By Craig Valency, MA, CSCS

Introduction

As I discussed in my introductory post, the missing link to true movement mastery is learning the 9 perceptual-motor skills as early as possible.

As fitness professionals, teachers, therapists, or parents, we have a unique opportunity to even the playing field by offering every child we work with an ideal environment to explore movement through all their senses.

These skills lay the foundation for an increased movement vocabulary with overall better coordination and the ability to learn the fundamental movement skills. With this foundation firmly in place, children are better equipped and more likely to engage in sports and recreational activities for a lifetime.

Here is a bird’s eye view of the 9 perceptual-motor skills we’re looking at in this series:

  • Body: Understand the parts of the bodies and how they move
  • Directional: Differentiate between the left and right sides of the body and move in all planes of motion
  • Spatial: Has a sense of how much space one’s body takes up and moves comfortably around other people and objects
  • Temporal: Has a sense of timing and rhythm
  • VisualCan visually focus and track objects
  • Vestibular: Develop an internal sense of their body’s position in relation to gravity
  • Auditory: Can accurately respond to sound
  • Tactile: Can respond to touch in competitive situations to counter a move, as in wrestling, or in cooperative situations to stay with a partner, as in dance
  • Proprioceptive: Interpret the internal sense of where the body is in space

Today, I’ll focus on vestibular awareness and discuss why it is so important to postural stability, coordination, movement efficiency, and the surprising link to visual awareness. I’ll outline what it is and give specific ideas that you can use to teach vestibular awareness in any youth fitness program.

What is vestibular awareness?

wheel-511668-mHave you ever wondered why kids love swings, spinning around endlessly just to get dizzy, or being swung in circles by their parents? All that motion makes the vestibular system of the inner ears really happy! It stimulates microscopic hair cells in the fluid- filled semicircular canals and improves communication to the brain, while fine-tuning sensory development – including visual tracking, balance, and spatial awareness in various positions relative to gravity. (http://kaboom.org/resources/build_playground_toolkit/accessibility/play_and_development/sensory_play/vestibular_play)

Wow! That is a lot of stuff going on in the inner ear! I think you deserve an explanation. So here comes the fun part: vestibular system anatomy and physiology!

I promise this won’t be as bad as it sounds. Just stick it out through a few fancy words, and everything else will make more sense; besides, you can impress your friends at parties, or get a Jeopardy question right!

Hold on, here we go…

Located deep within each ear, the vestibular system consists of three fluid-filled semi-circular canals, and the utricle and saccule; as well as the vestibular nuclei in the brainstem. This entire complex is crucial in the control of balance and the maintenance of postural positions, sending a steady stream of information about the positioning of the limbs, head, and eyes (Gambetta, 2007, p. 147).

The vestibular system basically has three main jobs to do:

  1. Give you feedback about the position of your head in relation to the ground (This is possible because the three semicircular canals in both ears are positioned at 90-degree angles to each other, which allows for accurate information about where your head is relative to those angles when it rotates)
  2. Give you feedback about the direction your body is moving (The utricle and saccule are responsible for sensing body movements relative to gravity and sending information about vertical and linear motion and acceleration, such as moving up and down, or forward and backward) (http://www.skybrary.aero/index.php/Vestibular_System_and_Illusions_(OGHFA_BN)
  3. Allows your eyes to stabilize images when your head is moving (Vestibular awareness is directly related to visual awareness via the vestibulo-ocular reflex, which allows the eyes to stabilize images, even when the head and body is moving)

Balance and the Vestibular System

Most of us have figured out that balancing with the eyes closed is not easy! Without vision we have to rely on the other “hidden” internal senses to maintain balance.

The three sensory strategies that we all use to help maintain balance include (1) vision (using the eyes to focus on one point to maintain balance), (2) proprioceptive inputs (the internal sense of where joints and limbs are in space), and finally (3) the vestibular system (feedback from the semi-circular canals in the inner ear to tell us where we are in space).

Vision is the first and most dominant sense that young children use for balance control, while the vestibular system is the last to develop. This helps explain why we rely on our eyes so much for balance!

Studies show that by the age of 12, and no later than 14, adult levels of balance control are reached, largely due to the development of the vestibular system, with girls usually developing this system earlier than boys (Drabik, J. 1996), (Hsu, et al., 2009), (Ferber-Viart, et al., 2007), (Peterson, Christou, & Rosengren, 2006).

