The Role of Limb Movements in Maintaining Upright Stance: The “Change-in-Support” Strategy
Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reaction...
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Published in | Physical therapy Vol. 77; no. 5; pp. 488 - 507 |
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Main Authors | , |
Format | Journal Article |
Language | English |
Published |
United States
American Physical Therapy Association
01.05.1997
Oxford University Press |
Subjects | |
Online Access | Get full text |
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Abstract | Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reactions are not just strategies of last resort, but are often initiated well before the center of mass is near the stability limits of the base of support. Furthermore, it appears that subjects, when given the option, will select these reactions in preference to the fixed-support "hip strategy" that has been purported to be of functional importance. The rapid speed of compensatory change-in-support reactions distinguishes them from "volitional" arm and leg movements. In addition, compensatory stepping reactions often lack the anticipatory control elements that are invariably present in non-compensatory stepping, such as gait initiation. Even when present, these anticipatory adjustments appear to have little functional value during rapid compensatory movements. Lateral destabilization complicates the control of compensatory stepping, a finding that may be particularly relevant to the problem of falls and hip fractures in elderly people. Older adults appear to have problems in controlling lateral stability when stepping to recover balance, even when responding to anteroposterior perturbation. Increased understanding and awareness of change-in-support reactions should lead to development of new diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling in elderly people and in patients with balance impairments. |
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AbstractList | Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reactions are not just strategies of last resort, but are often initiated well before the center of mass is near the stability limits of the base of support. Furthermore, it appears that subjects, when given the option, will select these reactions in preference to the fixed-support "hip strategy" that has been purported to be of functional importance. The rapid speed of compensatory change-in-support reactions distinguishes them from "volitional" arm and leg movements. In addition, compensatory stepping reactions often lack the anticipatory control elements that are invariably present in non-compensatory stepping, such as gait initiation. Even when present, these anticipatory adjustments appear to have little functional value during rapid compensatory movements. Lateral destabilization complicates the control of compensatory stepping, a finding that may be particularly relevant to the problem of falls and hip fractures in elderly people. Older adults appear to have problems in controlling lateral stability when stepping to recover balance, even when responding to anteroposterior perturbation. Increased understanding and awareness of change-in-support reactions should lead to development of new diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling in elderly people and in patients with balance impairments. Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important functional role in maintaining upright stance than has generally been appreciated. Contrary to traditional views, change-in-support reactions are not just strategies of last resort, but are often initiated well before the center of mass is near the stability limits of the base of support. Furthermore, it appears that subjects, when given the option, will select these reactions in preference to the fixed-support "hip strategy" that has been purported to be of functional importance. The rapid speed of compensatory change-in-support reactions distinguishes them from "volitional" arm and leg movements. In addition, compensatory stepping reactions often lack the anticipatory control elements that are invariably present in non-compensatory stepping, such as gait initiation. Even when present, these anticipatory adjustments appear to have little functional value during rapid compensatory movements. Lateral destabilization complicates the control of compensatory stepping, a finding that may be particularly relevant to the problem of falls and hip fractures in elderly people. Older adults appear to have problems in controlling lateral stability when stepping to recover balance, even when responding to anteroposterior perturbation. Increased understanding and awareness of change-in-support reactions should lead to development of new diagnostic and therapeutic approaches for detecting and treating specific causes of imbalance and falling in elderly people and in patients with balance impairments. [Maki BE, McIlroy WE. The role of limb movements in maintaining upright stance: the "change-in-support" strategy. Phys Ther. 1997;77:488-507.] |
Audience | Professional |
Author | William E McIlroy Brian E Maki |
Author_xml | – sequence: 1 givenname: B E surname: Maki fullname: Maki, B E email: maki@srcl.sunnybrook.utoronto.ca organization: Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada. maki@srcl.sunnybrook.utoronto.ca – sequence: 2 givenname: W E surname: McIlroy fullname: McIlroy, W E |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/9149760$$D View this record in MEDLINE/PubMed |
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Snippet | Change-in-support strategies, involving stepping or grasping movements of the limbs, are prevalent reactions to instability and appear to play a more important... |
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SubjectTerms | Adaptation, Physiological Adult Aged Aging - physiology Anatomy & physiology Arm - physiology Human locomotion Humans Leg - physiology Middle Aged Motor ability Movement - physiology Movement disorders Postural Balance - physiology Posture Posture - physiology Posture disorders Sensation Disorders - physiopathology Space life sciences |
Title | The Role of Limb Movements in Maintaining Upright Stance: The “Change-in-Support” Strategy |
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