Postural Stability and Dyslexia

Postural Stability and Dyslexia

Gait and Posture published research on postural stability and dyslexia.  The participants included 24 children with dyslexia and 24 children without dyslexia who were evaluated to determine the influence of foot soles and visual information on postural control.  To evaluate postural stability, the surface area, the length and mean velocity of the center of pressure and the Romberg Quotient (a percentage of the measured instability during eyes closed to that during eyes open) was measured in two postural conditions (with and without a 4 mm foam under feet) and in two visual conditions (eyes open or closed).

The results indicated the following:

• the surface area, length and mean velocity of the center of pressure were significantly greater in the dyslexic children compared to the non-dyslexic children, particularly with foam and eyes closed.
• the Romberg Quotient was significantly smaller in the dyslexic children and significantly greater without foam than with foam.

The researchers concluded that children with dyslexia are not able to compensate with other available inputs when sensory inputs are less informative (with foam, or eyes closed), which results in poor postural stability.  In addition, the researchers suggested that the impairment of the cerebellar integration of all the sensory inputs is responsible for the postural deficits observed in children with dyslexia.

 

The lead author of the study, Nathalie Goulème, Ph.D., recommends:

• exercises on a balance platform challenging children to maintain their stability in different conditions i.e. eyes closed, unstable or visual stimulation in order to improve postural control and utilize efficient sensory strategies.
• children to participate in sports, games and leisure activities that require eye-hand coordination and balance skills.

When children have difficulties maintaining postural control it involves more energy, therefore during higher cognitive load tasks such as reading attention is shared possibly decreasing learning capabilities.

Reference:

Bell, Katie. (2017) Dyslexia affects ability to adjust to impaired sensory feedback.  LER Pediatrics.  Retrieved from the web on 12/7/17 at http://ift.tt/2izq84G

Goulème, N., Villeneuve, P., Gérard, C. L., & Bucci, M. P. (2017). Influence of both cutaneous input from the foot soles and visual information on the control of postural stability in dyslexic children. Gait & Posture, 56, 141-146.

If you need more core strengthening activities for children check out:

The Core Strengthening Handbook:  This download includes 50+ activities including:

• Quick and Easy Core Strengthening Activities for Kids
• Core Strengthening Exercises With Equipment
• Core Strengthening Play Ideas

The Core Strengthening Exercise Program: This digital download includes exercises to help make core strengthening fun and entertaining for kids while promoting carryover in the classroom and at home!  FIND OUT MORE.

 

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Gross Motor Skills, Postural Stability, and Autism

Gross Motor Skills, Postural Stability, and Autism

Research indicates that children with autism spectrum disorder (ASD) frequently exhibit deficits in gross motor skills and postural stability. Research in Autism Spectrum Disorders published research examining the relationship between gross motor skills, postural stability, and autism.

The participants included 11 children with ASD and 11 children without ASD ages 5-12 years old.  Each child was evaluated with the Test of Gross Motor Development-3 (TGMD-3) and postural sway measurements on a force plate during quiet standing on a solid and compliant surface.

The results indicated the following:

• sway area on a solid surface, age, and diagnosis were significant predictors of motor skill performance.
• the severity of ASD, as assessed by the Repetitive Behavior Scale-Revised (RBS-R), was not predictive of motor skills.
• children with ASD exhibited deficits in postural stability compared to children without ASD.

The researchers concluded that postural stability appears to influence the ability of children to perform gross motor skills.

Reference:  Mache, M. A., & Todd, T. A. (2016). Gross motor skills are related to postural stability and age in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 23, 179-187.

Read more on postural stability and children with autism here.

Need activity ideas to encourage postural stability for children with autism?  Check out Classroom Activity Posters.  This digital download is a collection of 16 exercise activities, 4 large posters and a brief, simple video demonstration of each exercise.The posters are divided into four groups: posture, alerting, ready to work and focus/balance.  All of the exercises are performed in standing.  Try these activities prior to starting fine motor activities, for posture breaks, to refocus students attention and for vestibular/ proprioceptive input in the classroom.

