By physiotherapist Hannah Harboe
The supporting surface we balance on when standing has an area that corresponds to a circle drawn around our feet. When we stand with our feet together or on one foot, our supporting surface is smaller, and when we stand with our feet apart, the supporting surface is of course larger. The smaller the supporting surface, the more challenging it is for us to keep our balance.
If we wobble and find it difficult to balance, we may also find it difficult to shift all our weight over onto one leg.
The combination of these two challenges, i.e. a small supporting surface and immature balancing skills, explains why children learn to walk before they can run and when they learn to walk, they toddle, i.e. they walk with their legs wide apart and hesitantly.
When walking, a toddler always has one foot resting on the underlay, and he or she transfers his/her weight from one foot to the other relatively slowly. The child moves his/her feet so that both are in contact with the underlay at the same time, i.e. the child maintains an adequate supporting area. When a human being runs, only one foot rests on the underlay at any one time and, for a brief moment, we hover in the air without contact with the underlay. When running, our supporting area is smaller and weight transfer rapid.
If a child has difficulty shifting his or her weight from one side to the other i.e. from one leg to the other, that child’s difficulties can be due to any of the following factors:
• Physical pain
• Immature nervous system
• Over-reactive vestibular system
• Inadequate proprioceptive registration
• Inadequate or over-reactive tactile registration
• Secondary mental impairment including a fear of losing control
Regardless of the cause, weight transfer exercises are necessary if the child is to succeed in moving freely in all kinds of motor activities.
The Robo-Board is designed so that an exaggerated weight transfer is needed to move the board forwards. Unlike a conventional skateboard that rolls easily when we mount it, the effect of the Robo-Board’s wheels (four small wheels set into two circles, one at each end of the board) is for the board to remain stable when the child mounts it.
Miriam is five years old. A cautious child, she shies away from motor play and high intensity rough-and-tumble. Miriam arrives at the clinic. Her parents find that she has not developed the same motor skills as her peers. She dares not try new motor activities.
As Miriam is due to start school, her parents would like to see her develop stronger motor skills. They hope that she can learn to ride a bicycle with a view ultimately to cycling to school on her own.
During motor screening, I discover that while Miriam is actually capable of performing many coarse motor functions, she often lacks the courage to do them. Things go wrong for her because she lacks confidence in her own ability. Her balance is shaky, her body reacts with stress, her movements stiffen and Miriam trembles and sweats.
On the next four occasions Miriam visits the clinic, we do exercises and activities that she experiences as play and free movement that do not call upon her to perform. Gradually, Miriam builds the courage she needs to relax while playing. I am very aware of the need to praise her when she gives herself a challenge and when she relaxes and has fun.
When Miriam performs exercises that are challenging with regard to keeping her balance, she is still unsure and afraid of falling and getting hurt.
Then we begin to train using the Robo-Board. At first, I hold her firmly at the hip so that she is neither surprised by nor loses her balance when the board starts to move.
Gradually, Miriam discovers that she can shift her weight from one side to the other and get the board to move. She discovers how much weight she has to transfer onto one leg in order to move it. As soon as she catches onto the idea of weight transfer, I discretely reduce the amount of support I give her and settle for assuring her that I am close by and will catch her if she should lose her balance.
Her parents and I praise her for having the courage to try something new. Over the next couple of sessions, she becomes increasingly brave. Her new-found courage has a knock-on effect on other activities. Miriam is experimenting more with her motor skills.
Spring comes. Miriam is ready to learn to ride a bicycle. She only needs to practise a couple of times before she succeeds in pedalling under her own steam with Dad at her side.