The equipment we use is a static plate Vestibular Technologies CAPS™ BalanceTRAK system (US. Patent 7,163,516).

For stability measurement, BalanceTRAK uses age-based reference values validated by independent medical studies and independently obtained peer-reviewed reference studies and data. Comparison to these reference values provides a statistical value of balance impairment calculated as a ‘stability score’.

Posturography enables us to test and measure functional movement in ways that we were unable to do previously, and we can do all this quickly, and see the results in real time.

Using weight-shifting efficiency as a metric takes us beyond the paradigm of assessing spinal function in terms of biomechanics to one in which spinal mechanics becomes integral to the control of centre of gravity, as the purpose for creating stability and mobility.

This is important because it gives us a better model from which to assess human mobility, but also because it is quantifiable with posturographical analysis.

Consider for instance, the biomechanical adjustments that occur for an individual riding a bicycle around a corner. To achieve this, they must first turn away from the corner before turning back in order to maintain their centre of gravity over the wheels. Subtleties in changes of centre of gravity need to be taken into account in the rehabilitation of chronic spinal pain, but particularly so in rehabilitating motor control after a brain injury.

When discussing this approach with patients I explain what happens as they start to lose efficiency in controlling their centre of gravity in terms of a postural deterioration cycle that we see as part of the aging process.

Initially we see a forward weight-shift from the heel to the ball of the foot which leads to posterior chain loading and stiffness, then leads to pain, then we start to see deterioration in the ability to project our centre of gravity, so we see shortening in step, which eventually means requiring a stick and then a walker.

Treatment planning therefore is not just about addressing the site of pain, or improving spinal function, but about creating long term stability and efficiency in weight-shifting.

Posturographic equipment measures the projection to the ground of the individual’s Centre of Gravity (CoG). This projection is called their Centre of Pressure (CoP).

Stability is measured with Postural Sway. Postural sway is the involuntary weight-shifting compensations that an individual performs in order to maintain themselves upright. The test we use is the modified Clinical Test of Sensory Interaction in Balance (mCTSIB). The individual’s results are compared to an age, height and sex matched normative database in order to provide a statistical likelihood of a fall.

Many musculoskeletal ailments such as lower back pain, neck pain and headaches are a result of postural change, but where there is little or no stability loss.

These patients respond well to physical therapy and postural re-education.

We provide a six-week program of video education and movement repatterning exercises designed around our ethos of improving weight-shifting efficiency.

We provide the physical therapy in our office, but the re-education is now provided through our online portal as ‘Perfect Posture Consulting’.

This is provided as ‘coaching’ not therapy. The client submits a video at the end of each module which we then provide online coaching on. The benefit of coaching in this way is that the client is able to see the difference between what they are doing and what they should be doing compared to the model demonstration, and we can provide specific advice on what to work on in the next module.

This also means that wherever the client is, they can see their local clinician for the physical therapy and do the re-education with us.

It is available through The Posture Portal here.

Early stability loss can be addressed through our Postural Re-education Program, however when balance starts to be compromised (typical early signs include difficulty getting out of a chair and shortening in step), we need a Falls Risk Assessment (as described above) and balance rehabilitation.

The Falls Risk Assessment provides us with the differential diagnosis and the specificity for rehabilitation.

Rehabilitation therefore is focused to the specific systems that are compromised.

For instance, in the example given above in Falls Risk Assessment relating to semicircular canal activation, we can test each semicircular canal by applying a head movement specific to its plane or action and assessing the resultant postural sway and then comparing it to its opposite.

If a canal is compromised, the rehabilitation becomes clear. We can then retest the canal, and if we see improvement in sway, retest stability to see if what we have done has improved balance.

Balance rehabilitation also includes, flexibility, strength training, movement repatterning and education as described above in our Postural Education Platform.4

Once stability has been established and limit of stability increased, we work on stability during the gait cycle. Rehabilitation includes step timing, coordination, obstacle management, and dual task management.

We provide a full hands-on manual therapy as part of our musculoskeletal and neurorehabilatative care.

This includes, connective tissue release, joint mobilisation and manipulation, fascial release tendon repair and the full repertoire of osteopathic technique as you might expect of an osteopathic practice.

Posturography can be used to measure performance as well as measuring deficit. In particular we can measure power, velocity, acceleration and displacement of a particular movement.

This can be particularly helpful for athletes in measuring progress in a particular skillset, or for measuring lower limb strength in balance rehabilitation.

I am currently writing a Posturography training program for Physical Therapists. If you would like to learn how to incorporate Posturographic testing and rehabilitation in your practice, please email me from the contact form here.

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