Motor Skills Ep 2: Postural Stability and Tone

Join me as we discuss postural stability and tone and hoe they can impact upon a child's ability to engage in occupation! This episode is a treasure trove of practical strategies and playful activities that parents and educators can incorporate to support core strength and postural control in kids. I'll guide you through the nuances of muscle tone, a crucial yet often misunderstood aspect of postural control. If you've noticed a child who appears clumsy or in need of extra support during activities, this conversation is an essential listen. I'm here to support you with insights and advice drawn from my professional experience, ensuring that every child can rise to their unique challenges with confidence and resilience.

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DISCLAIMER:
Whilst I will always make evert effort to share correct information as at the date of the podcast, research is constantly happening and as a profession we learn more everyday. One therapist may have a different way of doing things to another, and every child's needs are unique. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or others Consult your child's paediatrician or therapist for any recommendations for your child. 

Transcript

Speaker 1 0:09

Hello everyone and welcome to episode 2 of our motor season in Bell's OT corner. Today we're going to jump into everything postural stability, or postural control and tone. Now, you may have heard these words thrown around a little bit before. They're words that you might see pop up if you've ever had a report done on your child by a health professional, and sometimes they're explained and sometimes they're not. So what we're going to do today is we're going to explain them. We're going to talk about what they mean and always linking it to what they mean practically. So what do they mean in terms of impacting on our ability to engage in occupations? And then we're going to flesh out for some of them not for all of them, but for some of them we're going to flesh out what are the things that you can do at home to help build some skills in these areas and what are the things where you do need to go and seek some professional advice as well. Because, as always with this podcast, I aim to bring that knowledge and help you guys understand a little bit deeper. But there will be times where it is most appropriate to go and seek the professional help. So we're going to start off diving into postural stability.

Speaker 1 1:23

So postural stability is all about our body's ability to keep itself upright. In essence, it's how we can control our posture whilst completing tasks. And there's lots of things that can impact upon postural stability Our body awareness might impact upon it, our core strength might impact upon it, our tone may impact upon it. There's many more things, but the most common ones that we see are our core strength, or our strength in general, and our tone impacting upon our postural stability. So how can we think about postural stability and I want you to think about this as all of your muscles working together without you having to think about it to keep you upright. So if we think about this when we're walking along, you might be walking around outside and there might be a curb that you need to step up onto, or you're going down some steps, but one's a little bit uneven, so your foot lands a little bit different, so you start to fall to the side a little bit, and it's your postural stability that helps you go, bring that back up, keep that center of gravity nice and aligned and keep myself upright to be able to engage in different occupations. If we think about it when we're seated, our postural stability is that idea that I can maintain a nice tall posture. Maybe I need some lip breaks where I lean a little bit more, but when I need to, I can turn on all these muscles and I can sit myself up nice and tall.

Speaker 1 2:52

So what does it look like when we see kids that might have difficulties with their postural stability? These might be kids that look a little bit clumsy. They might be kids that are always leaning against something. They might be kids that in the classroom, when they're doing a tabletop activity it might be some maths, it might be arts and crafts, it might be English but they're leaning on their arms, they're slumping in their seat, they're hunched over. And now let's think about what that means.

Speaker 1 3:28

If we're leaning on our arms because my core and my back extensors they're not quite strong enough to keep me up, well then all of a sudden I can't lift from my elbow, so I'm hunching further forwards. I've only got less range of movement in my arms because I need my elbows to keep me secure, and so doing tasks that require some of that finer manipulation could be more challenging, or I might be a little bit slower at doing them. But once I sit up tall and I turn on that core. And if you think about the episode last week where we talked about having that nice strong trunk before we have the branches in our arms, before we grow the leaves in our fingers, once I sit up tall and I turn on that nice strong base of support, all of a sudden I can reach around the table a lot more. Maybe I need to reach for a different pencil and I can do that. I can move my arm all around the page for what I need to do and all of these tasks become a little bit easier.

