Negative contribution of automatic postural control

“Negative” Contribution of
automatic postural control
following stroke.
By
Rajul Vasa
Applied Movement Scientist
Mumbai [India].

Natural recovery
• Following brain stroke, brain begins to heal
naturally with reduction in swelling, reduction
in the pressure on the surviving neurons,
improved circulation and connectivity
between distant neurons, instant plastic
changes, dendritic sprouting in chronic stage
etc. BUT…….. Yet….. most of the stroke
patients of today struggle to recover function
of their paretic body like a fellow stroke
patient who suffered stroke in the last
century.

Lesion
• Primarily Brain Lesion is
considered to be responsible
for loss of function, weakness,
spasticity and abnormal
movements.

COM
• In my experience, brain lesion is only a catalyst. Prime player
behind chain of complications and poor recovery is

‘Negative contribution’
of
automatic postural control
i.e.
control of our body Centre of Mass (COM)

• COM is an invisible entity and not an anatomical structure in
our body.
• We can take COM safety for granted because safety is highly
automatic and it is a priority for all living beings.

Impact of stroke
• First impact of stroke is general
paresis of muscles of one side of
the body. (some strokes have effect on both
sides of the body.) Paretic flail weak
muscles are unable to generate
spatiotemporally effective force
to control and restore COM to
safety.

Instant plasticity
• Instant plasticity and adaptability of
self-organizing brain automatically
triggers switching control of Centre of
Mass (COM) to muscles of good side of
the body to prioritize safety from
falling.

[Instant plasticity is positive plasticity for safety in
acute state]

Getting adapted to use good side.
• Switching control to good side from
instant plastic changes can be
detrimental to recovery of paretic
muscles on a longer run because stroke
patients get adapted to depend on his
good side for safety from falling during
all postural movements like sitting
down, getting up, standing, walking.
etc.

Negative plasticity
• Positive plasticity of acute state helps in short
term to be able to use good body to sit, get up,
stand and walk but adaptability of the system
turns this advantage into disadvantage with
Negative plasticity
in chronic state
with
• Inability to reload paretic side.
• Inability to control and restore COM to safety
with paretic body.

Unloading of paretic limb.
• Paretic lower limb muscles cannot
sustain the weight of the Head, Arms,
Trunk [HAT] mass. This makes self-
organizing brain to automatically
‘Switch Off’
the control of COM from paretic side. This
results into automatic shift of head arms
and trunk [HAT] mass onto the good leg
resulting into Poor loading of paretic leg
despite verbal feedback, mirror feedback,
EMG feedback.

Switching off
• Switching off the control on COM from
paretic side and transferring it to good
side happens without the knowledge of
the stroke subject.
• This results in automatic dependence of
the patient exclusively on his good side
of the body.
• He sits, gets up, and walks, using his
good hand whenever he attempts it.

Negative contribution of automatic postural control

Snowball effect
• Using good side to control, restore
COM to safety and using good limbs
to sit, get up and walk puts the
stroke subject on a reverse escalator
with negative recovery in terms of
abnormal spastic movements that
takes snow ball effect with passage
of time with paretic limbs getting
towed by good limbs.

Vicious Circle
• Despite initial natural healing in and
around lesioned area poor loading on
paretic leg triggers vicious circle of
pathological abnormal movements from
Spino- spinal connectivity between
good limb and paretic limbs. These
abnormal movements are ‘Here to Stay’
unless therapy focuses on making
paretic body capable of controlling and
restoring COM to safety.

Leading and Following
• Ability of good side to control and
restore COM to safety makes good
side turn into a LEADER leading and
controlling posture uninterruptedly.
• This makes paretic side TO FOLLOW
the good side uninterruptedly as
safety of COM is automatic and is
always a priority.

Towing
• In order that paretic side with
huge inertial mass can be
towed by good side easily
optimally and economically,
self-organizing brain begins to
take several steps.

Car is hooked to towing van
• Contracture in deep short muscles
and connective tissue at the central
axis in the body hooks and binds
paretic body to the good body for
easy towing.

Log
• Brain with lesion triggers Contracture in
connective tissue, in Thoraco-lumbar Fascia
that connects cervical spine to pelvis and
sacrum.
• Brain with lesion also induces stiffness and
contracture in those large muscles which are
attached to Thoraco-lumbar Fascia and travels
all the way to upper limb like Lattissimus dorsi
thus binding both girdles together like a log to
enable easy towing by good side.

Anticipatory Postural control.
• Slightest instability, disequilibrium and
threat to the safety of COM triggers
anticipatory control to safeguard COM.
• Self-organizing brain restricts medio-
lateral COM movement on paretic side in
anticipation of threat in case if COM
moved into paretic territory with weak
flail muscles which are unable to restore
COM to safety.

Solution by self-organizing brain
• With restrictions of medio-lateral movement
of COM on paretic side, paretic lower limb is
unable to bear weight of torso and upper
limb thus reducing load on LL thereby
reducing threat giving indirect safety to COM
• Also when self-organizing brain switches
postural control for safety of COM to good
side, no external verbal visual auditory
feedback can change the solution arrived by
self-organizing brain; not to shift weight
medio-laterally on paretic lower limb.

Spino-Spinal connectivity
Brain exploits Spino-Spinal neuronal
connectivity and limb to limb knowledge,
inter limb knowledge to activate many
muscles of paretic weak side together in a
chain reaction in a synergic pattern to
decrease ‘Increased degrees of freedom’
from paresis that could otherwise pose
threat to the safety of COM. Safety being a
priority for all living being.

Arm in abnormal flexion posture.
Brain triggers anticipatory control with
slightest movement of COM and exploits
Spino-Spinal connectivity and limb to limb
knowledge, inter limb knowledge to bring
the linked segments of paretic upper limb
in flexion posture so as to bring the arm
closer to the central axis so that segmental
COM of paretic upper limb does not pose
added threat to global COM by running out
of the support surface.

Snow ball effect
Poor loading on paretic leg, abnormal
flexion posture in upper limb, tight wrist
and fingers continue to get worst with
passage of time from negative contribution
of automatic postural control that makes
good limbs to dominate for safety from
falling and paretic remain off loaded unless
brain is re-reorganized with Vasa Concept
to steer the paretic side to recover as
desired.

Negative contribution of automatic postural control

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