Balance and Co-ordination Difficulties

What is balance and coordination?

Balance is the even distribution of weight enabling someone or something to remain upright and steady. It is our ability to stay in control our body position during tasks. It is to our core muscles that enable us to balance effectively. We need balance for most tasks, whether it is sitting at a table, stretching to reach something or stepping up onto a pavement. We need balance in most of our daily activities, that includes both static (still) and dynamic (moving) balance.

We need static balance to be able to maintain a stationary position with control (e.g. “freeze” or “statue” games), we need this to be able to stand in queues or staying still to listen to someone giving us instructions. Dynamic balance is the ability to remain balanced while moving (e.g. running or bike riding).

Why do we need balance and coordination?

Balance and coordination allows us to get up and move around in our daily lives, if we had no balance self-care skills and life skills would be very difficult. It also enables us to be participate in sports as it is required for all of our body movement’s physical skills. 

Balance and coordination also enables appropriate posture and positioning for table top tasks and allow us to complete fine motor activities. By balance skills without having to be aware or focus on them it allows us to engage in other activities such as school work and making friends.

Balance skills enable us to participation in sporting activities which are good for children and adults as they help with the ability to self-regulate, as well providing social networks and friendship groups, it assists us to have a sense of belonging in a community or social setting. 

When children are struggle to maintain balance that is required for our body movements throughout the day, the child may have to exert too much energy and effort towards that and the  body will fatigue, this it makes other tasks such as reading, writing  and learning difficult.

If a child has developed good body balance and coordination they are less likely to fall or get injured easily. They will have developed appropriate postural responses to save themselves from e.g. by putting hands out to protect themselves as they fall.

Underlying skills needed to develop balance and coordination skills 

The child will need the physical strength and endurance to engage in balance and coordination activities. He/she will need to have the ability to exert force against gravity/resistance.  They require some degree of postural control i.e. the ability to stabilize their trunk and neck which enables coordination of other limbs.

• The child should be able to isolate movement e.g.  Have the ability move an arm or leg while keeping the remainder of the body still.
• The child needs to have an awareness of body positioning i.e. to know where their head is in relation to their body. They also require an understanding of the body’s movement in space in relation to their limbs and objects.
• The child will need to have developed bilateral integration skills i.e. using both hands together.
• The child will need to have developed the ability to cross the midline. This is the ability to cross the imaginary line running from a person’s nose to pelvis that divides the body into left and right sides.
• Hand eye coordination must be somewhat developed. This their ability to process information received visually, to control, guide, and direct the hands for the completion of an activity, such as writing or catching a ball.
• Hand dominance should be developed. This is when a child consistently uses one hand to complete a task. Hand dominance allows refined skills to be developed.
• The child will need to have some level of self-regulation, i.e. the ability to obtain, maintain and change their level of alertness and arousal for an activity or situation.
• Proprioception is also required for balance skills. Proprioception, is the body’s ability to sense its location, movements, and actions. It is the information that the brain receives from our muscles and joints to make us aware of body position and body movement. It allows us to move without having to consciously think about the environment.
• The child will require some sensory processing skills in order to accurately process sensory stimulation from the environment as well as their own body.

Problems with balance and coordination may include:

• The child is “accident prone” he/she will trip or fall often and when they do they may struggle to ‘recover’ quickly from being off balance.
• The child may look quite robotic i.e. moves stiffly and lacks fluidity in body movements.
• The child may “opt out” of physical activity not just structured sports but playground toys or games
• Their developmental milestones may be delayed e.g. crawling, sitting and walking. They may be slower than their peers in mastering physical activity such as riding a bike, swimming or football.
• The child is less successful than their peers in  team sports and can be “left out” of team games
• The child may have difficulty with grading their activity e.g. they may push harder, move faster or invade others personal space, they may not be aware of this and are unable to understand why their peers are upset with them.
• The child may be hesitant and fearful of new physical games or playground equipment that other children the same age appear to enjoy.
• The child may be anxious/distressed during gym class. 
• They may find it difficulty following  verbal instructions especially in large groups
• The child may appear clumsy and uncoordinated and may find themselves in unsafe positions.
• The child may require lots more encouragement to participate in physical games.