Speaker 1 4:18

Now you may have noticed before when I was talking about postural stability and sitting up tall, I mentioned I'll turn on my core and my back extensors. So the really big ones, big muscle groups that we think about when we're thinking about this postural stability, is our core and I'm sure you're all familiar with your core that sits in and around your tummy, because that helps kind of that base stability, keeping my, keeping my center of gravity nice and strong. But we also then have our back extensors and to think about your back extensors, I want you to imagine you're lying on your tummy or you've seen your kid lie on their tummy if they're doing tummy time, for example, and as soon as they want to look up at something they have to lift up through their back, they're squeezing those muscles through their back to lift up their body. Now, wherever you are right now, if you're sitting or standing, I want you to try sitting up tall and feeling what happens in your body. If you sit up tall, you notice your tummy will help lift you up a little bit and then it's all through your back. If you try and squeeze the muscles in your back, try and squeeze your shoulder blades together, those your back extensors turning on to keep you up nice and tall, and these can play a huge role in getting that really strong base set so that we're then going to be able to engage in different tasks and different occupations. Now, what we're noticing with a lot of kids now is all kids can benefit well, actually, everyone, everyone can benefit from building up some core strength and building up some of these underlying strength that we need so that we have the endurance to then persist with some of our occupations, and it just makes things a little bit easier. It means that I can focus on doing the tasks that's tricky instead of having to focus my energy on sitting up tall and doing all these other bits that we really want to shift to being a behind the scenes sort of thought.

Speaker 1 6:14

So, as always, we talk about the so what? What can we do? And there is lots that we can do at home to help a child develop their postural stability, and the biggest one is start to increase activities that are going to target some of that gross motor skills, specifically gross motor skills that are going to help build some of that core strength. So things like bouncing on a therapy ball or an exercise ball or sitting on one where you might play some wibble, wobble games, where we're going to tip to one side and then come back and then tip to the other side and see if they can use their tummy muscles to bring themselves back. We might do some forwards and backwards rocking. We might do some games where we lie down on the floor when we're doing the game, like it could be a board game that you're doing anyway. When we're going to play sitting lying on our tummies, it might be that you go to the park a little bit more and you try and do some more climbing or some swings. All of these things really help build up some of these underlying core strength. And I guarantee, if you go onto the internet, go onto Google, give a good Google of core strength activities for kids and thousands upon thousands will come up. But, as always, if you have any questions, shoot me a message, send me an email, send me a dm, and I'm sure I can point you in the direction of where there are some extra, extra activities, because there are heaps and heaps out there.

Speaker 1 7:34

But the idea is looking at maybe through some of the play times that you have with your kids, can we do a couple of these activities now, if we think within the classroom, what can we do? Well, if we know that there's a kid that's going to slump a little bit more, we can start to build in different flexible seating options for them. So if the task that we're doing might be a little bit easier, I might sit the kid on a wobble cushion, because then they're having to build up some of that core strength as they wibble and wobble and as their pelvis shifts, they have to use their core a little bit more for maybe five minutes and then I take it away, and then maybe the next day we might do six minutes and then we take it away and we might do some six-minute breaks a couple of times throughout the day and we're just looking at those little opportunities where we can build in that extra core challenge. Maybe I let this kid complete work in the classroom lying on his tummy, or maybe the whole class can do a game or an activity where we're lying on our tummy and having to lift up to look up at the board. And also the other thing to remember is allowing this kid to have breaks or these children to have breaks. If you notice that they're slumping and they have some poor postural control and we think it might be because their core strength is a little bit weak, well, let them have a little bit of a break and then remind them to sit up straight, but not every single time when they're sitting up straight, because they're just going to get physically fatigued, and so we let them lean a little bit and then we remind them oh, make sure we're sitting up tall. And then we have those conversations between teacher and home around just building in some of these extra activities that are really going to target some of those gross motor skills that focus on core strength and core stability. So that is what our postural control is.

