I see quite a lot of 6/7 year olds who are having difficulty balancing on one foot to kick a ball or hop.  During my assessment, I explain to parents that children’s ability to accomplish these higher-level gross motor skills begins when they are just a baby, during tummy time.  Here they begin to experience central stability with the earliest activation of the anticipatory core team (the respiratory diaphragm, pelvic floor, transversus abdominis and the multifidus) followed closely by activation of the posterior oblique synergist (contralateral glutes and latissimus dorsi).  This relationship continues to develop in all movement transitions.  As the child matures, the lateral synergist comes online (contralateral glute medius and adductors) in preparation for standing, walking and balancing on one foot.  Other major postural synergists come in to play as well, creating a firm foundation for higher-level gross motor skills.

The children in the first picture are displaying the integration of central stability with all the synergists. They have stabilized the weightbearing hip using hip extensors and hip abductors in mid-range and are controlling the position of the leg on the non-weightbearing side, at the same time as controlling their trunk in midline (for more information about the development of weight shift at the pelvis, check out Shift Happens).  Although their control within this position varies, the developmental pattern remains constant.  Contrast that with the alignment of the child in the second photo.  He lacks adequate central stability and is compensating to achieve the position.  His weightbearing hip is stabilized by dropping his pelvis on that side and resting at the end range of hip abduction.  The non-weightbearing leg is falling in to adduction.  His trunk is laterally flexed to counterbalance and keep his head in the middle.  The child utilizing this pattern is less stable and therefore it is difficult for him to access this pattern in play.

Treatment involves re-establishing the alignment necessary for central stability and teaching the child to activate the respiratory diaphragm properly to engage the anticipatory core team. Then we can efficiently strengthen the reactive core synergists in concert with central stability.

One last note about balance: it is impacted by our emotional arousal and informed by our sensory systems.  We should be layering our intervention strategies for musculoskeletal activation, sensory processing and regulation so our clients can find and keep their balance.

PRACTICAL APP:

Analyze the pattern a child uses as they move in to standing on one foot. Do you see any of these compensatory patterns?

1. Trying to lift their foot without shifting their weight to the opposite side?
2. Trying to unweight their leg by laterally flexing their trunk to the opposite side?
3. Shifting their weight by dropping their pelvis first?

Any of these patterns indicates that there is a problem with activation of central stability.

For more on integrated assessment and treatment, join us for Expanding Your Toolbox: Integrating Therapeutic Approaches in September 2014.

This blog was written for PediaStaff, a great resource for therapists.  You can find them at www.pediastaff.com. 

photo credits: skinnychef.com, waterstreetbooks.com, ot-mom-learning-activities.com