Postural control in children
with sensory processing disorder
In order to meet the
environmental demands in an effective way, a child must be able to assume and maintain
stable positions, move without losing balance and have adequate postural
control to support movements of hands and legs. This becomes essential for a
child to be competitive and successful at his/her performance areas such as
play, home and school.
Postural deficits that are
often associated with vestibular and proprioceptive dysfunction include a group
of components as follows.
1. Low tone in extensor muscles
2. Poor postural stability
3. Poor co-contraction
4. Poor equilibrium reactions
5. Poor tonic flexion in neck muscles.
Example of poor postural control: A teacher complained about
child that each time the child was asked to pick up materials from bag that was
placed under the chair, the child had to get up from chair, turn around, sit
down to pick up things and repeat the
same procedure to get back to chair. The child lacked the postural control that
was required to remain seated and retrieve the materials from the bag. This is
a typical example of inadequate postural control.
Home and school behavior:
-
Finds difficulty sitting still
-
Appears clumsy
-
May be lethargic/ lazy or be slow at day
to day activities
-
Looses balance and falls often
-
May seem weak due to poor proprioception
-
May seek intense vestibular input yet
avoid challenging vestibular activities while on play ground with peers present
-
Drops things often from hand
When
children exhibit cluster of postural difficulties, they are most likely to have
difficulty in processing vestibular and proprioceptive sensation. Hence
intervention should be emphasized on activities that provide enhanced
vestibular and proprioceptive sensation that simultaneously challenge posture.
Those activities should address the following 4 components of posture.
-
Postural extension
-
Postural flexion
-
Postural stability
-
Balance
A.
Postural extension: Activities given on prone position,
i.e., child lying on tummy, gives good effort to extension position. These
include,
-
Lying prone on flat swing and do
activities like fixing puzzles, dropping coins etc using hands
-
Lying prone on gym ball and reach for
toys overhead to allow lifting head and neck against gravity
-
Lying prone on elbows and playing with
toys or blowing candles placed in front can be given for kids with low muscle
tone
-
Lying prone from a higher surface such
as cot or barrel/ bolster and weight bear with hands on floor will allow good
co-contraction for shoulder and neck muscles and performing activities using
one hand in this position will provide good opportunity for weight shifting.
-
Lying prone on a wedge with neck and arm
unsupported to net a ball into a basket overhead is a highly challenging task
for developing tonic extension.
-
Activities can be done lying prone on
scooter board, hammock or lycra swing
B.
Postural flexion: Activities given on supine position, i.e.,
child lying on back, where head and limbs are aimed at moving towards the
abdomen gives good effort to flexion position. These include,
-
Lying supine on an inclined mattress or
wedge and raising head and trunk to reach target held by the care giver
-
Lying supine with a little pillow under
head and playing kicking ball
-
Lying supine on floor and propelling
swing through legs
-
Sitting on a disc swing, hammock or
lycra swing and picking up objects from floor
-
Hanging on trapeze to swing and cross
over an obstacle
C. Postural stability:
Creating activities with postural rotation and weight shifting helps the child
attain postural stability through facilitating mobility superimposed on
stability.
-
Rotation can be given through activities
such as rolling inside a barrel, swinging at all directions with change in body
postures as in reaching for toys overhead and under swing etc
-
Weight shifting can be given using any
piece of equipment that move or any activity that involves reaching at various
positions such as kneeling, standing, quadruped, one leg standing, squatting,
bending etc.
D. Balance: The ultimate
goal of postural control is to maintain body balance when there is a movement
threat to the body or support surface. This can be achieved through reaching
out from various static postures to elicit subtle equilibrium reactions and
progressing to activities that can be performed by placing the child on any
unstable equipment such as swing, gym ball, balance board, balance beam, bean
bag, spin disc, see saw, etc. Care should be taken that activities to develop
balance should progress from static to dynamic postures and should never be a
threat to the child.
