Window 5: Posture – Concussion Assessment and Brain Health

Written By: David Burns

postureOur brain determines how we stand, the curves of our spine, our awareness of our head position relative to our body and our joint angulations. It is for this reason, that a part of the functional neurological exam at Issaquah’s Brain Centers NW includes an evaluation of posture.

Posture evaluation is important for baseline testing, concussion assessment and brain health evaluations. Here are a few things that I look at when examining posture:

Can you maintain a stable upright posture? The posture is observed both with the eyes open and closed; with feet normal width apart and / or feet together. Notice if there is a sway when eyes are closed. Is the sway in a consistent direction or is it all over the place? Postural sway can be caused by an issue with the inner part of the cerebellum, the brainstem vestibular nuclei, abnormal information from the inner ears, asymmetry in the pathways down to the spine that stabilize the joints or an abnormal perception of where you are in space.

Is the individual’s head on straight? You want to have them close their eyes and turn their head left and right with their eyes closed. Is their head tilted or rotated? Head tilt may reflect an assymetry of input from inner ear, cerebellum, brainstem, midbrain or may be a compensation for an eye alignment issue. While their eyes are closed ask them to put their head back to center. Do they accurately put their head back to center or is it to one side or the other? When they open their eyes, if they are off center do they make the correction? This process can be repeated with head tilt and with head flexion and extension. Head position and body awareness is dependent on the information we get from our joints, the information we get from our inner ear and our perception of where we are in space which is a brain function. Any one of these things can cause a disturbance in head alignment.

Do they have asymmetries in joint angulations? Tone of muscle is a reflection of brain function and can vary, changing joint angulation. This is obvious when we see somebody post stroke. The same is true for “soft” brain lesions or physiological asymmetries of brain function. Is there any internal rotation of the shoulder? Is there flaring of one foot (i.e. is the hip externally rotated)? Is there a difference in the angulation at the elbows?

Look at the curves of the spine from the back and from the side. In the same way that brain function changes joint angulation because of the influence on muscle tone the same is true for the curves of the spine. Think about the curves of the spine that develop in an infant as they sit and than stand. Think about a toddler with their big lower back sway and pelvis angulations. What happens when we age, does posture change?

Did you know that scoliosis has a significantly greater prevalence in children with neurobehavioral issues? Why?…Brain.

This blog and the other blog “windows” into brain function are not intended for anybody to make any diagnosis or determine treatment for anybody. It is simply intended to help patients understand what a functional approach to neurology, brain function, concussion management, sports performance evaluation may entail. But most importantly, to help the patient or client communicate with the provider so that they or their children can achieve the best brain health possible. Achieving optimal brain health is an interdependent process, an active process that starts with communication.

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