What Contributes To Your Child’s Balance?

There are three main components that make up a person’s balance. These include: vision, somatosensation, and our vestibular system. These components need to work seamlessly together in order to allow both adults and children to maintain their balance in all different environments and scenarios.

 

Vision is pretty simple: what you’re able to see with your eyes allows you to keep your balance. You may notice that your young child needs to look down more frequently, especially in newer environments. Somatosensation is what we are able to feel, and particularly important for balance is what we are able to feel with our feet. This comes in handy for walking across uneven surfaces, such a grass or dirt. Our proprioceptive receptors are able to detect changes in terrain and accommodate accordingly. Finally, our vestibular system is what is located in our inner ear. This system allows us to detect changes in movement and motion, and accommodate accordingly.

 

If one component of balance is unavailable for use, the other two must compensate for this loss. Take vision for example: When you are walking at night or in the dark, your vision is at a disadvantage, and therefore, the vestibular and proprioceptive systems have to compensate for the corresponding loss of visual input. Many people, children included, may tend to over-rely on vision, particularly if the other two components aren’t functioning properly. It is therefore essential to ensure that all three components are contributing to one’s balance.

 

An example of the development of the somatosensory component is evident in young children when they are first learning to stand. You may remember your child rocking back and forth from their feet to their heels. This allows the child to gain knowledge of their limits of stability, and is also providing essential somatosensory input. They will learn to associate the feeling of being too far on their toes with a loss of balance, as well as going too far back on their heels. This discovery play is essential for all children, and helps to develop a sense of what appropriate balance feels like!

 

The vestibular system becomes essential for maintaining balance during movement.  The development of this system can be enhanced by encouraging  your growing child to participate in activities that involve movement—such as swinging, jumping, and playing catch!

 

It is essential to encourage kids to explore and discover their balance! Some activities that encourage balance development include: standing on one foot, walking along narrow surfaces (such as along curbs), jumping off higher surfaces, standing with their eyes closed, and walking along uneven or unsteady surfaces (such as grass or tan bark or over pillows at home).

Here are some older blog posts that address activities that can work on balance!

Jumping and Balance Path

I know we’ve talked about a jumping path before but I loved this path that I happened to observe one of my therapists using with her kiddo. It incorporates jumping forward, jumping over, jumping on, jumping off, jumping open, and jumping close. And then, it adds in balance via single leg stance and toe taps!

The best part was, watching her kiddo help her put it together and knowing that he had put his cut out feet in the open position like she had asked him to.

Here’s a video of the final product!

What other variations can you think of?

Balance and Vestibular System Ideas

Balance is an important part of movement and safety and is a requirement for every day activities. Balance can involve keeping two feet on the floor, or even standing on one foot. There are many activities that require balancing on one leg. Some of these are: running, stairs, kicking, and walking in varied directions.

Try these activities to improve your little one’s balance today:

• Popping bubbles: Have your child stand on one leg, and use the other foot to try and pop a bubble.
• Kicking a ball: Practice standing on one foot for 5-10 seconds prior to kicking the ball to your partner.
• Balance beam: Make your own balance beam by using a pool noodle. Practice walking up and back. If this gets too easy, walk backwards!

Some of our older blog posts that address balance are:

• Taking the Vision out of Balance
• Ball vs Platform Swing for Balance Reactions
• Balance Boards
• Fun way to work on balance reactions
• Balance Beam Ideas

The vestibular system is one of our key components of balance and helps individuals of all ages maintain visual stability. Children may experience deficits with their vestibular system for many reasons, and these deficits can impact their ability to actively participate in age appropriate activities and recreation. Here are some ideas for stimulating your child’s vestibular system:

• • Vestibular Input Activities
  • Sensory Processing: The Vestibular System
  • Vestibular Activities
  • 10 Calming Vestibular Activities
  • Toys for Vestibular Development
  • Why Kids Need Upside Down Play

Fun with Balance Beams

I don’t know about you but balance beams are one of our staples to use with kids. As I was writing this post, I looked around and realized just how many different ones we have, and we actually use them all!

Clearly having a kid walk on a balance beam will work on their balance.  If forces them to narrow their base of support which challenges their balance. You can make it as easy or as difficult as you want.

Some things to take into consideration when you are selecting which beam to use:

• Wider is less difficult than narrow
• Firm is less difficult than soft and squishy
• Straight is less difficult than curved or zig zag
• Lower to the ground is less difficult than higher off the ground

That being said, there are times we will use one that is more challenging than you would think appropriate for the child. We might use a higher one, even though the child is still struggling with one low to the ground. This could be because when it is low to the ground they try to go too fast, or step off too easily.  When its higher they may slow down and take more deliberate steps.

