    • Musculoskeletal mechanisms

    • Neuromuscular mechanisms

    • Sensory mechanisms

    • Perceptual mechanisms

    • Cognitive mechanisms

  • Strategies for recovery: sensory and motor

  • Age-related differences to postural control and balance

  • Assessment of postural control and balance

  • Intervention for postural control and balance problems

The ability to keep the body steady while engaged in activities that use the limbs is critical to functional independence. Control of posture provides the stable base from which balance is achieved in a variety of body positions, whether the body is still, preparing to move, or preparing to stop (Wade & Jones, 1997).

Clinical Connection:

Imagine getting onto a bus while jostling packages, a magazine, and a wallet. The search for exact change occurs simultaneously to walking onto the bus steps. This results in a misjudgment of the height of the step and causes a trip. Recovery of balance is achieved by steadying pressure against the bus followed by mounting the steps to deposit the coins. A search for a seat ensues while the bus lurches forward, requiring a rapid movement in the opposite direction of the bus’s movement to avoid falling down or spilling the packages. The task is completed upon sinking into an open seat, arranging the packages on the floor, and reading the magazine as the bus moves toward the destination.

The many tasks involved in this example illustrate the complexity of the postural control and balance systems. These systems involve recovery from instability, as well as the ability to anticipate and move to avoid instability (Shumway-Cook & Woollacott, 2001). These mechanisms are the focus in this chapter. It will describe the systems that keep a person in balance, as well as the abnormalities that can occur to those systems, and approaches to use in intervention to help patients/clients to re-establish stability and balance for optimal function.


Postural control is the most basic of voluntary movements; it provides stability to the body so that interaction with the environment using the upper and lower extremities is possible (Gallahue & Ozmun, 2002). Because postural problems often result in injury and because stability is essential to leading an independent lifestyle, it is of great concern (Wade & Jones, 1997).

Definition and Description

Postural control is defined as the ability to maintain a steady position in a weight-bearing, antigravity posture. As mentioned in Chapter 4, it represents a functional relationship between stability (holding an antigravity position steadily) and ...

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