Friday, January 6, 2017

Strength and Power Training for Kiddos with Poor Coordination!

When we PTs see a clumsy or uncoordinated kiddo, one of the first thoughts we think is “That kid can use some balance training!” or “They could benefit from functional activity practice!” What current evidence based research is finding is that strength and power training can be just as helpful if not MORE helpful than functional movement training!

Our muscles and our body learn through experience. Some kiddos who have difficulty with coordinated movements may be having a hard time using past movement experiences to predict the requirements for future movements.(2) According to Menz et al, “Because daily function requires complex movements, repeated practice requiring control of multiple degrees of freedom, as found in activity-level intervention, may not be effective at decreasing compensatory strategies and improving feedforward control.” What this means is that training functional tasks may be too challenging for these kiddos who have difficulty with coordinated movements.

Strength training that consists of multiple repetitions of isolated, simple joint movements can help a kiddo’s motor learning at the beginning stages prior to progressing to more functional and complex skills. This blocked practice will help the child’s ability to plan their movements due to the improved neural pathways and motor unit recruitment for the muscles groups needed for the task.

While Fong et al suggested that each exercise be performed as 4 sets of 10 reps each at 70% of their one repetition max and Menz et al suggested that each exercise be performed as 3 sets of 30 reps and increase weight by 1 lb until they are unable to complete the exercise, the common denominator between these two studies is that they require multiple repetitions. In my own practice, I find it challenging with some kids to have them attend to a set for that long, and I end up doing 20 sets of 5 reps! While this may not be the protocol according to these studies, what I find is that this is just as beneficial because these kiddos are getting the exposure and experience that they need. Remember: multiple repetitions equal more practice!

Here are some of the strength training exercises found to be beneficial according to Menz et al and Fong et al:
  • Squatting

  • Bridging

  • Heel raises
  • Leg Press - hold onto both ends of the Theraband while the middle of it is placed under your foot
  • Hip abduction - tie a Theraband into a circle and place them around the ankles

  • Hip flexion - tie a Theraband into a circle and place one end on the bottom of the resting foot and the other end at the top of the active foot

  • Prone knee flexion - tie a Theraband to a table leg and tie the other end around your ankle

  • Knee extension - tie a Theraband around a table leg and tie the other area around your ankle

  • Ankle dorsiflexion using Theraband

  • Shoulder extension using Theraband

  • Scapular retraction using Theraband

It is important to note that these exercises were from only two studies based off a randomized clinical trial and one case study. Also remember that every child is different. Not all exercises may be beneficial for your kiddo! My hopes are that this list of exercises just gives you an idea of something else to try if balance and functional training are not showing significant improvements in your child’s balance and coordination.

Resources:
Fong SM, Guo X, et al. (2016) Functional Movement-Power Training for children with Developmental Coordination Disorder: a randomized controlled trial. Medicine, 95(16).
Menz, SM, Hatten, K, Grant-Beuttler, M. (2013). Strength training for a child with suspected developmental coordination disorder. Pediatric Physical Therapy, 25(2), 214-223.

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