Speaker 1 9:20

Now, you might have heard me mention at the start of the episode that one thing that can impact upon postural control is tone, and tone is a little bit of a buzzword. I'm seeing it pop up more and more, and so I wanted to do today's episode so that everyone can really understand what tone is and what that means functionally. So tone I want you to think about it as a bit of a continuum. We have everything from low tone degrees of that and then we hit a range that's normal tone degrees of that and then we hit a range that is high tone. So high tone you might be heard referred to as hypertonia. Low tone, you might have heard been referred to as hypotonia.

Speaker 1 10:01

Now, what is tone? Tone is essentially the degree of tension in a muscle at rest. Now let's break that down a little bit. What do I mean by a muscle at rest? Well, a muscle at rest is when I am not actively using that muscle, and so it might be that I'm sitting down as I am right now, my arms resting in my lap. I'm not using it to reach for anything, I'm not grasping anything, I'm not reaching up above my head, my arm is just chilling in my lap. Those muscles in my arm are at rest, I am not actively using them to do anything. And what do we mean by the degree of tension? Now, this means we can think of this as the readiness of that muscle to contract. Is it ready to go and do something? Is it already contracting or is it a little bit floppy and looser?

Speaker 1 10:59

And the easiest way I've found to think about this is if you think about three different rubber bands. Think about a rubber and you have rubber bands and a deck of cards. And so think about the first rubber band that you pick up. You pick it up, you stretch it a little bit, you open it up around the rubber bands and then you let it go and it snaps into place. And it was really easy. It was just the right size to open up, had just the right amount of tension to it that it would just one loop around the deck of cards and it held. This would be kind of what we would think of as our normal tone. That rubber band or those muscles were ready to do the task.

Speaker 1 11:36

If we think about a different rubber band, maybe this one's a little bit older, a little bit bigger. It's one of those bigger rubber bands that's really thin, a little bit bigger. It's one of those bigger rubber bands that's really thin, and so when you go to wrap it around the deck of cards, you've got to wrap it once and then twist it and wrap it twice, and then twist and wrap it three times and maybe it needs four or five times around this deck of cards before it gets the tension that it needs to do the job of holding those deck of cards in place. This would be what our low tone is, and we'll talk about these each in a little bit more detail, but I just kind of wanted to give you a general conception for it. And then think about that third rubber band.

Speaker 1 12:11

We've got a really small little rubber band that's really quite tight, maybe one of those ones that has the bigger thick band around the edge of it, and so when you go to use this rubber band, you've really got to fight against it. You've really got to open it up, open it up, open it up to get it open enough to get it around the deck of cards, and then it snaps back really quickly. This would be a high tension, a high tone, sorry, or a high pertonia, always get those two mixed up hypertonia and hypotonia. I'm always worried I'm going to say the wrong one, but hypertonia, so high tone and where you're having to fight against that muscle. So when we think about this, we think about it as being the level of tension on a muscle If we think about that normal tone range. So we've got that rubber band that we just open nice and easily snap it around once happy days job's done, band that we just open nice and easily snap it around once happy days job's done In kids or in practically in adults and humans.

Speaker 1 13:07

We see this as I am ready to do the task, whatever the task may be. So let's think about it as I'm picking up something from the table, I'm picking up the keys, I'm ready to do it as soon as I want to do it, with the right amount of strength and with the right amount of force to complete that task easily, with fluid movement. So if we break this down, if I have keys in front of me, my muscles are ready to extend to reach forward. It's a nice smooth movement. I can open my hands and I can close it around my keys, bring that elbow up or use that bicep to bring my arm back up, and it's a nice fluid movement because my muscles are in a position where they are ready to complete that task. Now we could think about this as any task, from dressing to brushing my teeth, to using cutlery, to completing a school task, to walking down the hallway in a nice line, to walking down the hallway in a nice line.

