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1、Balance and Posture,Andrew L. McDonough,平衡和姿势 安得烈-麦克唐纳,What is Balance?,Technically defined as the ability to maintain the center-of-gravity (COG) of an object within its base-of-support (BOS),什么是平衡,学术上定义为物体在支撑面上保持重心稳定的能力。 Technically：adv.技术上，工艺上；学术上；专业上,What is Posture?,The stereotypical alignment
2、of body/limb segments Types Standing (static) Walking - running (dynamic) Sitting Lying Lifting,什么是姿势？,身体或肢体的常规标准是： Types：类型；类型 Standing (static)：站（静态） Walking - running (dynamic);步行运行（动态 ) Sitting:坐 Lying：卧 Lifting：举起，抬起,Stereotypical：n.常规 Alignment：n.队列，排成直线；结盟；校直，调整；工准线 Limb：n.肢，翼；大树枝；分支；枝干 vt.割断
3、的四肢，肢解；砍树枝 Segments：n.部分（ segment的名词复数 ）；瓣；计算机（字符等的）分段；动物学节片,Relationship - Balance & Posture,Postural alignment (and the changes/adjustments made due to perturbations) is the way balance is maintained Maintaining the COG within the BOS If this relationship isnt maintained then a system will be unba
4、lanced,平衡和姿势的关系,姿势的调整（这种改变或干扰是由于干扰形成的）是保持平衡的方法。 通过支撑面保持重心 如果这种关系不保持然后系统将不平衡 Perturbations：干扰,Base of Support,x,H-H,TM-L TM-R,x - Vertical projection of COG,Walking,x,Static,Dynamic,支撑面,x - Vertical projection of COG：X-重心的垂直投影 Vertical ：adj.垂直的，竖立的 projection：n.预测；规划，设计；心投射；突起物,Transition - Static to
5、 Dynamic BOS,Heel-to-heel distance will decrease Feet come together toward midline Toe-to-midline distance will decrease Reflects “toe-in” Overall effect - BOS narrows,静态到动态支撑面转变（过渡）,脚跟与脚跟的距离会减少 -脚一起朝向中线 脚趾到中线的距离会减少 -反应了脚趾 整体效果就是支撑面变小 Transition ：n.过渡，转变，变迁,The Effect of a Narrowed BOS,Chances of CO
6、G falling within BOS decrease Subject becomes less (un-) balanced COG moves forward of BOS - precursor event to walking Foot will be advanced to extend the dynamic BOS,支撑面减小的影响,由于支撑面减小重心落点会改变。 -物体变得失去平衡或不平衡 重心随着支撑面移动走路的前提 脚会提前扩大动态的支撑面,Center-of-Gravity,The point about which the mass is evenly distri
7、buted The balance point If an object is symmetrically loaded the COG will be at the geometric center,重心,质量均匀分布的点 平衡点 如果一个对象是对称载体，那么它的重心在其几何中心。,Center of Gravity of Human Limbs and Segments,Limbs/segments are usually asymmetrically loaded COG tends to be “off-center” Closer to the “heavier end” Sourc
8、es Dempster (1955) Braune and Fischer (1889) Winter (1990s),人类肢体或者某部分的重心,人类肢体或者某部分通常是非对称的载体。 重心趋于偏离中心 -接近于较重结束 来源,Dempster,Subjects were 150 lbs. males (astronauts - NASA) COG located at a point as a percentage of total limb length,Knee,Ankle,43.3% 56.7%,Total limb length,Dempster,主体分别为150磅。男性（宇航员 -
9、 美国航空航天局） 重心位于一个点作为整个肢体长度的百分比,Location of COG,Entire body Suprapedal mass Suprafemoral mass HAT Head,S1 - S2 ASIS Umbilicus Xiphoid process Occiput,重心的位置,整个身体 肾上腺质量 剑突,Example: Change in the Location of the COG of Body - Right Unilateral AK Amputee,COG will shift upward and to the left Question: How
10、 will this change affect the patients perception of balance? Answer: Profoundly!,例如：人体重心位置的改变右边单方面的AK截肢,重心将转向向上和向左 问：如何将这种变化会影响患者的认知平衡 答：深刻！ Unilateral：单方面 Amputee：截肢,General Rule,As COG shifts upward the object/subject becomes more “top-heavy” Increases the “tendency to be over-thrown”,Moment arm,M
11、oment arm,一般规则,由于重心上移，对象/主体变得更加“头重脚轻 增加倾向于抛出 Moment arm：力矩臂,Role of Anti-gravity Postural Muscles,Generate torque across joints to: “Resist the tendency to be over-thrown” Keep limbs, joints, body segments in proper relationship to one another so that the COG falls within the BOS,反重力的姿势肌肉的作用,通过关节产生扭
12、转力：抵制倾向于抛出 保持肢体、关节、身体部分在一个适当的关系以至于重心落在支撑面上。 Torque：扭转力,Some Examples - Questions,What happens to the COG & BOS in: Someone walking along a sidewalks and encounters a patch of ice The toddler just beginning to walk The surfer coming down off of a wave The tight-rope walker who loses her balance,一些例子
13、- 问题,重心和支撑面发生了什么在： 有人在人行道行走遇到一块冰 孩子刚开始走路 冲浪者从波浪上冲下来 紧绳上行走失去了平衡 Toddler：n.蹒跚行走的人；幼童装；学步的幼儿,A Systems Model of Balance1,1Courtesy of Sandra Rader, PT, Clinical Specialist,平衡系统模型,目标/任务方向 肌肉骨骼系统 中心位置 稳定性 动作协调 环境组织 感官组织,Stability & Balance,Result of interaction of many variables (see model) Limits of Sta
14、bility - distance in any direction a subject can lean away from mid-line without altering the BOS Determinants: Firmness of BOS Strength and speed of muscular responses Range: 80 anteriorly; 40 posteriorly,稳定性 平衡,许多变量的相互作用的结果（见模型） 稳定性的限制-一个主体在任何方向上不通过改变支撑面而是通过倾斜远离中线 影响因素： 支撑面的坚固性 肌肉反应的强度和速度 variable
15、s:变量 Determinants:影响因素： Firmness:坚固性 Anteriorly:前方 Posteriorly:向后,Limits of Stability,稳定性的限制,Model Components Musculoskeletal System,ROM of joints Strength/power Sensation Pain Reflexive inhibition Abnormal muscle tone Hypertonia (spasticity) Hypotonia,骨骼肌系统的模型组成,关节活动度 力量 感觉 -疼痛 -反射性的抑制 肌肉张力异常 -肌肉张力
16、增加（痉挛） -肌肉张力,Model Components Goal/Task Orientation,What is the nature of the activity or task? What are the goals or objectives?,目标/任务导向的模型组件,活动或任务的本质是什么？ 目标或目的是什么？,Model Components Central Set,Past experience may have created “motor programs” CNS may select a motor program to fine-tune a motor experience,中心点的模型组成部分,根据以往的经验可能已经创建了“运动程序” 中枢神经系统会选择一个运动程序发现一个微小的运动经验,Model Components Envir