Recall that the semicircular canals are what allow a person to know where his head is in relation to gravity. In comparison to the visual and proprioceptive systems, the semicircular canals of the vestibular system are the last to fully develop in children for the maintenance of postural stability. They can be stimulated earlier, however, through various head and body movements and balance exercises.

A 2012 study on visually impaired 10-year-old children showed the power of a targeted vestibular exercise protocol to improve dynamic balance. The intervention group significantly improved balance compared to a control group in the 8-week study.

The exercise protocol involved rolling, crawling, hopping, skipping, and walking patterns that would stimulate the vestibular system. Because the children could not rely on vision for balance, the authors asserted that improvements were largely due to adaptions with proprioception and their vestibular systems (Jazi, Purrajabi, Movehedi, & Jalali, 2012).

Do girls really have better balance than boys?

Have you ever noticed that girls like to twirl more than boys do? I’ve even seen girls often twirl themselves all the way to the drinking fountain and back, without missing a beat! It has long been assumed that girls have better balance than boys. Research is now showing that there may be some truth to that assumption, and twirling may be part of the reason.

According to Peterson, et al., (2006) girls did better in integrating sensory information for balance and had overall better body control than boys up to the age of 12. They also found that 7 to 8 year old girls achieved higher scores on the use of their vestibular systems than did boys of the same age.

The authors believe that girls may have had an advantage in static balance because they often participate in activities requiring more body control in static positions, such as ballet and gymnastics. They pointed out that these types of endeavors require rolling, spinning, and other rotational movements that could stimulate the vestibular system and lead to better adaptations to balance training than those with a less developed vestibular system.

Teaching vestibular awareness

Vestibular awareness training should start by allowing kids to play and explore more, especially in ways that promote vestibular development. This includes using swings and slides at the park, as well as running, climbing, or traversing on uneven or sloping terrain in a variety of natural settings.

Next, implement specific activities to ensure that their vestibular system is fully stimulated. For example, encourage them to spin their bodies or move their heads in all directions so that all 3 semi-circular canals are stimulated. Do activities that promote head movement while stabilizing the eyes, and finally, work on whole body balancing in various conditions. Some kids with vestibular sensory disorders, may need more stimulation than normal, so they are constantly swinging and spinning around, other kids are overly sensitive to this stimulation and can’t handle excessive spinning movements. The kids on the extremes may need to be referred to occupational therapy if it interferes with normal function. Most kids, however, will see a normalization of these responses with proper, targeted activities for their vestibular system.

Here are seven fun ways you can stimulate vestibular development in kids:

  • Single leg balance 3 ways – Have the kids stand on one leg with their hands on their hips. See if they can hold it for 20 to 30 seconds; vision will be the dominant sense they use to maintain balance. Once they can do that, they should try it with eyes closed. Now the proprioceptive body sense will take over, along with the vestibular system. Finally, see if they can balance on one leg, with their eyes closed, while standing on a softer, more unstable surface such as a foam pad. In this situation, the feedback from the ground to the body is not as accurate, so proprioceptive inputs are less reliable; and the vestibular system is the dominant one used for balance.
  • Spinning tops – Have the kids put their arms out and spin in one direction 5 times. Then have them stop and balance on one leg and hold the position for up to 20 seconds.
    • Variations:
      • Spin 10 times in each direction
      • Vary the speed of the spins
      • Start with a 5 second balance hold and increase in 5 second increments up to 30 seconds
      • Balance with eyes closed
      • Balance with feet in line (toe to heel)
      • Walk on a line or low balance beam after spinning to work on dynamic balance
  • Log roll bonanza – Have the kids lie on the ground and log roll in the direction you call out. On your command, have them pop up as fast as possible. Your command will be the position you want them to get in. For example, “Roll left… now stand on your left foot!”
    • Variations:
      • Rolls can be from the crab to bear position (hands & feet only)
      • Other command options can be a jump, single leg hops, 3 point balance, crawl, or run to a designated area
  • 180-degree jumps – First have the kids do jump squats to warm up. Next have them do quarter turn jump squats, and finally, challenge them with 180 degree jump squats. Tell them, “Squat down, jump up, and land facing the opposite direction.” This drill stimulates the vestibular system’s multiple roles, including conveying information about vertical acceleration against gravity as well as rotation.
  • Summersaults – this allows for the forward and backward stimulation of the vestibular system. It’s best to do this on mats or on a grass field. They can be done as part of a series of tumbling or other locomotion drills, or simply as one section of an obstacle course.
    • Variations:
      • Knee hug rockers: if a child is uncomfortable doing summersaults, or if it is too overstimulating, have him simply lie on his back, pull his knees to his chest, and make his body form a ball. He can gently rock forward and backward on his spine, keeping his chin tucked.
  • Head rockers! – This is a drill we also use for visual awareness. Because the vestibular system is also responsible for stabilizing the eyes while the head moves, it is important to do this to stimulate the vestibular system. Kids are partnered up, with one child holding a ball at head level. The other partner should focus on the ball and move his head side to side, then up and down, diagonally, and finally in circles, never losing sight of the ball. The partner who is holding the ball should call out directions. This drill helps with the communication between the vestibular system and eyes, as well as improving directional awareness and auditory awareness.
  • “Yes, yes. No, no!” – While doing various locomotion patterns, move the head left and right, then up and down while maintaining eye focus straight ahead.
    • Variations:
      • While walking; skipping; lateral slides; cariocas
      • While doing agility ladder drills
      • While doing static balance drills