 

 

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Postural Control and Mini Trampoline Training

Postural Control and Mini Trampoline Training

Pediatric occupational and physical therapists frequently use mini trampolines during a therapy session or as a recommended activity for home use.  This modality for exercise training is used for proprioceptive input, plyometrics, lower extremity strengthening, aerobic fitness, and sensory input.  A recent research study examined the impact of trampoline plyometrics on postural control and jumping height in 24 pre-pubertal children (average age 9.3 years old).

The 24 participants (15 girls and 9 boys) were divided into a trampoline group or a control group.  The trampoline group completed 4 weeks of plyometric training on a mini-trampoline (3x/week)  during physical education class while the control group participated in the standard PE class.  Postural sway and maximum height in countermovement and drop jump were measured before and after the intervention.

The results indicated the following:

• postural sway decreased significantly in normal quiet stance for the trampoline group but not the control group.
• statistically significant decreases in postural sway in the anteroposterior direction during one – leg stance was found for the trampoline group.
• postural sway was unchanged in both directions for the control group.
• statistically significant improvements in jump height were found only for trampoline group after training.

The researchers concluded that training on a mini trampoline could be incorporated into children’s exercise programs to facilitate balance and lower-limb strength.

Reference:  Arabatzi, F. (2016). Adaptations in movement performance after plyometric training on mini-trampoline in children. The Journal of sports medicine and physical fitness.

Cut and Paste Sensory Diet: This electronic book includes 2 sensory diet books, one for home and one for school and over 150 picture word cards.   My Sensory Diet for School includes daily activities that occur during the school day such as riding the bus, staying in line, floor time, snack, cafeteria, recess and more.  My Sensory Diet for Home includes daily activities such as morning time, breakfast, homework, bath, shopping, and more.  For each page, there is a daily activity statement with 4 squares to paste the picture word activity cards.  The picture word cards include tactile, proprioceptive, vestibular, oral, smell, coordination and balance activities. FIND OUT MORE.

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Postural Control and Functional Tasks for Children with Cerebral Palsy

Physical Therapy published research examining postural control during a functional play activity. Previous research has indicated that when motor tasks are made more relevant through functional tasks, performance improves, including in children with movement pathology.

The participants in the study included 30 children with cerebral palsy who were compared with 30 typically developing children during a single measurement period.  Postural sway was quantified using a portable force platform system during a precision manual functional play task and a baseline condition of no task.   Postural sway variability and postural sway regularity were analyzed.  The results indicated the following:

1.  an apparent difference in postural control (greater irregularity, greater sway variability) during quiet stance between children with CP and peers with typical development
2.  this difference was reduced during the performance of the precision functional play task.

The researchers concluded that the postural control system is flexible and adaptable even with the pathological features associated with cerebral palsy.

Reference:  Schmit, J. M., Riley, M., Cummins-Sebree, S., Schmitt, L., & Shockley, K.(2016).Functional Task Constraints Foster Enhanced Postural Control in Children With Cerebral Palsy. Physical Therapy, 96(3), 348-354. Accessed March 03, 2016.http://dx.doi.org/10.2522/ptj.20140425.

Play Strong: Activities to Promote Muscle Strengthening in Children Through Play  This is a collection of 40+ activities that promote muscle strengthening in children.   This is an excellent resource for pediatric therapists, parents and physical educators.  Find out more here http://www.yourtherapysource.com/playstrong

Light Touch, Postural Sway and Children with Autism

Gait & Posture published research comparing 16 children with autism spectrum disorders (ASD) and 16 typically developing children (TD) to determine the effects of a light fingertip touch on postural control.  Postural sway was measured with a force platform in different conditions:
anteroposterior (AP) and mediolateral (ML) directions, light fingertip touch (LT) and no touch (NT) conditions, and with both eyes open (EO) and both eyes closed (EC).

