So many of our clients seem to have no idea where their bodies are in space.  It is clear that there are many layers as to why this occurs. I’d like to explore some possibilities as to why our clients seem to get lost in space and how we can help them stay grounded with a better awareness of midline.

When typically developing babies are born, physiological flexion helps them cope with gravity.  This biomechanical alignment gives their body a sense of being connected and secure.  It also contributes structural support for the beginning of the perceptual reference of “the middle”.

As soon as the baby begins to move, the Moro reflex comes into play.  This is the first time the baby experiences a quick movement of the arms and the legs away from the secure flexed position and an involuntary return to flexion – further contributing to the development of the concept of midline.

More primitive movement patterns are expressed – the Tonic Labyrinthine Reflex, the Asymmetric Tonic Neck Reflex and the Symmetric Tonic Neck Reflex all provide the early sensorimotor wiring to help the baby to differentiate their body in different planes of movement¹.  Anti-gravity extension followed closely by anti-gravity flexion begin to develop, and these balance the trunk as we come further up against gravity².

With gravity, movement and neurological maturation, the baby also begins to develop the alignment that supports gradual increased activation of the inner core muscle team.  This development of central stability of the body is crucial to the development of the child’s perception of midline³.

As the baby matures, primitive movement patterns are no longer sufficient for postural control and more mature patterns begin to develop.  Head righting, trunk righting and equilibrium reactions emerge and are further integrated into the more complex anticipatory and reactive postural adjustments – the manifestation of mature postural control.  But for all postural control reactions, a child must have a perceptual sense of midline so they know where it is they should return to when they shift off the center.

All of these reflexes and reactions depend on the registration, processing and integration of information through the vestibular system and it’s connections to the visual system.  Unfortunately as we know, many of our clients experience challenges in the function of their vestibular system.  Vestibular dysfunction can contribute to low tone, which alters the quality and quantity of physiological flexion.   It can also impact primitive reflex expression/development and the differentiation of anti-gravity extension and flexion.  The development of balance reactions and mature postural control are also significantly impacted by vestibular processing.  Challenges in any of these areas can interfere with the development of the concept of midline. Without a good quality central stability contribution to their perceptual sense of midline, our clients may continue to feel lost in space.

PRACTICAL APP:

When you are working on crossing midline with a client, look at their alignment.  Are they sitting back in a posterior pelvis in posterior tilt?  This alignment doesn’t support the activation of the inner core muscle team and it’s contribution to central stability.

Alternatively, when your clients try to sit up tall, does their alignment look more like this?  Unfortunately although the pelvis looks better here the alignment of the rib cage has been disrupted, which again, doesn’t support the activation of the inner core muscle team either and central stability will be impaired.

So the next time you begin an activity that involves crossing midline, spend time critically assessing alignment.  Set up a neutral pelvis and neutral rib cage and make sure they are in relationship to each other.  This will support activation of central stability and contribute to the child’s sense of midline.

References

1.  Zafeiriou DI.  Primitive reflexes and postural reactions in the neurodevelopmental examination.  Pediatr Neurol. 2004; 31(1): 1-8.

2.  Arndt SW, Chandler LS, Sweeney JK, Sharkey MA, McElroy JJ.  The effects of neurodevelopmental treatment-based protocol for infants with posture and movement dysfunction.  Ped Phys Ther. 2008; 20(1): 11-22.

 3.  Mannell S, Wiebe J.  Applying the Evidence: Core stability in the child with motor challenges Part 1.  San Diego, APTA CSM 2013.

For more discussion regarding assessment and treatment of children with hypotonia, check out the upcoming continuing education course Defying Gravity: Understanding and Treating Children with Hypotonia.

For a more in-depth discussion of assessment and treatment of central stability and postural control, join us for any of our Dynamic Core for Kids workshops.

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

photocredit: 60pages.com