Understanding Balance and Stability

Balance

Balance is the ability of the body to maintain equilibrium, which means staying centered and upright against the force of gravity. Whether a person is sitting or standing, static or dynamic, balance ensures that they remain safe and upright without moving. This state of equilibrium is achieved without any velocity or acceleration, making it a key aspect of static and dynamic postures.

Stability

Stability, on the other hand, involves maintaining equilibrium through acceleration. When a person moves from one point to another, such as during functional ambulation or transfers, they rely on stability. Stability is the body's ability to stay balanced while in motion, which is crucial for performing daily activities that require movement.

The Importance of Stability in Occupational Therapy

In therapy, distinguishing between balance and stability is vital. For instance, when a patient cannot sit upright without falling over due to insufficient postural support muscles, we focus on improving their balance. This involves working on static sitting and gradually incorporating dynamic elements, like using a Dynadisk, to enhance postural reactions.

Once a patient achieves good balance, we shift our focus to stability. This involves enhancing coordination, gross motor skills, and agility to ensure that the patient can maintain equilibrium while moving. For example, stability training is essential for patients who need to perform occupations that require functional ambulation, transfers, or navigating stairs.

Six Factors of Stability

To enhance stability, we can focus on six key factors: lowering the center of gravity, keeping the center of gravity and line of gravity within the base of support, using focal points, increasing mass, widening the base of support, and increasing friction between objects and surfaces.

1. Lowering the Center of Gravity

Lowering the center of gravity increases stability. For instance, when people feel like they might fall, they instinctively crouch to get closer to the ground, making them more stable. This strategy can be particularly beneficial for individuals with Parkinson's or Lewy body dementia, whose bodies naturally succumb to the weight of gravity into a forward flexion and kyphosis. Teaching patients to lower their center of gravity can help them feel more secure and stable.

2. Keeping the Center of Gravity and Line of Gravity Within the Base of Support

Maintaining the center of gravity within the base of support is crucial for balance and stability. When teaching patients, we can visualize and center their body around a vertical line from their center of gravity to the ground. Tools like the Wii balance board or other balance equipment can help patients visualize and stabilize their center of gravity.

3. Using Focal Points

Using focal points is a powerful technique to enhance stability. By focusing on a fixed point, patients can maintain better postural alignment, which keeps their center of gravity within the base of support. This technique is especially useful for patients with Parkinson's disease during gait training, as it helps them stay upright with a strong posture.

4. Increasing Mass

Greater mass equals greater stability. In therapy, we often see this principle in action with durable medical equipment. For example, a four-wheeled walker, which has more mass, provides more stability than a lightweight two-wheeled walker. Teaching patients to use heavier, more stable equipment can significantly enhance their stability during mobility tasks.

5. Widening the Base of Support

Increasing the base of support makes a person more stable. For example, instructing patients to stand with their feet wider apart can improve their stability. This principle is also applied in the design of mobility aids; walkers with a wider base provide more stability than canes.

6. Increasing Friction Between Objects and Surfaces

Increasing friction can enhance stability. This can be achieved by using anti-slip materials, such as Dycem under a plate to prevent sliding or rubber soles on shoes to avoid slipping on wet floors. In wheelchair mobility, gloves can increase friction between the hands and wheels, improving control and stability.

Practical Applications in Therapy

Teaching Stability Strategies

Education is crucial in occupational therapy. Teaching patients about these six factors can empower them to use strategies to enhance their stability in various contexts. For example, instructing a patient with Parkinson's to focus on a spot during gait training can significantly improve their posture and stability.

Incorporating Stability Training into Therapy Sessions

Incorporating stability training into therapy sessions can involve various exercises and activities. For instance:

• Static and Dynamic Balance Training: Begin with static balance exercises, such as sitting or standing on stable surfaces. Gradually progress to dynamic exercises that involve movement and changing postures.
• Functional Mobility Exercises: Practice functional tasks that require stability, such as walking on different surfaces, navigating stairs, or performing transfers.
• Using Balance Equipment: Utilize balance equipment, such as balance boards, Dynadisks, and stability balls, to challenge and improve patients' stability.

Tailoring Stability Training to Individual Needs

Every patient is unique, and stability training should be tailored to their specific needs and abilities. For instance, a patient with a higher fall risk might benefit from exercises that focus on lowering their center of gravity and widening their base of support. Conversely, a patient with good balance but poor coordination might benefit from agility and coordination exercises.

Conclusion

Understanding the difference between balance and stability is essential for occupational therapy practitioners. While balance involves maintaining equilibrium without movement, stability encompasses maintaining equilibrium through acceleration.