The Human Balance System

The Human Balance System

What is balance and what are the contributing factors that affect our balance?

Balance= Maintaining your center of mass/gravity over your base

When working properly, we are able to function over a variety of surfaces without losing our balance and falling to the ground.

Contributing factors that make up balance:

Sensory Input: What information are we getting by our brain from different sources (eyes, muscles and joints, and vestibular organs)

Eyes: Gives us visual feedback of what is in front of us 

Muscles and Joints: Tell us where our joints are in space (proprioception), I.e. did we step on a firm surface that will hold our weight or is it something we need to react to? Sensors in our joints and muscles tell us what pressure we are feeling and where.

Vestibular Organs: Our inner ear we have our utricle, saccule and three semicircular canals that help us detect gravity, linear movement and rotational movement. Fluid in the semicircular canals (endolymphatic fluid) moves when we move our head and the information from the sensors in these canals in our ears are sent back to the brain symmetrically.

All three of these sensory inputs work together to help keep our center of mass over our base.  All of this sensory information is sent to the brain stem which is then sorted and integrated in with the information provided by the cerebellum. Cerebellum in the center in our brain for coordination and also where we store some of the learned behavior or automatic behaviors. For example: We know that ice is slippery so we take more care walking over ice than a dry sidewalk. If one of these sensory inputs becomes disoriented, another can take over to help reorient your balance.

Motor Output: Information that is leaving the brain

Facilitation: Learned behavior that helps us to adjust, for example, practicing cartwheels until our brain can interpret the sensory information to where you no longer lose balance.

Balance is a complex and amazing combination of sensory and motor outputs. All of these things work together to maintain our center of mass over our base. When one input is compromised, another may take over. As we age, some of these inputs become compromised causing a decline in balance. The good news is, our brain is adaptable and can utilize other components of balance to help compromise. Practice makes perfect!

References/ Cited Sources:

the Vestibular Disorders Association, with contributions by Mary Ann Watson, MA, and F. Owen Black, MD, FACS, and Matthew Crowson, MD, Read This Article

The ABCs of Problem Behavior

The ABCs of Problem Behavior

Tantrums, meltdowns, outbursts, oh my! If you are a parent or teacher, you know them all too well. So how do we get them to stop? Or better yet, how can we best prevent them from starting next time in the first place.

When you read you begin with ABC (and when you sing you begin with Do Re Mi). But, just as reading and musical composition can be complex and overwhelming when you first learn, learning your ABCs of behavior isn’t always so easy...but it is a very good place to start.

Antecedents are things that happen prior to the behavior you are trying to address, and knowing these events can help change what follows them. Antecedents can often be easy to identify, such as a tantrum following being told it is time to leave the playground or that we are not getting a toy at the store today. But sometimes, antecedents are more complex and difficult to pinpoint. It may seem like an outburst came without warning; however, being a good observer over time may lead you to the identification of a pattern. 

Behavior(s) of Interest. These are the things you want to see change. It is important to discuss specifically what the behaviors of a tantrum look like focusing on observable events, especially when multiple caregivers are involved. That way, when creating a plan to respond, everyone is on the same page. For example, behaviors of interest might include hitting, kicking, screaming, and throwing items.

Consequences are things that occur after the behavior(s) of interest. Consequences include anything that follows the behavior. Examples might include a rule reminder or lecture, using a stern voice, using a calming voice, providing an alternative item or activity to help calm, taking away an item or activity, or timeout. What we do following a tantrum is either going to make the behavior more or less likely to occur again in the future. Behavior management may require you to change your behavior to change the child’s  behavior.

Learning your ABCs of problem behavior is a good start because knowing these events can help determine the reason, or the function, of the behavior. Behavior occurs for a reason that serves the interest of the individual engaging the behavior. If we can identify that function and match our responses accordingly, research shows we will have better outcomes. 

Why Your Baby Should Crawl

Why Your Baby Should Crawl

A few years ago, my friends and I started a book club in hopes of expanding our minds and having stimulating conversation. As the years have gone by, and we have gotten married and had babies, the topic has moved away from characters and plot lines, and gone more towards weddings, travels, and babies. While I do not have a baby of my own, I am able to hold my own with the baby conversations because of my experience as a pediatric physical therapist.

