Balance & Coordination

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What is balance and coordination?

Balance is the ability to maintain a controlled body position during task performance, whether it is sitting at a table, walking the balance beam or stepping up onto a kerb. To function effectively across environments and tasks, we need the ability to maintain controlled positions during both static (still) and dynamic (moving) activities.

Static balance is the ability to hold a stationary position with control (e.g. “Freeze” or “statue” games). Dynamic balance is the ability to remain balanced while engaged in movement (e.g. running or bike riding).

Why is balance and coordination important?

Age appropriate balance and coordination allows a person to be involved in the participation of sport with a reasonable amount of success as it will aid fluid body movement for physical skill performance (e.g. walking a balance beam or playing football). The involvement in sport is helpful in maintaining self regulation for daily tasks as well as developing a social network and achieving a sense of belonging in a community or social setting. Furthermore children will be able to maintain appropriate and controlled body movement during task performance which reduces the energy required and minimises fatigue.

With good balance and coordination there is less likelihood of injury as a child will have appropriate postural responses as (and when) needed (e.g. putting hands out to protect yourself when you fall). The physical attributes of balance and coordination also allow for appropriate posture for table top tasks and subsequent success at fine motor tasks.

Building blocks necessary to develop balance and coordination include:

  • Attention and concentration: The ability to maintain attention to a specific task for an extended period of time.
  • Body Awareness:Knowing body parts and understanding the body's movement in space in relation to other limbs and objects.
  • Bilateral integration: Using two hands together with one hand leading: e.g. opening a jar lid; with the other and helping and stabilising the jar).
  • Crossing Midline: 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: The ability to process information received from the eyes to control, guide, and direct the hands in the accomplishment of a given task, such as handwriting or catching a ball.
  • Hand Dominance: the consistent use of one (usually the same) hand for task performance, which allows refined skills to develop.
  • Muscular strength: the ability to exert force against resistance.
  • Muscular endurance: theability of a muscle or group of muscles to exert force repeatedly against resistance.
  • Self regulation: the ability to obtain, maintain and change alertness level appropriate for a task or situation.
  • Postural Control: the ability to stabilize the trunk and neck to enable coordination of other limbs.
  • Proprioception: is information that the brain receives from our muscles and joints to make us aware of body position and body movement.
  • Sensory processing: accurate processing of sensory stimulation in the environment as well as in one's own body.
  • Isolated movement: the ability to move an arm or leg while keeping the remainder of the body still.


You can tell there are problems with balance and coordination if the child:

  • Falls easily, trips often or can’t ‘recover’ quickly from being off balance.
  • Moves stiffly and lacks fluid body movement (e.g. runs like a ‘robot’).
  • Avoids physical activity (e.g. playground use, sports participation).
  • Is late in reaching developmental milestones (e.g. crawling and walking).
  • Is slower than their peers in mastering physical skills (e.g. bike riding, swimming or tree climbing).
  • Is less skilful than their peers in refined sports participation (e.g. team sports).
  • Pushes harder, moves faster or invades the personal space of others more than they intend to. 
  • Is fearful of new physical games (e.g. swings) or scared of heights that do not faze their peers.

When you see difficulties with balance and coordination, you might also notice:

  • Motor (muscle) planning of how to perform a physical task (e.g. they may start at step three not one).
  • 'Floppy' muscles so that the body looks limp or overly 'tight' muscles so the body looks rigid.
  • Spatial awareness of how they are using or placing their body (e.g. so that they invade other peoples personal space without knowing it).
  • Endurance for fine and gross motor tasks.
  • Pre writing skill development: The pencil strokes that comprise most letters, numbers and early drawing.
  • Pencil grasp: The efficiency of and the manner in which the pencil is held, allowing age appropriate pencil movement generation.
  • Pencil control: The accuracy with which one moves a pencil for drawing and writing.
  • Left right discrimination: Conceptualising difference so you can 'know' the difference between left and right side of the body.
  • Hand dominance: The consistent use of one (usually the same) hand for task performance, which allows refined skills to develop.
  • Articulation: Clarify of speech sounds and spoken language.
  • Self care: Dressing independently and holding and using cutlery.
  • Sensory processing: Accurate registration, interpretation and response to sensory stimulation in the environment and one's own body.