I’ve been asked why we don’t just use some tape on the ground. Well we do, but that doesn’t have the same effect as being elevated off the ground. When the child is off the ground, most times, they have a sense of it and are more cautious. It can work on their confidence for novel situations, or even help with their fear of falling as they practice being successful over and over.

We have several kids who like to move, and use movement to find their stability. They actually have a harder time doing things that require them to be still. By giving them a balance beam to walk on, they are challenged and most often have to slow down which can help work on their static stability.

Now walking is the easiest way to use a balance beam. Its the most common way we use it, but that doesn’t mean its the only way. Some of the other ways we have used balance beams are:

• Side stepping – Have the child take sideways steps to the left and the right to cross the beam. This works best if they are going out and back so they get both sides, but if they are only going one way, just have them switch the direction they are facing as they walk each time.
• Blindfolded – This helps to work on their awareness of their bodies and decreases their ability to use vision to help their balance. Check out our post on using animal masks to work on balance!
• Squats – As the child walks along the beam they can squat down to pick up treasure in front of them, or they can turn to the side to pick up treasure on the floor.  Usually treasure is a bean bag or a puzzle piece or a Squigz or whatever has captured their fancy that session!
• Catch – Have the child stand on the balance beam and play catch with them. If there isn’t anyone spotting them make sure they are in a safe place if they lose their balance
• Backwards – Walking backwards is another challenge to balance and body awareness. A fun way to incorporate it is to have the child go through the ‘adventure’ backwards. Anything novel usually captures their attention for a short period of time!
• Jumping – We have jumped on them like bunnies, jumped over them like obstacles, and used them to practice side to side jumping.

What are other ways you have used balance beams?

 

Taking the Vision out of Balance

We are finding that a lot of the kids we work with rely on their vision to help them maintain their balance.  Now this isn’t all bad, and vision is one of the inputs that our body uses to help keep us upright.  But, if all things are equal, our first line of defense should be our proprioceptive system.  This is the system in the joints and muscles that sends messages to the brain to tell it where our body is in space.  When we rely on vision we are moving that to our first line of defense.

The challenge with vision being the first line of defense, and not our proprioceptive system is that it can make balancing difficult when a child is in a busy environment, or when they are distracted and can’t visually attend to what they are doing.  This is often why you see a kiddo lose their balance more when there are a lot of people around, then when they are by themselves.  They are visually distracted so they aren’t focusing on watching what they are doing.  Since their proprioceptive system is used to vision driving the bus, it is slow to react and often its not enough time for the child to regain their balance.

So what can we do to help?  We recently bought some fun animal sleep masks that we have been using with our kids.  They can pick what animal they want to be and then we make a game out of it depending on what they are working on.  It could be as simple as walking across our large therapy room (on the mat) towards the crash pad.  One kiddo pretended he was a mouse cop and collected all the stuffed animals and brought them back to the police station.  If you just want to focus on balance while staying still, you could have them practice standing on one foot, or tandem stance (one foot in front of the other), or even just standing on two feet.  You can play statues where they have to freeze in that position, or Simon Says, to name a few ideas.

Using the Ball vs the Platform Swing for Balance Reactions

  

As a therapist, we use the therapy ball a lot with our kids.  It helps them to work on balance reactions and postural control as well as provides vestibular input in a variety of directions.  The kids love it because usually we sing to them and bounce them and they may even forget they are working.  There are a few things to consider when using the ball though.  Generally you are holding onto the child in some way so they are being provided stability (most likely at the pelvis) which allows them to only concentrate on activating their core without having to figure out how to counterbalance at the pelvis.  In addition, usually kids are sitting with their feet hanging down in front of them so they are able to pull in their leg muscles to assist with activating their trunk muscles by using the overflow.  If they over recruit their muscles, they can generally push against your hands to give themselves extra support.  Finally (although I am sure there a quite a few more points that I didn’t bring up), if you are holding them at their pelvis or even their trunk, I can almost guarantee that you are helping them correct their posture in some way, shape or form.

Another alternative to use in conjunction or to switch it up is to utilize a platform swing.  You can have the child sit in ring sitting, tailor sitting, side sitting, etc in front of you and then you can move the swing forward, backwards, sideways or even diagonal (similar to the directions you can move the ball) and see how the child reacts.  This method is great because it can let the child practice sitting ‘independently’ (although with you close by) so they can practice using their pelvis to counterbalance their trunk reactions.  For example, if the swing moves to the right, the child needs to stop the movement towards the right by pushing their left hip down into the surface and use their trunk muscles to shift them back to midline.  In the beginning, especially with the side to side motions, kids have a hard time preparing their body for the movement and need help to not topple over.  I usually start with slow, small movements until they begin to get the hang of it and then I will increase the speed or the size of the movement.  By having their legs crossed in front of them they also have to work harder to isolate their trunk extensors and other trunk muscles.  If you have a kiddo with higher tone, they will attempt to push their legs into extension while trying to stabilize.