At last week's "book" club meeting, the conversation turned to developmental milestones, specifically crawling, after one of my friends said, "My pediatrician said that crawling is no longer a milestone." Now, without immediately jumping on my pediatric PT soapbox, I calmly addressed why I don't love that statement. Let me start by saying, I DO understand why pediatricians are relaying this information to parents. If your child is delayed in crawling or skips it all together, this is not necessarily a red flag for a possible underlying medical condition or cause for immediate concern. But I DON'T believe we should write off crawling all together.

So, you may ask, why would my pediatrician say that? With the decreased time babies are spending on their stomachs due to the "back to sleep" campaign to reduce SIDS in combination with more time spent in carriers such as swings and bouncy seats, they are missing out on all the benefits of being on their stomach. If they were rarely on their stomach prior to crawling, there is a decreased probability that they are going to use crawling as a means of getting places.

And why do I believe crawling is important? Crawling is an important stage of a baby's life when so many of the body's systems work together to enhance development and set them up for future success. Crawling on hands and knees in an alternating pattern helps to develop four major areas: movement, manipulation, postural control, and balance.

Movement: While moving forward, babies increase use of their right and left sides of their body and cross over sides of their body with their arms and legs. This helps to stimulate both sides of the brain and set them up for bilateral coordination tasks (jumping jacks, skipping) as they grow up. Also, since their hands are moving forward, babies have a whole new perspective of their eyes following hand movement, setting them up for good hand-eye coordination tasks in the future (throwing and catching, and following words on paper when reading). This movement also improves their social skills as well. Now they are learning about personal space and moving outside of their restricted area when sitting or in their carrier. They are able to engage more socially, seek out more experiences, and learn their limitations on where they are/are not supposed to crawl.

Manipulation: Crawling is the only time in a baby's life when they are going to take body weight through their hands. With this weight bearing and movement of the hands, a baby is developing the muscles of the hand to create their arches, increase strength, and increasing stability around their joints of fingers, wrist, elbow, and shoulders, which are all things that relate directly to manipulating objects such as toys, crayons, typing, etc., These are skills that they will use for the rest of their lives.

Postural control: Good postural control requires muscle strength and muscle stability to maintain the body in good alignment. On your hands and knees, muscles from your whole body
are engaged from hands to shoulders to core to legs. As your child grows, these muscles need to stay strong and work together to keep good alignment of your muscles and bones and prevent orthopedic issues (like back pain or knee pain) in the future.

Balance: In order to balance, your vision, proprioception (where you are in space), and vestibular (inner ear) systems work together to hold your body in place. When rocking and crawling forward on your hands and knees, these systems are working together in a whole new space and position. More time spent in crawling over a variety of services will require these systems to work together and continue to develop. This will set you up for more challenging balance situations in the future like walking over changes in surface, riding a bike.

So, how are you going to get your baby to crawl? Stay tuned for several helpful tips!

Physical Therapy is Integral to Recovery After Joint Replacement

Physical Therapy is Integral to Recovery After Joint Replacement

As the realm of orthopedic medicine has continued to expand over the years, surgeries have become more and more commonplace. Among those surgeries, some of the most frequently performed operations are joint replacements. Joint replacement is a surgical procedure in which either some or all parts of a joint are removed and replaced with a prosthesis, an artificial body part. Many joints in the body can be replaced, including the hip, knee, ankle, shoulder, elbow, wrist, and thumb. The most commonly performed joint replacements are hips, known as a Total Hip Arthroplasty (THA), and knees, known as a Total Knee Arthroplasty (TKA).  Typically, these surgeries are performed on older patients with severe arthritis but are also performed after severe trauma in elderly patients, such as a fall. Joint replacements are designed to replicate movements of a normal joint so that people can return to normal, healthy lifestyles. 

Physical Therapy (PT) is often an integral part of the recovery process for patients that have undergone a joint replacement. PT often starts very early in the patient’s recovery, and can even begin on the day of the surgery, in the case of a TKA or THA. Patients often spend a couple of days in the hospital, where they undergo PT before they are sent home. Once the patient returns home, they are usually treated by a Home Health PT until they are strong enough and mobile enough to leave their home. When a patient is no longer homebound, they are typically referred to an outpatient PT clinic by their surgeon. In outpatient PT, the patient should expect to perform a number of exercises to help strengthen the muscles around the replaced joint and throughout the affected extremity. As the patient progresses, the exercises will increase in intensity accordingly. The PT will also be stretching the patient to help the patient attain full range of motion in their replaced joint. The goal of outpatient PT is to help a patient return to their desired level of functional and recreational activity.