Speaker 1 14:00

All of these times that I'm using my body, when I have normal tone or when an individual has normal tone, their muscles are ready to engage in that motor task without any additional effort. So now, if we think about low tone, actually I'm going to do high tone first. So if we think about hypertonia or high tone, this is that really small rubber band, the one we have to really work hard to open it up first, and then it kind of snaps back in place. And there are different types of hypertonia and I don't want to get into all of them, because hypertonia is one of those areas where, if you have concerns about your child, please see a GP, and your GP will then be able to refer you on to the appropriate allied health professionals, because physiotherapists work really closely with tone. So do occupational therapists.

Speaker 1 14:50

But hypertonia essentially means that the muscle is tighter. At rest it has more tension. Think about going to do a task if my muscle is already tight. I'm having to fight against that tightness to get my muscle and get my body into a position where I can then do the task. And as I'm fighting against that tension, it might slip and so I might get some jerky movements or I might get some uncontrolled movements. That happen because I'm having to fight against that already tight muscle.

Speaker 1 15:23

One thing that can happen with hypertonia and one of the activities that therapists do do is they do lots of stretching to help keep that range of motion. So if you think about if you had your bicep and if your bicep had quite high tone and you were quite tight through that and you were trying to extend your arm out, you'd get a lot of resistance as you're trying to open that arm out and you might have a little bit where it flicks back. You might have a little bit where you've gotten it, but then you lose a little bit of control. There's lots of components that can happen within hypertonia, but what we want to make sure is that you can still make that full range of movement to prevent things that are contractures or to prevent you losing that range of movement.

Speaker 1 16:09

But thinking about hypertonia is needing that extra effort when you're doing a task to fight against the muscle or to get your body into the position. So, before you've even done the task, it's that extra effort to get your body ready for the task because you've got those tighter muscles at rest. So this is not about tight muscles because I've worked them really, really hard. This is tight muscles at rest. So that is a hypertonia. And, as I said, particularly for hypertonia, if your doctor's raised concerns about this or you've heard it mentioned, please do make sure that you're hypertonia. And, as I said, particularly for hypertonia, if your doctors raise concerns about this or you've heard it mentioned, please do make sure that you're surrounding yourself with some allied health professionals that can provide you advice for your child and for the type of hypertonia that they may have. Now, in terms of the what can we do for hypertonia, it is the same sort of breakdown that we were thinking through when we looked at some of those sensory skills in terms of looking at well, what are you trying to do, where is it difficult and what supports can we put in place? So, if you are working with an occupational therapist and maybe the child's hypertonia is impacting upon them being able to brush their hair in the morning. Well, maybe we change the hairbrush that they use, or maybe we change the position so they can sit down. So the range is a little bit easier. We look at those supports that we can put in place within the environment or within a bit of equipment, and we look at what are some of those stretches or other activities that we can do to help our body itself as well. But, as you can see, this does then become quite specific for the individual child, which is why we want to make sure that we're getting those right supports around the child. So that's everything about a hypotonia that we're going to go into today.

Speaker 1 17:52

The last thing that I wanted to talk about and this is probably going to be the biggest part of the episode is a hypotonia or a low tone. So what is low tone? Low tone is that rubber band that you're having to put around again and again and again, because there is not much tension in these muscles at rest. They are not ready to do anything. These muscles are floppy. They might feel, or the child might look really floppy. The muscles themselves might feel a little bit spongy to touch, like if you push against a muscle. There isn't much tension there and you can feel that it's a little bit spongy and a little bit soft. And so what does this then mean?