Now I know not everyone has access to a platform swing so what other tools or tricks have you used to work on balance reactions on a dynamic surface, without giving the kiddo stabilization?

Using a Balance Board

There are many uses for balance boards but I thought I would share some of the ways we have used it.

1. I had a few kids who were having trouble squatting.  They didn’t want to bend their knees and preferred to just bend forward at the hips.  By putting them on a balance board and making the surface just a little unstable, they needed to adjust their movements to maintain their stability and it encouraged them to bend their knees even more.
2. I have found that a lot of kids spend time moving forward and backwards so their system is used to changes in this direction but side to side is not as common of a movement and often needs more practice for the body to anticipate how it needs to react in order to maintain stability.  By having kids stand on the balance board (as seen in the video) and perform activities where they need to reach in different directions, they are taking in a ton of input as to what happens when they move in each way and letting their body figure out how to react.  With enough exposure they become much more efficient at maintaining stability and the process becomes unconscious and lets them concentrate on having fun!
3. For kids who like to keep their weight on their heels, they have challenges when their weight is shifted forwards.  Because their center of gravity is sitting towards their back, their balance reactions kick in faster than they should when they begin to move their weight forward on their toes.  By having a kiddo on the balance board so that it rocks forward and backwards you can work on having them shift their weight forward in a similar way to what is shown in the video and have them get used to having their center of gravity in a more forward position.

How do you use balance boards?

Fun way to work on balance reactions

Growing Play posted the coolest idea recently: Surfing on Dry Land.  We tried to go out and get enough noodles and a boogie board so we could try it with some kiddos but it was too late in the season; so we had to make due with what we had and get creative for the boogie board (aka surfboard).  Luckily we had a kiddo coming in who is working on her balance and is almost always game for trying new activities.

The first time we tried it we had her stand with her feet even and facing the therapist.  This was definitely easy for her.  Then we had her stand staggered stance facing the crash pad (so she could jump off when she was finished).  This was definitely trickier.  Because she was facing the direction of the movement she got to work on her forward and backward balance reactions.  She is engaging her ankle reaction, her hip reaction and using her trunk and arms to maintain her balance when the other reactions weren’t enough.  We also switched it up so that she could lead with the other foot and practice both ways.  To make it a little easier we could have had her standing with her feet even while we moved her forward and backward but she was able to handle the challenge of staggered stance and stand like a ‘surfer’.

Who else has tried this great idea?  How did you use it?

Anticipatory or Reactionary Balance

For the sake of this post I am going to combine the idea of balance and postural control.  They are not exactly the same thing but they are similar in terms of what I am going to talk about.  Most people just think that balance is what keeps us upright.  While yes that is true its amazing how complex it can be. I am going to attempt to keep it simple (hopefully I succeed).

If you are walking down a hall and someone runs by from behind and bumps into you and you don’t lose your balance, you are using reactionary control.  You had no idea it was coming and yet you were able to react to what was happening to you and stay upright.  Maybe you needed to use your hands (protective extension) or take a few steps but you were able to pull together strategies to stay upright and not fall.  Another example of reactionary balance is if you are walking and the ground changes and you weren’t paying attention such as a slight change in height or a change in surface stability.  Your body has to react to stay upright.  This idea applies to whether you are sitting, standing, walking, running, etc. With reactionary the kiddo’s body needs to recognize that its balance has been disturbed and then send out the message to get the correct adjustments being made in just the right amount of time, in just the right sequence and with just the right amount of force (I feel like I’m quoting Goldilocks and the 3 Bears!).

With anticipatory it is when you are about to do something and your body makes the adjustments it needs to in order to stay upright.  For example, whenever I go to the Cheesecake factory they bring out those large water glasses and I go to pick it up, expecting it to be glass and I almost give myself a bath because it is plastic and much lighter than my body had prepared for.  The next time I go to pick it up I have made the necessary adjustments and can pick it up without dousing myself.  Another example is if a kiddo is just learning to crawl and they are figuring out how to move one arm and then the next and then the legs as well, all without falling flat on their face, they are learning the adjustments their body needs to make so that they can anticipate lifting their arm without losing their balance.  Same thing applies to kicking or throwing a ball or reaching for an object or almost anything we do on a daily basis.  With anticipatory the kiddo’s body needs to recognize that something is going to happen that will disturb its balance and make the adjustments before it happens.