The results indicated the following:
1.  ML sway was significantly greater in the ASD group than in the TDC group.
2.  a significant reduction in postural sway in the ML direction in the LT condition compared with the      NT condition which applied to both the EO and EC conditions.
3.  the reduction in ML sway between the NT and LT conditions was significantly greater in the ASD      than the TDC group.

The researchers concluded that the effects of a light fingertip touch on reducing postural sway appears to be more efficient in children with ASD compared with TDC therefore suggesting that a light fingertip touch may be helpful in improving postural stability in children with ASD.

Reference:  Fu-Chen Chen, Hsin-Lin Chen, Jui-Hung Tu, Chia-Liang Tsai. Effects of light touch on postural sway and visual search accuracy: A test of functional integration and resource competition hypotheses. Gait & Posture.  Volume 42, Issue 3, September 2015, Pages 280–284

Looking for balance activities?  Check out Cross the Beam game to challenge postural control and balance skills.

Postural Care A to Z Free Resource

Another great resource found on Facebook.  This resource was shared by Sparkle Occupational Therapy.  It is an award winning document entitled The A to Z of Postural Care from the University of Kent.  The document discusses various types of adaptive equipment, manual handling, emotional support, inclusive education and the golden rules about equipment use.  Then it goes through each letter of the alphabet discussing postural tips and facts ie A is for alignment, ask, ability and attitudes.

You can download the 52 page document for FREE here http://www.kent.ac.uk/chss/docs/A-Z_Posture_Booklet-v5c-pages-web.pdf

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Classroom Activity Posters: a collection of 16 exercise activities, 4 large posters and a brief, simple video demonstration of each exercise.  The posters are divided into four groups: posture, alerting, ready to work and focus/balance. All of the exercises are performed in standing. Try these activities prior to starting fine motor activities, for posture breaks, to refocus students attention and for vestibular/ proprioceptive input in the classroom.

FIND OUT MORE at http://yourtherapysource.com/cap.html

 

Exercise, Postural Control and Cerebral Palsy

Developmental Medicine and Child Neurology published a systemic review to to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy.

Six databases were searched using the following keywords: (‘cerebral palsy’ OR ‘brain injury’); AND (‘posture’ OR ‘balance’ OR ‘postural balance’ ); AND (‘intervention’ OR ‘therapy’ OR ‘exercise’ OR ‘treatment’).

The following results were reported:

1.  the searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with cerebral palsy.

2.  5 of the 13 interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training.

3.  6 of the 13 interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback.

4.  progressive resistance exercise was an ineffective intervention

5.  upper limb interventions lacked high-level evidence.

The researchers concluded that the use of exercise-based treatments to improve postural control in children with cerebral palsy has increased significantly in the last decade.   More research is required to establish links between postural control impairments, treatment options, and outcome measures. In addition, the researchers recommend low-burden, low-cost, child-engaging, and mainstream interventions to be explored.

Reference:Dewar, R. et al.  Exercise interventions improve postural control in children with cerebral palsy: a systematic review. Developmental Medicine & Child Neurology
Early View - Article first published online: 18 DEC 2014 DOI: 10.1111/dmcn.12660

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Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders - A Guide for Parents and Professionals.   Author: Sieglinde Martin M.S., P.T.  FIND OUT MORE at http://yourtherapysource.com/CPmotorskills.html

Postural Stability Training Effects on Gait in Children with Cerebral Palsy

Research was published assessing the dynamic bilateral postural stability on balance control and gait parameters in 30 children with spastic diplegia cerebral palsy (8-10 years old).  The children were divided into two groups.  One group received 2 hours per session of physical therapy for 3x/week for 8 weeks.  The second group received 1.5 hours per session of PT and 30 minutes of dynamic postural stability training program using the Biodex Stability System.  All children received pre and post assessments to evaluate the stability indices (anteroposterior, mediolateral, and overall) and three-dimensional motion analysis system to evaluate the spatiotemporal parameters including step length, velocity, cycle time, stance, and swing phase percentage.

