Postural Control

Postural control is balance – the ability to maintain balance in a posture while attending to, and engaged in, a task. Postural control emerges on the basis of an innate necessity to gain and maintain upright postures, and is achieved and refined in all functioning positions and postures during the first 10 years of life, with the greatest gains made in the first 3 years. [1,2] The successful acquisition of postural control in the trunk, neck, and hips allows the limb muscles to be used for effective movement and function.

Deficient postural control combined with the necessity to remain upright results in the chronic, compensatory use of limb muscles to maintain stability rather than engage in motions. Limb muscles working to hold postures shorten over time as the adapt to a tonic use history. Shortened limb muscles and surrounding tissues become increasingly stiff (i.e. form contractures). Limb movements are labored in the presence of tonic recruitment for balance and remaining upright and of contractures.

Treatment approaches that address issues of postural control and diminished sensory awareness include:

• The rhythmic stabilization techniques of PNF, intended to elicit co-activation of the postural muscles though deep compression [3]
• Handling techniques targeted to build trunk muscle strength and control from the NDT approach [4,5,6]
• P-A’s strategies for enhancing sensory input through the body-ground interface while the child is engaged in play [7]
• SI therapy seeks to contribute to the child’s ability to receive and use sensory information effectively.

TheraTogs’ Role in Postural Control

TheraTogs systems implement many of the principles and methods used in treatment to promote postural control by:

• Delivering a cozy body hug that raises the level of body awareness on the torso. The fabric used to make the undergarments is lined with foam and is designed to stretch horizontally.
• Assisting in aligning the trunk and hips. The fabric used to make the undergarments is designed to resist vertical stretch so that it offers gentle postural stability. Because it is only fabric, it cannot “do the work” of the postural control muscles. The muscles remain active, but work in a new and more correct length and relationship to the underlying spine and joints.[3]
• The addition of strapping to the garments can further improve postural alignment, connect the thorax to the pelvis, and/or deliver a deep compression through the joints of the spine and hips to promote co-activation of the trunk muscles.

Tip: TheraTogs are made of elastic fabrics. They are not capable of providing passive support to the torso. They cannot possibly produce limb motions. They provide flexible assistance to the wearer who functions in improved postural and joint alignment. It is common to find the wearer develop fatigue while undertaking routine activities in improved alignment. Antigravity muscles are being recruited in new ways and at shorter lengths. Caretakers can easily grant rest periods by loosening key straps temporarily.

References

1. El-Kafy, Ehab Mohamed Abd, and Shamekh Mohamed El-Shamy. “The impact of conservative soft orthotic intervention with strapping on thoracic kyphotic posture and spinal mobility in children with cerebral palsy: a randomized control trial.” Bulletin of Faculty of Physical Therapy 27.1 (2022): 1-8.
2. Kafy, El, Ehab Mohamed Abd, and Shamekh Mohamed El-Shamy. “Efficacy of TheraTogs orthotic undergarment on modulation of spinal geometry in children with diplegic cerebral palsy.” Bulletin of Faculty of Physical Therapy 26.1 (2021): 1-8.
3. Hadders-Algra M, Carlberg EB. 2008. Postural Control: A Key Issue in Developmental Disorders. Clinics in Devel Med.No. 179. London: Mac Keith Press.
4. Shumway-Cook A, Wollacott MH. 2011. Motor Control: Translating Research into Clinical Practice, 4th edition. Lippincott Williams & Wilkins: Philadlephia PA.
5. Sareen, A. Proprioceptive Neuromuscular Facilitation.
6. Arndt SW, Chandler LS, Sweeney JK, et al. (2008). Effects of a neurodevelopmental treatment-based trunk protocol for infants with posture and movement dysfunction. Pediatric Physical Therapy, 20(1), 11.
7. Knox V, Evans AL. 2002. Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy: A preliminary study. Devel Med Child Neurol.44(7), 447.
8. Howell JM et al. 2002. Neuro-Developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice.
9. Institute for Perception-Action Approach.