What can be done to help improve balance and coordination skills?

  • Improve attention to task and alertness levels in readiness to respond quickly when they lose their balance.
  • Explicit teaching of mechanics: Correct alignment of your body in order to maintain balance (e.g. placing your hands under your shoulders rather than out in front when crawling).
  • Strengthen the 'core' namely the central muscles of the body to provide greater body (especially trunk) stability.
  • Simplify tasks to concentrate on only one movement at a time, until the child is ready to integrate several at once.
  • Improve muscle strength to allow for better muscle control.
  • Improve muscular endurance to increase the length of time with which a child can maintain balance and coordination.
  • Improve sensory processing to ensure the body is receiving and interpreting the correct messages from the muscles in terms of their position, their relationship to each other, the speed at which they move and how much force they are using.
  • Social motivators: If a child has a friend or family member involved in a sport, they may be more persistent in participating and practicing those specific skills.


Activities that can help improve balance and coordination:

  • Unstable surfaces: Walking over unstable surfaces (e.g. pillows, bean bags or blankets on the floor) that make the trunk do lots of work to maintain an upright position.
  • Unstable swings and moving games, including suspended climbing ladders and jungle gyms. When swings move in unexpected ways it forces the trunk to do more work.
  • Wheelbarrow walking (walking on your hands while an adult holds your legs up).
  • Swimming: Involves the body having to work against resistance of the water, thus providing better awareness of where the body is in space.
  • Kneeling with no hands touching the floor to tap a balloon back to another person with your hand.
  • Hopscotch: Requires a child to switch movement patterns frequently and rapidly
  • Stepping stone games with big jumps (i.e. no steps between the 'stones') will challenge a child's balance.
  • Bike and scooter: Both activities require the child to continually make postural adjustments to maintain balance.


Why should you seek therapy if you notice difficulties with balance and coordination?

  • To increase your child's confidence in gross motor activities (e.g. playing on the playground, running, jumping).
  • To enhance their self-esteem (so they aren't ostracized or picked last in sport team due to their physical ability skill challenges).
  • To increase sporting ability and confidence to engage in sports. Participating in sport enables a child to enrich their lives with positive people and develop strong friendships.
  • Having appropriate balance and coordination will enable children to participate in sport and we know that active children are more likely to be active adults, resulting in a healthier and longer lasting life.
  • Physical education is a part of the school curriculum which includes athletics and swimming carnivals and often participation is compulsory. Without appropriate balance and coordination
  • children will find it difficult to comply with school regulations to participate.
  • Having the balance and coordination to successfully carry out gross motor skills will reduce the likelihood of injury and thus increase the longevity of a child's ability to be involved in sporting pursuits.


Left untreated, difficulties with balance and coordination can lead to:

  • Social isolation as they will struggle to participate insocial activities such as going ice skating, riding, social hit of tennis, each volleyball or other various activities.
  • Poor self esteem when they realise their skills do nt match their peers.
  • Bullying when others become more aware of a child's dfficulties.
  • Poor fine motor skills (e.g. writing, drawing and cutting) due to poor core stability, meaning they do not have a strong base to support the use of their arms and hands.
  • Inability to ride a bike or scooter, which will limit the options for play with peers as many like to ride their bikes as a means of catching up with friends.


What type of therapy is recommended for balance and coordination difficulties?

If your child has difficulties with balance and coordination, it is recommended they consult an Occupational Therapist. It may also be appropriate to consult a Physiotherapist for these gross motor skills. It is important to acknowledge however that in many (but not all) paediatric cases, there is a large overlap in the skills addressed by Physiotherapy and Occupational Therapy.


 If you are concerned about balance and coordination difficulties, the next step is:


Other relevant resources:

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