Our last system in this series is cognitive resources. This is not cognition in the sense that we think about postural control every moment of every day (which would be exhausting!) but rather in the sense that there is a layer of unconscious energy that our brain dedicates to postural control. Over my career, I have met a few very involved children who were up on their feet using sheer force of will because it meant so much to them. Conversely I have met children who were motorically capable of walking but had no interest in developing the skill. I think a key to understanding their outcomes is cognitive resources.

We have learned about the contribution of cognitive resources by studying postural control in dual task conditions. That is, researchers study the balance of a group, then add another motor or cognitive task to the balance task and observe what happens to postural control. We have learned that when we add a second task, the neurotypical adult population displays little functional difference in postural control. Neurotypical children have difficulty with dual task standing/walking and cognitive skills, with their performance improving steadily until sometime after 12 years old. This indicates that in typical development a child’s motor skills are still developing and are not as automated as they are in adults.  

The same cannot be said of other populations. Dual task conditions remain more challenging for children with brain injury, children with Down syndrome, children with intellectual disability, children with CP, and children with dyslexia.

The good news is that research suggests dual task training improves postural stability in several different populations. Elhinidi et al studied children with infantile hemiparesis and found that dual-task training significantly improved the postural stability of the children with hemiparesis. Seo et al concluded that dual-task training was more effective for improving balance in adult patients post-stroke. And Houwink et al recommended dual-task training for children with CP and Developmental Coordination Disorder. Also it would seem that our instructions can influence outcomes, so we should endeavour to keep our verbal cues consistent.

The practical application: As your client’s balance improves, continue to challenge them by layering another simple motor or cognitive skill on top of their balance skill. Then up the ante and increase the complexity. This approach will ultimately help postural control to become more automatic and therefore, more functional. 

Finally, I would like you to consider the scenario that applies to a great many of our clients . Our children are already devoting cognitive resources to their emotional regulation and their postural control, so essentially they are already dual tasking all the time. When we ask them to perform complex motor or cognitive tasks on top of this, we are really asking them to perform three tasks at once. No wonder their regulation and postural control tend to fall apart under the weight of such demands. Let us tread gently and appreciate how hard they are working each and every day.