Brain Neurorehabil.  2013 Sep;6(2):47-53. 10.12786/bn.2013.6.2.47.

Anatomy and Physiology of Balance

  • 1Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea.


Postural balance is controlled by intricate connections between the vestibular, visual and proprioception system. Among these, the vestibular system is one of the key factors in coordinating and maintaining balance. The peripheral apparatus for the vestibular system consists of the semicircular canals, which sense head rotation; and the otoliths, which sense gravity and linear acceleration. The central vestibular pathways form a large network from the vestibular nuclei, ocular motor nuclei, integration centers in the pons and rostral midbrain, vestibulocerebellum, thalamus, to the multisensory vestibular cortex areas in the temporoparietal cortex. The most important structures for the central vestibular pathways are those mediating the vestibulo-ocular reflex (VOR), and the descending pathways into the spinal cord along the medial and lateral vestibulospinal tract which mediate postural control. The cortical structures involved in vestibular function are the parietoinsular vestibular cortex, the retroinsular cortex, the superior temporal gyrus and the inferior parietal lobule. Activation of the cortical network during vestibular stimulation is not symmetrical; dominance is stronger in the nondominant hemisphere, in the hemisphere ipsilateral to the stimulated ear and in the hemisphere ipsilateral to the slow phase of the vestibular caloric nystagmus. Disorder of the vestibular pathway, anyway along its various tracts, may result in balance and coordination impairments and lead to misperception of motion.


cerebellum; postural balance; proprioception; vestibular; vestibulo-ocular reflex
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