Speaker 1 18:37

If we have low tone and I should say as well I forgot to say earlier, but I should say tone doesn't change and tone is the level of tone that you have. It's one of the things about your body, but it's not something that we can change and improve on. What we can improve upon is strength in our muscles, so that once we've turned our muscles on and once we've got them ready, we have the strength there to persist through an activity, but our initial tone. So once we let those muscles go to rest again, that doesn't change. And that's the same with any type of tone, the type of tone that you have in your muscles. It's what you're born with. It can come from many different factors, but what you get is what you have. And then we look at what are the supports that we can put in place to help you manage to be able to do whatever the activity is. And it's not a good thing, it's not a bad thing, it is just the reality of what life is. It might mean that some things are a little bit more challenging for you, and so we put the appropriate supports and things in place. So, keeping that in mind, when we think about low tone and some of these people that might be a little bit floppier, one of the most important things that we're going to do is we're going to help them figure out how to turn those muscles on and what it feels like when my muscles are turned on and I get them to a point where they are contracting and they are ready to do an activity. And we also help them build strength so that, as I said before, once we get those muscles on, we have the strength to persist through an activity and have that element of endurance as well.

Speaker 1 20:18

So what would a kid with low toe maybe look like? Well, it might be a child that, as I said before, is a little bit floppy, a child that leans on everything. Maybe they look a little bit uncoordinated or a little bit clumsy. Maybe, when you're sitting in the class on the floor, if you're doing any floor time activities, this might be the kid that's always sitting into the back of their pelvis and they're rounding through their spine and they're slumping forwards onto their elbows or they're leaning against their friend and they just, you know they try and they start sitting up and then, oh, it just, it's all too much and they flop or they might lie on the floor. These are the kids that you might see at home that are in front of the tv and not sitting up. They're just flopped all over the couch and it looks like they almost blend and become one with the couch. It might be the kids that at dinner time, particularly at the end of the day, when their muscles are tired, they're extra floppy and you're just like come on, sit up, come on, you can do it.

Speaker 1 21:16

It might be kids that, as you're getting dressed, it's really hard to hold and coordinate holding onto the clothes and then putting my legs through, because I'm just having to really use my muscles and it takes that extra effort and this is the really important thing to remember about tone, in particular with low tone is it's extra effort to get my muscles ready. So think back to that really loose band, rubber band, that we've had to stretch and put around, and put around and put around, and it was three or four times before we could actually do the job. That's the same when we've got low-toned muscles. I'm having to use a lot of effort to get them ready before I even can start doing the activity that I wanted to do. So what does this mean and what can we do? Well, what this means is it can impact upon our postural control, it can impact upon our postural stability, it can impact upon our confidence in completing tasks, and what it also might look like is a child that's using extra momentum or extra force to complete a task. And so I've finally got my muscles ready and I'm just going to fling it and do it really quickly. Or I've reached up and I'm, you know, taking my jacket off and I got it three quarters of the way and then my muscles gave out and so I've just flung it off my arm and I'm using the wrong strength for the activity.

Speaker 1 22:43

These kids you might see that it's a battle for them to sit upright for a long period of time, particularly if they don't have that strength and endurance component yet. So you might see they lack endurance in gross and fine motor skills and tasks or games that require that, like coordinated movement. So, like some PE games, maybe they're doing basketball, maybe they're doing a form of cricket or baseball, and just that ability to coordinate what my arms and what my legs are doing is really tricky because all of a sudden I'm bringing in more muscle groups that I have to then get ready to do the activity. So that's what these kids might look like. So what can we do if a child has low muscle tone? Well, we do two things, and one I've already mentioned where we want to kind of build that muscular strength and muscular endurance for these children so that once they've started the task, they have that ability to persist a little bit longer.

Speaker 1 23:40

The other thing that what we want to do is we want to look at building in warm-up activities want to do is we want to look at building in warm-up activities. Now, warm-up activities are where we want to help the muscles to activate, help us get into that state of feeling ready. I've gotten all my muscles and I've got to the point where I can engage in a task. Now I've turned them on think about that rubber band I've gotten it all the way around and now I can use my strength and my endurance to do the task. And so I'm taking that extra time before I start an activity to get my muscles and body ready. So these warm-up activities, they don't permanently alter muscle tone, but what they do is they help to be able to perform the task easier and with increased endurance.