 

The results indicated the following:

1.  children in both groups showed significant improvements in the mean values of all measured variables after treatment with a significant reduction in stability indices and improvement in gait parameters.

2.  significant differences were recorded in all measured parameters in the group that received the stability training, when compared with those who only received physical therapy.

The researchers concluded that balance training on the Biodex Stability System paired with traditional physical therapy may improve balance control and gait functions in children with spastic diplegic cerebral palsy.

Reference: Abd El-Kafy, Ehab Mohamed; El-Basatiny, Heba M. Youssr M.  Effect of Postural Balance Training on Gait Parameters in Children with Cerebral Palsy.  AJPM&R. November 2014 - Volume 93 - Issue 11 pp: 931-1018,e1-e8

Postural Control in Very Preterm Children

Recent research assessed the postural control of 90 very preterm (VPT) children (<30 weeks gestation) and 36 full term children (>37 weeks gestation) at four years old. Using a Wii Balance Board, various tasks were assessed including static two-limbed standing with eyes open, eyes closed, eyes open on a foam mat, eyes closed on a foam mat, single leg standing on each limb and a cognitive dual task (involved showing the participants a series of pictures that appeared on screen at 2-second intervals). Functional performance was assessed during dynamic jumping and hopping tasks using the outcome measure of flight time, with shorter time indicating worse performance.

The results indicated the following: 1

1. VPT children had impaired static and dynamic balance, with increased postural sway under all conditions.

2. VPT children had reduced flight times compared with children born at term.

3. When adjustments were made for body weight the only group differences in postural control were in the cognitive dual task and flight times (jumping and left leg hopping).

The researchers concluded that: "VPT children demonstrated reduced postural control at 4 years of age compared with term-born children when presented with a cognitive dual task. They also performed worse during jumping and hopping tasks".

Reference: Lorefice, L. E., Galea, M. P., Clark, R. A., Doyle, L. W., Anderson, P. J. and Spittle, A. J. (2014), Postural control at 4 years in very preterm children compared with term-born peers. Developmental Medicine & Child Neurology. doi: 10.1111/dmcn.12550

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Need postural control activities?  Check out some yoga for kids videos and resources at http://yourtherapysource.com/yoga.html

Postural Stability and Cerebral Palsy

Pediatric Physical Therapy published research comparing postural stability during static upright standing between 45 children with cerebral palsy (CP) and 45 age-matched peers with typical development (TD) ages 5-12 years old. A posturography device was used for assessment. Postural stability was evaluated under 4 sensory conditions: eyes open and eyes closed on a firm surface; eyes open and eyes closed on a foam surface.

The results indicated the following:
1. Statistically significant differences were obtained between children with spastic diplegic CP and children with TD under all conditions involving visual and somatosensory conflicts

2. no significant differences were found between children with hemiplegic CP and children with TD.

The researchers concluded that children with spastic diplegic CP have increased postural instability under sensory conditions with both visual and somatosensory conflicts.

Reference:  Saxena, Shikha MPT; Rao, Bhamini K. MPT, PhD; Kumaran, Senthil MPT.  Analysis of Postural Stability in Children With Cerebral Palsy and Children With Typical Development: An Observational Study. Pediatric Physical Therapy Fall 2014 Vol. 26 - Issue 3: p 325-330

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Effect of Touch on Trunk Sway

Gait and Posture published some intriguing research on the effects of touch and trunk sway in a seated position.  There were 13 healthy, adult subjects who participated in the study.  Each participant performed a total of 12 trials of 60-seconds duration in a randomized order, combining the experimental conditions of no-touch, hand-touch (right index finger touching an object) or back-touch (maintaining an object touching the back at mid level T10) with no sensory perturbation, paraspinal muscle vibration or galvanic vestibular stimulation - GVS (sending of electrical messages to a nerve in the ear that controls balance). The results showed the following:

• touch through hand or back decreased trunk sway and decreased the effects of muscle vibration and GVS 
• GVS led to a large increase in sway 
• muscle vibration was only observed as an increase of drift and not of sway 
• the stabilizing effect of touch was strong enough to mask any effects of perturbations of vestibular and paraspinal muscle spindle afference 

The researchers concluded that tactile information, whenever available, seems to play a dominant role in seated postural sway and therefore has important implications for studying trunk control.  

