What's wrong with W-sitting?

W-sitting is when a child sits on their bottom with their knees bent and feet positioned outside of their hips. In this position child sits on his bottom and knees are bent, feet tucked under and legs are splayed out to side, what looks a “W”.

In this position child’s base of support (BOS) is wider and his centre of gravity (COG), is lower allowing for increased stability through the pelvis and trunk.

Children find this position convenient for play as they do not have to work on maintaining their balance while concentrating on the game or task in hand.

                     Why is W-sitting problematic for children?

While sitting in this position, children cannot achieve active trunk rotation, and cannot shift their weight over each side. Weight shifting and trunk balancing are important aspects for developing core strength and midline crossing skills (essential for handwriting and hand dominance).

Due to affected midline crossing development, bilateral coordination is also affected, the skill essential for doing two handed activities such as skipping, throwing, catching, kicking, buttoning, doing laces or ties.

                               Consequences of W-Sitting

•    Hips and leg muscles to be shortened and tight.

•    Back or pelvic pain

•    Pigeon toed walking or in-toeing (feet turned in while walking)

•    Flat foot

•    Difficulties performing two-handed activities (e.g., buttoning)

•    Poor hand preference or dominance (e.g., handwriting difficulties)

•    Lack of cross body movements (e.g., throwing, catching)

•    Limited trunk movements (e.g., copying from the whiteboard)

•    Likelihood of hip dislocation (if child has hip problems)

                             Strategies to prevent/improve W-sitting

PRONE SITTING

Children do W-sitting when core strength is an issue. Reduced core strength causes poor posture and over-compensation of other muscle groups.

The following strategies can be helpful minimising W-sitting posture: -

1.Encourage a child to sit in different ways, such as: -

•  Prone position (on stomach and forearms)

•    Criss-Cross Sitting (Crossed Leg Sitting)

•    Side Sitting (alternate sides)

•    Long Sitting (feet straight out front)

CRISS-CROSS SITTING

2.Ask the child to get up and bring something from next room such as cushion, favourite toy or game.

3.Remind the child to “fix their legs” whenever you see them sit in a W position.

SIDE SITTING

4.Alternate ways to sit such as a beanbag, low chair, pillow, to sit on, or suggest him to lie on his tummy.

5.Exercises such as stomach crunches, the plank can be beneficial in improving core strength.

6. Anticipate and catch it before the child tries to sit in W-sitting.

LONG SITTING

7.Offer the child a small chair or stool as an alternative to sitting on the floor.

We should expect young children to move in and out of positions when sitting on the floor - that is natural and the way kids stay alert and learn to manage their bodies in space. Just as one size does NOT fit all, one sitting position will never accommodate the sitting needs of all children. Young children learn best when their bodies are safely and comfortably positioned!

References:

American Journal of Occupational Therapy: http://ajot.aota.org/

Paediatric Services: http://www.pediatricservices.com/parents/pc-22.html

The Pathways. Org: https://pathways.org/

Image source: Google images

Body awareness: Why is it so important?

Poor Body Awareness = Poor Motor Planning =Poor Gross & Fine Motor Skills

Body awareness is about understanding where our bodies are in space, as well as where and how we move them.
It is the internal awareness sense of the body, and its function is to make our body aware about, where it is, in relation to the environment.Body awareness is developed through proprioception sense and kinaesthesia. 

Moreover, it can be explained as knowledge of the boundaries of the body and its movements within space.For instance, it lets us know where is our right hand or left leg and what is the relationship between the two.

This develops since 9^th -12^th months in an embryo and completely develop by the time child is 5 years. Infants learn about their bodies and its relationship to surrounding on them during the normal course of development. Exploring, and manipulating objects is a process of developing body scheme. As they grow they learn about distances and sizes.

How does body awareness act on our body?

Our brain has body “maps” which carry information about every body part and its relationship to each other.

These maps support person to realise how his own body feels like when vision is blocked. Body awareness tells about the "doing sense" of the body without looking at different body parts. For example, scratching our back when it itches or wiping face when it has dirt on it. There are so many actions which are taken as for granted by us however our brain and body works phenomenally to process sensory information from the brain to various sensory systems. 

In above face wiping example, the brain sends messages to elbow so that specific muscles can contract and relax to bend elbow joint and hand can go up to face to clean the dirt. Related hand muscles also contract and relax.

We are able to put the lid on water bottle or pen without looking at it, control tap faucet while talking to someone, are some of the examples of body's "doing sense" while we are busy focusing on primary tasks. 

Our body's ability to change its posture unconsciously, when muscles of the particular group are fatigued in one position is a strong example body awareness.This process happens automatically while are sleeping or awake. 

Our proprioception receptors update these body “maps” (precepts) which helps the

brain in sending messages to needed body part for further actions. 