If a child has balance and coordination difficulties they may also have other difficulties including:

They may struggle with motor planning i.e. struggle to break down the task and  understand how to perform it 

• They may have low tone i.e. ‘Floppy’ so that the body looks limp or “rag doll like”
• They may have high tone i.e. tight’ the muscles so the body looks rigid and they look robotic in their movements.
• They may have difficulties with spatial awareness, they bump into things and misgauge how far away things are. They may struggle to know understand the placing their body and therefore invade other peoples personal space without recognising it.
• They may struggle with the physical effort if completing both fine and gross motor tasks.
• They may struggle to achieve the writing and pre writing skills i.e. pencil control and movement that comprise most letters, numbers and early drawing. Pencil grasp may also be difficult to achieve. 
• The child may not have developed left and right discrimination i.e. understanding the difference between the 2 sides of the body and the comprehension that there are 2 sides. 
• Hand dominance may not be established. 
• The child may have some difficulties articulation and clarify of speech.
• The child may have problems with self-care e.g. struggles to dress independently or use cutlery.

How to improve balance and coordination?

• Work on improving the child’s ability to respond quickly when they become unbalanced.
• Try to teach awareness of body mechanics and how the body works together.  Correct alignment of their body in order to maintain balance (e.g. placing your hands under their shoulders rather than out in front when crawling). Use your body to demonstrate effective patterns.
• Work on strengthen the ‘core muscles’ to provide greater body (especially trunk) stability and improve muscle strength throughout the body to allow for better muscle control. Use of a therapy ball is good for this.
• Simplify tasks so that the child can understand what you are asking them to do.  Concentrate on only one movement at a time, until the child is ready to integrate several at once.
• Work on improving muscle endurance to increase the length of time that the child can maintain balance and coordination.
• Improve sensory processing skills to help the child receive and interpret the correct messages from the muscles i.e.  Where they are, their relationship to each other, and the speed and force at which they move. 
• Use the child’s motivators to engage them, e.g. if they want to try a sport because a friend is in it or they want to “win” if the child is interested they are more likely to be persistent and motivated for practicing these specific skills.

Activities to help improve balance and coordination:

• Walking over unstable surfaces e.g. pillows, bean bags or blankets on the floor. This makes the trunk do lots of work to maintain an upright position.
• Make use of moving games and toys, e.g. swings and moving games, including suspended climbing ladders and jungle gyms. When unexpected movement occurs it forces the trunk to do more work.
• Wheelbarrow walking (walking on your hands while an adult holds your legs up).
• Swimming is a very good activity to improve balance and coordination as it involves the entire body having to work against the water resistance, and therefore provides better awareness of where their body is in space.
• Playing throwing a balloon to another person while in high with no hands touching the floor is a fun way to improve balance and coordination.Play hopscotch – this requires the child to switch movement patterns frequently and rapidly while also working on grading and coordination. 
• Stepping stone games with big jumps (i.e. no steps between the ‘stones’) will challenge a child’s balance.
• Playing on a bike and scooter require the child to continually make postural adjustments to maintain balance.

What are the benefits if therapy for a child with poor balance and coordination?

• Therapy will increase the child’s confidence in gross motor activities e.g. playing on the playground, running, jumping, they will be more likely to engage with their peers
• Therapy can promote self-esteem, as they gain skills and confidence they are more likely to participate in games with their peers. 
• It will increase the child’s ability and willingness to participate in sports. Participating in sports can enrich their lives and help them develop friendships.
• Therapy will help the child achieve a healthier lifestyle. Having appropriate balance and coordination enables children to participate in sports and it is recognised that active children are more likely to be active adults, resulting in a healthier and happier adults.
• Physical education is a part of the school curriculum and is compulsory for the child to take part in, this includes athletics and swimming and ball games. Without appropriate balance and coordination children will find it difficult to comply and may get into trouble.

What problems can occur as a result of poor balance and coordination?

• The child may feel/become socially isolated if they are unable to participate in social activities such as going ice skating, riding, social hit of tennis, beach volleyball or other various activities.
• The child can develop low confidence and poor self-esteem when they realise their skills do not match their peers.
• The child may become a victim of bullying when others become more aware of a child’s difficulties.
• They child may present with poor fine motor skills (e.g. writing, drawing and cutting) due to poor core stability.
• The child may not be able to ride a bike or scooter and miss out on opportunities to play with their peers as a result.