Although this research was performed in healthy adult subjects, perhaps this gives us some suggestions to try with children to help to decrease postural sway in sitting.  Is this why sometimes holding a fidget helps a child to sit more upright and stay more alert?  Perhaps that child who is constantly slumping to one side could use some tactile input to maintain a more upright posture.  Thoughts?  Experiences?

Reference: Maaswinkel E | Veeger Hej | Dieen JHv.  Interactions of touch feedback with muscle vibration and galvanic vestibular stimulation in the control of trunk posture Available online 19 October 2013 at Gait and Posture

Effects of Visual and Auditory Input on Postural Control in Children with Autism

Gait and Posture published research on the postural control of children with autism under two different task conditions.  Nineteen children with autism (ages 10-15) were compared to 28 typically developing peers.  Using a force platform to assess postural control, each subject completed a visual searching task and an auditory digital span task. The following results were seen:

• children with autism spectrum disorder indicated higher postural sway scores in visual task versus auditory task although typically developing children scores remained unchanged.
• children with autism spectrum disorder also showed significantly higher sway scores than typically developing children in all parameters.  

The researchers concluded that in addition to primary differences in postural control of children with autism, visual and auditory tasks may also influence postural control.

Reference: Amir Hossein Memari, Parisa Ghanouni, Monir Shayestehfar, Vahid Ziaee, et al. Effects of visual search vs. auditory tasks on postural control in children with autism spectrum disorder. Gait and Posture. In press on 8/6/13 DOI: 10.1016/j.gaitpost.2013.07.012   

Postural Control and Fine Motor Skills

The American Journal of Occupational Therapy published research on the relationship between postural control and fine motor skills in infants. The medical records were reviewed of 105 preterm infants. The Alberta Infant Motor Scale was used to assess postural control and the Peabody was used to evaluate fine motor skills. Statistical analysis revealed that the development of postural control is related to the development of fine motor skills particularly in this pre-term group of infants with delayed postural control. The researchers state that this information supports the intervention techniques during occupational therapy of proximal to distal development.

View the full study at AJOT.

Reference: Tien-Ni Wang, Tsu-Hsin Howe, Jim Hinojosa, Sharon L. Weinberg. Relationship Between Postural Control and Fine Motor Skills in Preterm Infants at 6 and 12 Months Adjusted Age. doi: 10.5014/ajot.2011.001503 American Journal of Occupational Therapy November/December 2011 vol. 65 no. 6 695-701

Postural Control in Standing

Here is an interesting open access research article on the postural control of children in standing. Using a force plate and a visual focus, the researchers examined the changes in postural control in 7-11 year olds and adults. The results indicated that postural stability improved linearly from 7-10 years old, stabilized somewhat at 10-11 years old and then increased to reach the adults level.

The authors discuss that the age range of 7-11 years old is a critical period of improvements in postural stability and processing visual/ vestibular information. One aspect of the study included adding vibration to the subject's ankle to alter somatosensory information. The younger children exhibited increased center of pressure velocity with the vibration and the velocity decreased with age. The authors concluded that only the adults could compensate by predominately using vision to maintain postural control in standing when the vibration was added at the ankles.

The researchers recommend further studies to examine the adolescent period and children with disabilities such as cerebral palsy and ADHD.

You can read the full article here.

Reference: Cuisinier R, Olivier I, Vaugoyeau M, Nougier V, Assaiante C (2011) Reweighting of Sensory Inputs to Control Quiet Standing in Children from 7 to 11 and
in Adults. PLoS ONE 6(5): e19697. doi:10.1371/journal.pone.0019697