In children with the poor body awareness, the relationship between body actions and these “maps” do not work well. Due to poor functioning of body percept, the brain is not able to plan actions leading to poor motor planning. This is the reason children with Dyspraxia are disorganised, forgetful and clumsy. Their brain is not able to do motor planning causing them not being able to judge speed, weight rate, the direction of any object or task. 

Moreover, these maps also contain memories related to environment such as gravity. For example, while sitting on swing we know our upper body is on swing however legs are swinging. 

Another common example is while swimming whether our body is in deep or shallow water. In both the situations, body maps help the brain to plan the movements according to the state of the body.

Signs and Symptoms: 

1) Might bump into other people or stand in very close proximity to other people when interacting with them.

2) May have organisational difficulties in the classroom as well as home.

3) The concept of right and left, up-down, under-over, in-out is confusing for children to understand and learn therefore following directions is a difficult task.

4) For children with poor body awareness subjects like mathematics, physics are difficult to understand. Geometry, shapes, volumes, calculations are hard to understand.

5) Copying from the blackboard is a struggle for them due to midline crossing difficulties.

6) There may be difficulty while playing football or cricket. Judging distance and speed of ball can be an issue.

7) Body Awareness also interferes with learning since child’s brain is not able to do motor planning resulting in poor control over tasks. e.g. self-care. Usually, these children also have laterality and coordination difficulties. They can be ambidextrous.

Tips for improving Body Awareness

1) Visual Feedback: Learning new task is challenging for them, especially, gross motor skills such as jumping jacks, synchronised opposite sideways or same side jumping, or skipping. Most of the gross motor tasks require proprioceptive input, received through muscle and joint receptors, however, due to poor proprioceptive sensory processing, the child faces  difficulties in performing new dance steps, actions or exercises. These children should be given regular visual feedback through a mirror which can support them seeing what they are doing in order to learn and manipulate their body in the correct manner.Moreover, repetition of novel tasks is important.


2) Heavy Work Activites (Proprioceptive Input): Pushing and pulling heavy objects such as barrels, cart, large bean bags, pile of chairs or pushing another child on swing will provide muscles and joint receptors information about position of body parts (leg, arms, head and trunk) in space and in relationship with other objects.These activities provide deep pressure to muscles, joints, ligaments and key points (shoulder, pelvis and hips) to the tactile defensive child.Moreover, living movement break will support the child to concentrate better in studies such as sending him to the office to handover papers or asking him to distribute assignments in the classroom.


Hippotherapy: This therapy is used under the supervision of an occupational therapist. This process involves riding a horse with simultaneous involvement of a variety of therapeutic activities. Riding a horse provides various kinds of sensory information including, tactile, visual, proprioceptive and vestibular.Maintaining positions, staying alerted while riding, facilitates postural control and balance. This therapy helps in developing balance, core body strength (changing different positions, supine, prone, quadruped), as well as midline crossing, weight shifting and upper and lower body control. Resource


4) Obstacle courses: Make obstacle courses and ask the child to complete them in different positions (supine, prone, kneeling) while sitting on a scooter board.Engaging children into creating obstacle courses will support Dyspraxic children in developing ideation, planning and execution skills. Moreover, moving on the swing, through the tunnel, over the bench will help in developing spatial awareness concepts in relationship to the environment.


3) Animal Walks: Walking like a bear, the elephant, a duck or a seal will improve body sense.It will help in developing body's internal awareness. Additionally, animal walks provide proprioceptive-vestibular inputs activating sensory processing systems. Along with this, core body strengthening, balance, postural control of upper and lower body develops supporting the child to perform better in gross motor and fine motor skills.


5) Involve in home chores: Involving the child in kitchen activities such as asking him to give you different items needed will help to develop under-over, left-right concept. You may ask him to put the cake for baking in the lowermost shelf of the oven or put in dishes within the dishwasher. Doing work like car washing, vacuuming, cleaning, mopping will give proprioceptive feedback. Tasks like preparing to dine  (putting cutlery on the table, with correct position of utilities) will help in developing left, right, top, bottom concepts.


6) Target Games: Activities involving trunk rotation and both sides of the body should be incorporated such as throwing bean bags while picking from left and throwing them to the right side. Throwing them in hoops, buckets or bags can be done for proprioceptive input.Moreover, throwing balls, rings, darts at targets from various distances can be helpful to improve visual motor skills.Activities, like tossing balls and playing bat ball, will improve eye-hand coordination too.


7) Body Paint: Ask the child to paint his particular body parts such as right-hand or left-hand index finger. This can be a great fun activity for sensory seeking seekers and children with tactile discrimination difficulties. Drawing different shapes, letters and numbers on hand, leg and back will help in improving body awareness as well as self-concept.

8) Hiding Objects Games: Hide different objects in the room and ask the child to find them. Two things can be hidden together such as lock and key.Throwing balls ring darts, at the target. 


9) Confined Space: Children should be given small, organised spaces to work in as they feel secure and confident in confined spaces compared to large space areas.

10) Handwriting difficulties: This is a concern for children with poor body awareness. To know more, read the article.  

