GUEST BLOGGER: Kathryn Biel

I’m preparing myself, as many of you are to head back to school. Seriously, where did the summer go? But in thinking about the things we may need to get ready for school, we often think of the basics: pencils and erasers, folders, a supportive pair of sneakers, a high quality backpack. One of the things that many of our students may be lacking, without even knowing it, is postural control.

Postural control is the ability to maintain and control one’s body in space for the purposes of orientation and stability. Anyone watching a toddler stand for the first time will understand that it is literally a careful balancing act. However, once children are upright and moving, it’s easy to forget about the multiple factors that influence postural control. But think about what we’re asking our bodies to do. We’re asking them to hold still and move all at the same time. To maintain the axial body while moving some (all) of our five appendages (including the head). To coordinate input from internal and external sources and factors and keep us upright and stable. When there’s a deficit or dysfunction in one of these factors, postural control and balance can be grossly and finely affected.

The systems that are necessary for postural control include the musculoskeletal system, the sensory system, and the cognitive or cortical system. Numerous variables within these systems (such as range of motion, strength, muscle tone, attention, vision, and vestibular processing) must work together to maintain a delicate balance that holds the body still while providing movement to interact and react with the environment.

At times, a deficit in one system can lead to overcompensation with another. For example, the child who can balance endlessly on one foot with his eyes open, but falls almost instantaneously when his eyes are closed. It is then up to us to figure out where the dysfunction is occurring and how to provide a treatment plan and strategies to minimize the dysfunction.

We’re seeing these children in school all the time. They’re the kids who can’t sit upright without external support. They’re the kids who can’t maintain sitting in their seats while looking up at the board and then down at their desks (due to unintegrated primitive reflexes). They’re the kids who trip and fall. The kids who aren’t able to sit or stand still.

And then, as therapists, the question is what to do about it? How much external support do we provide? What positions are acceptable and functional? How do we help the child become more functional within the school environment?

If you’re looking for more on postural control and movement theories, and how to improve function with minimal direct handling or positioning equipment, check out the Sixteen Annual Therapies in the School Conference where Barbara Hodge will address this topic and more!

~Kathryn Biel, PT, DPT