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62 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

Central Limb Postural
Command Movement Instability

Feedforward for Postural
an cipated postural Adjustment Feedback for
instability unan cipated
postural instability
FIGURE 3-6 Basic principles of postural control�

Impairment of Postural Control

Disruption, damage or impairment to any of the systems involved in postural control
will have an impact on an individual’s postural control mechanism to a varying degree. If
the individual is unable to utilise normal mechanisms of postural control due to damage
to either an immature brain as in a young infant, or a more mature brain as in an older
child or adult, they will have difficulty controlling, organising and adapting movements in
response to a task or environmental stimuli. They may be unable to change their posture
and consequently spend a sustained period of time in a certain position without the ability
to oppose the force of gravity. For example, tightness or shortening of particular muscle
groups may have distinctive postural presentations; in a sitting position, tight hamstring
muscles may pull the pelvis into a posteriorly tilted position and create a subsequent
slumped spinal posture (Fig. 3-7).
Similarly, we know that damage to specific parts of the brain during the course of
a disease can also cause distinctive postural problems, such as is seen with the imbal-
ance of dopamine and acetylcholine (both neurotransmitters) within the basal ganglia in
Parkinson’s disease, resulting in a distinctive stooped posture, tremor and bradykinesia or
reduced movements (Fig. 3-8).
Any impairment of postural control can lead to a cycle of significant long-term issues,
which in turn may lead to a further loss in postural ability. Thus, careful and timely man-
agement of posture is of benefit to address impaired postural control.

What Is Postural Management?
Postural management is ‘a planned approach encompassing all activities and interven-
tions which impact on an individual’s posture and function’ (Gericke, 2006).
It has been advocated that to be most effective, it needs to be considered over a 24 -hour
period (NICE, 2012). It should not just include the provision of seating and other position-
ing equipment, but encompass a more holistic approach through a wide variety of inter-
ventions, including:

• Postural management equipment.
• Individual exercise.