Proprioception:The Position Sense

Apart from five basic senses (vision, auditory, touch, olfactory and gustatory), we have three more hidden senses called as Proprioception, Interoception (recently discovered) and Vestibular Sense. 
The following discussion is about our proprioceptive sense and how it works in typical and atypical children.Awareness about one’s own body position happens due to this sixth sense is known as proprioception.

Proprioception is also called as “position sense” since it tells us, where we are we sitting, standing, lying or walking in relation to any object or surrounding. The word Proprioception comes from Latin word, “proprius” meaning “one’s own”. This sense supports a child to regulate their responsiveness to sensations. 

This sensation occurs when our muscles move or work.Consequences of poor proprioceptive functioning are the poor academic achievement, lack of self-care skills, difficulties in self-regulating emotions, attention and stress.

To know more about proprioception, let’s consider a simple example.

Suppose, you are blindfolded and asked to ascend and descend stairs you have never seen. Now your eyes do not have any experience or measurement of these stairs.The depth of every stair is unknown that can actually help your body to go up and down without falling or tripping. It is obvious that your balance will lose while doing this activity.

So what role does body play to protect you?

To be careful and protect you from falling, your hands will try to search and hold railing or any other external support. 
Your dominant foot will step forward slowly and attempt to judge how much is the height of the first stair so that you can climb the second step easily, with a swift movement. 
As you will climb further, your body will be confident enough to take steps confidently and instantaneously with controlled balance. 
Moreover, descending stairs will be easier for you now since the body can easily judge and feet can measure the steepness of staircase.

So how does this all happen?

This all happens because of our Proprioceptive sense! It is a hidden sense, that carries sensory information telling us about our own body’s movements and positions. It allows the brain to understand body's position, posture and place in relation to surroundings and other individuals.
Whether we are standing under the tree, over the bed, in the sand or on the top of the cliff, this unconscious awareness happens due to this sense.

Being able to walk in the dark room without losing balance control, typing without looking at the keyboard, driving a car without looking at brakes and other components, or performing ballet will not be possible without this sense.

This sense is the foundation for our body postures and actions. It makes us feel where are we sitting standing or lying in relation to our surrounding.

Consider, while sitting on the chair, how does our body know, where it has to sit? How much our knees need to bend according to chair’s height? Is chair comfortable or not?This all work is done by Proprioceptive sense.

It informs body about direction, velocity and force needed by one’s body

for doing any task. Finely graded movements, body coordination and body scheme are some of the areas that are affected due to lack of proprioception.Heavy work activities are calming for these children.

The functions of proprioception are to increase body awareness and contribute to motor control and motor planning (praxis). Children with poor proprioceptive sense have poor body awareness which causes difficulties in carrying out a gross motor and fine motor activities such as playing football, get dressed, zipping a jacket, buttoning a shirt or doing handwriting tasks.

Characteristics of poor prop (short form used by OTs) sense can be easily observed within the classroom or home setting among SPD (Sensory Processing Disorder) children such as, they would slap feet on ground while walking, or hold pencils too tightly to make a clear impression, or that the points break, there can be erasure holes on sheet producing messy work.

Unlike typical children, atypically developing children are not able to judge space around themselves. They might bump into other people or objects.  They may enter into other person’s intra-personal space which is considered weird and uncomfortable by most of the people. Such a child might be considered strange however reason behind this action is not his intentional bad behaviour but the lack of body awareness. 

Credit

People's strange reactions cause anger,depression and emotional liability in the child since he is not doing all this deliberately or intentionally but indirectly trapped by his own body.

The perception of judging ordinary tasks such as the weight of a coffee mug, holding a pencil efficiently in order to write, poor balance while standing, tripping while walking, difficulties in planning actions are some of the examples of poor proprioception. 

Moreover, children with poor proprioception usually slip from their chairs while sitting in classrooms or other settings. These children have affected body positions and difficulties in organising their sensations therefore falling is usual. Providing Wobble cushion or wobble wedge provides combined tactile-proprioceptive input helping the child to sit appropriately. Moreover, it helps in preventing slouch and increases attention on the task. These resources can be purchased from different websites such as Amazon  at cheaper prices.

Other weighted items such as weighted vests or weighted lap pad provide calming effect on the child. They support child to stay in place and focus well

credit

on given task.

Other classroom activities to can be Brain Gym and yoga exercises to improve child’s focus in academics. Mediation has very calming and long lasting effect.

Sensory Diet designed by Occupational Therapist is essential to be incorporated in child’s schedule specifically to meet the needs of the individual's own nervous system.  Its purpose is to help the person become more focused, adaptable and skilful.  It is the combination of alerting and calming activities that helps in organising child’s behaviour and needs.

Home activities can include jumping on a trampoline, riding scooter or bicycle, participation in running, jumping, hopping activities, obstacle courses, sand play, hopscotch play, gymnastics, horse riding.

                                                                   

Credit