Quite a few years ago, I purchased this Christmas book (- it appeals to my sense of humour).  As the story goes, one year Olive the dog is merrily preparing for the holidays when a Christmas song comes on the radio and she hears “Olive, the other Reindeer…..”, so off she goes to the North Pole to help Santa and the rest of her reindeer family.  Together they form a not-so-perfect team to get the job done.  Naturally I see parallels between this story and my clinical practice 🙂  For our clients, functional tasks are the jobs and yes, it takes a whole sensory and motor team to get them done.

Typically, we rely primarily on visual information when we are young, to organize our postural control.  By the age of 4-5 we are able to combine that with somatosensory information so the process is more refined.  And finally, somewhere around the age of 12 we can solve sensory conflict situations (ex. when you are sitting in the train and the train next to you begins to move and it takes you a moment to figure out it’s the other train moving, not you) (1,2).  Unfortunately many of our clients don’t process/integrate somatosensory information very well (3) and/or their alignment interferes with activation of anticipatory postural adjustments (4).  So the team isn’t pulling together very well.  However, in treatment we can support the weakest members of the team and put the strongest members of the team to better use. This can help our clients maximize their sensory and motor information and get the job done more efficiently.   Our research indicates we should be training in alignment (4), using visual cues (5), and auditory cues (3, 6). My clinical experience supports that training using vestibular and proprioceptive sensory input also benefits some of our clients.

If we assess and treat in an integrative way, it won’t matter that the team isn’t perfect, we can help all the systems to work together for improved postural control and function for our clients.

Thanks to all of you who have read and commented on the HeartSpace blogs this past year – I really enjoy the conversations.  And I want to wish “Olive you” a wonderful holiday season!

PRACTICAL APP:

Review your assessment and ensure that you are looking at the whole team:

• Musculoskeletal (range, strength, endurance)
• Sensory (vestibular, proprioception, tactile, functional vision, auditory)
• Postural control (primitive movement patterns, Dynamic Core strategy, righting, protective and equilibrium reactions, anticipatory/reactive postural adjustments)
• Autonomic nervous system function (SNS/PNS balance)
• Cardiorespiratory (breathing pattern, expansion)
• Motor planning
• Motor learning style

With this information, we can develop comprehensive treatment plans that reflect the complexity of our clients’ needs and strengths.

References

1. Foudriat BA, Di Fabio RP, Anderson JH.  Sensory organization of balance responses in children 3-6 years of age: a normative study with diagnostic implications.  Int J Pediatr Otorhinolarygol. 1993; 27(3): 255-71.

2.  Rinaldi NM, Polastri PF, Barela JA.  Age-related changes in postural control sensory reweighing.  Neurosci Let. 2009; 467: 225-229.

3.  Rinehart NG, Tonge BJ, Iansek R et al: Gait function in newly diagnosed children with austism: cerebellar and basal ganglia related disorder. Dev Med Child Neurol 2006;48(10): 819-24.

4.  Girolami G, Shiratori T, Aruin AS.  Anticipatory postural adjustments in children with hemiplegia and diplegia.  J Electromyogr Kinesiol. 2011; 21: 988-97.

5. Ledebt A, Becher J, Kapper J, et al.  Balance training with visual feedback in children with hemiplegia cerebral palsy: effect on stance and gait. Motor Control. 2005; 9(4): 459-68.

6. Suh JH, Han SJ, Jeon Sy et al. Effect of rhythmic auditory stimulation on gait and balance in hemiplegic stroke patients. NeuroRehabilitation. 2013; DOI 10.3233/NRE-131008

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