Conclusion

Vestibular awareness begins with lots of free play. Allowing kids to explore, run, roll, jump, and spin in a rich and varied natural environment promotes vestibular development, as their heads invariably move in multiple directions and their bodies accelerate forward or upward against gravity. Games that require tracking a ball, such as tennis or baseball, require the integration of the vestibular system with visual awareness. To even the playing field for those kids that do not have access to parks or natural settings, it is important to implement specific activities to ensure that their vestibular systems are fully stimulated. Start with various levels of static balance exercises. Add in jumps, spins, and rolls in various directions, immediately followed by a balance or locomotion task. Finally, do some eye tracking exercises to ensure good integration of the vestibular reflex responsible for maintaining a steady gaze during movement or play.

In part 8, I’ll talk about auditory awareness, which is the ability to respond appropriately to audible signals. Some kids are easily overstimulated by sound and they may act out. Others don’t seem to notice or respond well to sound. I’ll discuss ways to improve listening skills, and the ability to discern the distance or direction of a sound source.

References

Drabik, J. (1996). Children & sports training: how your future champions should exercise to be healthy, fit and happy. Island Pond, Vermont: Stadion Publishing Company, Inc.

Ferber-Viart, C., Ionescu, E., Morlet, T., Froehlich, P., & Dubreuil, C. (2007). Balance in healthy individuals assessed with equitest: Maturation and normative data for children and young adults. International Journal of Pediatric Otorhinolaryngology, 71, 1041-1046. doi: 10.1016/j.ijporl.2007.03.012

Gambetta, V. (2007). Movement aptitude and balance. In Athletic development: The art & science of functional sports conditioning (pp. 147). Champaign, IL: Human Kinetics.

Hsu, Y., Kuan, C., & Young, Y. (2009). Assessing the development of balance function

in children using stabilometry. International Journal of Pediatric Otorhinolaryngology, 73, 737-740. doi: 10.1016/j.ijporl.2009.01.016

Jazi, S. D., Purrajabi, F., Movehedi, A., & Jalali, S. (2012). Effect of selected balance exercises on the dynamic balance of children with visual impairments. Journal of Visual Impairment & Blindness, 466-474.

KaBOOM!: Vestibular play. (2015). Retrieved from http://kaboom.org/resources/build_playground_toolkit/accessibilit y/play_and_development/sensory_play/vestibular_play

Peterson, M. L., Christou, E., & Rosengren, K. S. (2006). Children achieve adult-like sensory integration during stance at 12-years-old. Gait & Posture, 23, 455-463. doi: 10.1016/j.gaitpost.2005.05.003

Skybrary. (2015). Retrieved from http://www.skybrary.aero/index.php/Vestibular_System_and_Illusions_(OGHFA_BN)

Vestibular disorders association: Pediatric vestibular disorders. (2015). Retrieved from http://vestibular.org/pediatric-vestibular-disorders

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