What’s interesting is that often anticipatory starts as reactionary (in my experience).  Think about it, lets look at the kiddo I mentioned above who is learning to crawl.  The first time they lift their arm they can’t hold their balance and they fall.  When they try it again they still don’t know what their body needs to do but they know they might fall so they are a little more prepared.  They lift their arm and start to feel themselves falling so they react to this loss of balance and manage to keep their balance.  The next time (ok, I’m speeding up the sequence, it probably takes lots of attempts for each adjustment) they now know they were able to stay up so their body starts to anticipate what will happen when they lift their arm and they are able to lift it and move it to a different spot all while maintaining their balance.  They of course start the whole process over again with each arm or leg they move and then even more so when they try to move the arm and leg together , or go onto a slippery floor instead of carpet.

Hopefully that explanation made sense and you can see how it can apply to almost every movement or task we do throughout our day.

In one of my upcoming posts I’ll talk about some ways to work on balance (anticipatory and reactionary), in the meantime I challenge you to pay attention to when you are using each of the types throughout your day!

 

Developing Sitting Balance

As kids begin to sit up they need to figure out how to maintain their balance.  As you can see in the video it doesn’t just happen, there is lots of ‘figuring it out’ involved!

With the invention of the Bumbo seat more and more people (yes I am generalizing) are putting their kids in it to have them sit up sooner.  Now don’t get me wrong, it has its uses and is good for short bursts but kids need their whole bodies to develop sitting balance.  The Bumbo seat provides them extra stability at their legs and hips which allows them to work on their trunk and how to react to stay upright but it doesn’t give them the opportunity to coordinate all of the components that go into sitting.

To help a kiddo develop sitting balance you want them to have some trunk control first.  If they don’t have trunk control then you want to give them extra support at the hips or even at the belly area so they can start to learn how to keep their head and upper trunk upright in a sitting position.  If they can hold themselves up then you can start to wean away the support.  If you notice in the video I keep my hands close by but I’m not holding on tight.  By keeping my hands close by I am provide limits so that the kiddo can maintain success.  This way if they start to topple they won’t have to pick themselves back up from the ground, but rather from wherever my hands are.  This requires less work against gravity.  It also provides a chance for kids to work on figuring out when they have to turn their muscles on and off as their trunk moves around over their base of support.

I’m going to try to outline some of the things that go into developing and maintaining sitting balance:

(it can help to have something that is really engaging in front of them so they are using their visual attention to help with staying upright)

As kiddos start to lose their balance (or move their trunk too far outside their base of support) one of the first things they need to do is recognize that they are no longer balanced or upright.

Once this happens they need to send a message to their muscles to turn on and try to correct things so that they can be upright again and not fall over.  Usually when this happens in the beginning the message gets there a little too late and they fall over.  This is why if you give limits so they don’t go all the way to the floor they still get to figure out what muscles to turn on.  With repeated practice they start to get the message in time and begin to activate their muscles when they notice a change in head and trunk position.

In the beginning their muscles tend to overshoot the target (sometimes they undershoot too).  This means that they over compensate and use too much force so they go too far in the opposite direction.  When this happens it takes practice for them to quickly get the message and switch the muscles that they are using.  Sometimes I feel like kids learning to sit are little weeble wobbles!

If you notice in the video the legs are coming into play a lot.  This is how they begin to use their legs for stability.  If they can ground their legs and keep a stable base they have more mobility in their trunk and arms and can do more things in sitting.  The grounding and stability begins with them activating their legs to try to counter balance the change in their trunk.  That’s why you see them lifting their legs into the air as they try to regain a sitting position. If you are holding on too tight or they are spending all their time sitting in stabilizing chair, they miss out on the opportunity to develop this.

With practice kids fine tune their timing and their reactions so that they barely have to do anything to keep themselves up when they are just sitting there.  The next step comes when they get bumped or are doing active sitting (such as playing with a toy).

When they are bumped their body has to react to the change in balance so it is a similar process to learning to sit and stay upright.  The challenge is usually figuring out how much they need to react and how quickly they need to do it.  Its usually easier to start with slow and small ‘bumps’ whereas the faster and harder ones are more challenging.

When they are playing with toys they have to use anticipatory balance reactions.  That means they need to recognize that if they move to reach for something, or if they pick up a toy they are going to need to counter balance that move so they don’t fall over.  They turn on their muscles in anticipation of the action or activity that they are about to participate in.  Just think about if you’ve ever gone to the Cheesecake Factory and you go to pick up their water glass.  You expect a heavy glass and so you adjust your force to that, well it turns out its plastic and you end up almost drenching yourself in water!  The second time you go to pick it up though your body has adapted and you use just the right amount of force.  This is similar to anticipatory balance control.

I know the video was a little longer than normal this week but I thought the dancing was so cute that I just had to share more!