Speaker 1 24:26

And we want to think about okay, so what times would we use these warm-up activities before a tabletop activity, before an activity that's going to have a large physical demand? So maybe before we're going to go and play some pee outside we might do it. Or if the physical demand is dressing, I'm going to do it before dressing. You know your child best and you see the children in your class and so think about those times when you notice this child that may have some low muscle tone really fatigues. And the reality is, and the bit that I really like, particularly within the classroom, with low muscle tone, is, these activities are very, very similar to some of the proprioception activities that we talked about before. Activities are very, very similar to some of the proprioception activities that we talked about before. They're very, very similar to some of those regulating activities. They're very similar to some of those movement break activities and so doing them as the whole class will benefit a range of children for a range of different reasons.

Speaker 1 25:23

So what are these activities? It depends upon the task, and so if I'm doing a larger physical task, I'm going to look for a larger physical activity. We might go on the trampoline, we might do star jumps, we might do hopping, we might do some animal walks. If I'm thinking about a fine motor activity and that's the task that we're going to do, well, then we might do some rolling play-doh, we might do some theropody, where we're going to squeeze. We might do finger shapes, where we try and copy your neighbors and we try and make different shadow shapes with our hands. We might do some drawing on a vertical surface right before I sit down, because that's going to get my shoulder working, that's going to get my core stability turning on and my hand turning on as well. Back to some of those bigger activities. Maybe we do some wheelbarrow walks or maybe we do a little stickers down that they need to try and hop and hop and hop to, to getting some pillows that then are going to give that little bit of extra balance, and then we might help them climb up and over things. Or maybe in the classroom they're going to then crawl under some chairs or crawl under the table to go around the corner. Obstacle course can be really easy to think of once you just get that little bit creative because you can use anything that is around you.

Speaker 1 26:52

Some fine motor activities. And again, guys, you can search these on google, but you know, playing with play-doh, scrunching up newspaper, squeezing water out of sponges, using a spray bottle at home, get them to help with cleaning, is a great one. Using a spray bottle at home, get them to help with cleaning, is a great one. Lots of different activities. But the idea is that we're doing this for a really short little burst, helping with really quite explicit verbal cues as well. And so you know if the child is having difficulties, we might say, well, let's think of the task. Let's say you're doing some star jumps and the child's having difficulties getting their muscles ready. So we might say all right, remember, we're going to turn those muscles in our arms on and we're going to bring our arms up together and clap, and then we're going to bring them down and then we're going to turn the muscles in our legs on and we're going to jump them out together and we're going to jump them back in so that they have that extra cue to be knowing what their body should be doing.

Speaker 1 27:47

And ultimately, the big thing I want you to think about with all of these things within low tone is it's that two-sided thing. We can do these warm-up activities to help get the body ready to then follow up with the task that we're trying to do, and we also want to look at building in these opportunities for additional strength and endurance so that we have the ability to persist through the task. And there are lots and lots and lots of resources out there If you have a little bit of a Google. But, as I said before, if you're having any difficulty, shoot me a message. Maybe I'll make one up for our little community here anyway that you guys can access. If that's something that you'd be interested in is having some easy go-to activities, send me a message so that I know if it's worthwhile putting it together for you guys. So that is our little summary of what our postural control is and what tone is. I hope that gives you some ideas of ways that you can tweak different activities at home and tweak different activities at school if this is something that you might see a child having difficulties with.

Speaker 1 28:51

So that's episode two done, and next week we are going to be diving into. All things, all about bilateral integration, crossing midline and hand-eye coordination. Again, a couple big, big buzzy words. A lot of these motor skills episodes are going to be diving into. That's the buzzy word. What does it mean and what are the games that we can play to help a child build some of these skills? That's all for this week, guys. I hope you have a fantastic week. I hope it's nice and sunny or some beautiful weather. Wherever you are, you can get out and do lots of fun, play things and start to play around with different bits of tone. Alrighty, have a great week and I will speak to you soon. Bye.