Before surgery, patients should not discontinue exercise. In fact, patients tend to recover more quickly following a joint replacement if they are active with exercise leading up to their surgery. Some strategies for pre-surgery exercise for knee and hip arthritis include low-impact cardiovascular activities, such as biking and swimming, and low load, high repetition exercises focused on strengthening the quadriceps and hip musculature. These surgeries regularly require at least a few months to a full year for a full recovery. Joint replacements have evolved to the point where they are now routine surgeries for many orthopedic surgeons. Currently, the outcomes after these surgeries are quite good, but there remain risks as with any surgery. If a patient is looking for any further guidance, they should not hesitate to consult with their surgeon or their physical therapist.

Hi, I’m an OT, and I put Chicken Nuggets on my head.

In my time as a pediatric occupational therapist, I’ve come to learn that fun is everything.  My success rate in getting therapeutic benefit out of an activity is directly correlated to how fun I make it. If I am a kid- will I sit still and complete 10 reps with an arm weight? No. Will I complete a challenge on the rock wall to climb to the top? Absolutely. It’s our job every day to make therapeutic activity the most fun thing on earth, and when it comes to feeding therapy, it’s no different.
Each of us has a very unique sensory system with different thresholds of what our body considers a “safe” amount of input. It’s biologically advantageous for us to go into protective mode in response to a toxic smell (we leave the area), a loud noise in the house late at night (our heart beats fast ready for “fight or flight”), or a taste of spoiled milk (we gag and spit it out instantly).  However, input not normally offensive for the average person can be very insulting to someone with a low sensory threshold. This is where our picky eaters come in.
Feeding is one of the only activities in which we use all of our senses at once. If I’m a child with an oversensitive sensory system, food has the potential to look, sound, smell, feel, or taste offensive.  Imagine- if the touch of different textures, or the smell, or even the sight of it enters my overresponsive sensory system- my body might respond to a chicken nugget like yours would spoiled milk; Gagging, spitting out, refusing to interact with it. Even if I was willing to put it in my mouth, coordinating all of my motor actions to sit up, feed myself, and manipulate the food is a lot to handle. Not to mention if I had reflux after every meal, I would be even less excited about dinner time. The behavioral responses you may see are responses such as refusal, crying, or running away. But if you were a child and you had a medical issue, sensory issue, or difficulty with motor coordination every time you were presented with foods, wouldn’t you have high anxiety surrounding food and resist it too?
So how do we help our picky eatersEating is not an instinctive behavior beyond the very early weeks of our lives. Learning to eat takes many, many steps. We have to teach our children to eat. But before we do that, we have to make food fun. We have to PLAY. Herein lies the most important part of feeding therapy, the best piece of advice I have to offer; if you want to teach your picky eater to eat, we must decrease the anxiety around food and mealtimes first.
I put the chicken nugget on my head. Uh oh, it’s about to fall, here it goes! Ahhhhhh! Crashhh! Instantly, according to this two year old I am the most fun person in the world with the source of the joke being the food they won’t eat. But they’ll play with it. They’ll put the chicken nugget on my head, touching it, feeling it, getting crumbs on their fingers, smelling it, waiting for it to fall. They’ll squish it to see what it’s going to do in their mouth; they’ll learn all about it. But more importantly, they will laugh, play, and enjoy themselves. And suddenly, this food isn’t so scary. Feeding therapy is a slow progression but it absolutely has to revolve around play. We need to explore, play, get messy, and learn about our food before we can ever eat it. Only when we are comfortable and our body has gotten desensitized to the novelty or to the threatening texture will we ever gain any ground in starting to expand our diet.
So, that is why as an OT, I have had a chicken nugget: in a ball tower; in the bed of a toy truck; in a toy dinosaur’s mouth; on a fire truck’s ladder; in a dog’s food bowl; in a racecar; on top of a block tower; and- on my head. And I wouldn’t have it any other way.