Good Posture: Is it Vestibular or Proprioceptive?

These two senses that baffle parents when kids with sensory processing issues struggle with posture and efficient, safe movement can often be confused. They are not the same, but they can both affect postural control.  Here is my attempt to make things a bit clearer on this foggy morning in NY.

Proprioception (and it’s close companion kinesthesia) are the senses that provide the brain with information about where our body parts are at rest and while moving, respectively.  That means that you can close your eyes (try it after reading this sentence) and perceive what position your fingers are in without looking.  You can tell how much pressure you are placing on an object and even how far apart your hands are from each other.  This amazing skill is accomplished by the brain’s interpretation of information it receives from muscle and joint receptors.  These little organs tell the brain about how stretched the muscles are or how firmly a joint is closed.  That is proprioception at work.

When your body moves, even a little, even slowly, muscle  and joint receptors transmit messages about which and how many muscle fibers are firing and how quickly and in what direction the joint is changing position.  Reach out to the side while looking at this screen.  You know how high your hand is at all times while moving, without looking over there.  That is kinesthesia.

A little side note:  motor planning combines the ability to create a mostly automatic mental plan of the action you want to execute (praxis), and then actually doing it with a well-funcitoning proprioceptive and vestibular system.  Thinking “I am going to reach out to the side”, then accomplishing this smoothly is motor planning.  Wow!

Simply amazing!  I never tire of anatomy and neurology.  How this system works effortlessly is nothing less than a miracle.  Knowing what to do when it does not is…. therapy.

In my early career in hospitals, I had the opportunity to work with a woman who had a stroke that damaged her proprioceptive pathways in her spinal cord but left her mentally able and without any paralysis.  No vestibular damage.  This is unusual, and for her, it was just as crippling as having a limp leg and arm.  Without looking, she could not perceive when her legs were bent or straight, whether she was crushing an orange or dropping it.  She would need constant supervision and support for the rest of her days, even with good therapy.

Does this sound a tiny bit like a child who breaks his crayon without any intention of doing so?  Crushes his cookie in his hand and then cries?  Slides off the chair and has no answer when you ask why that happened?

Not being able to sense where your body is and how it is moving while you are sitting at the dinner table is a sign that your proprioceptive processing is off.

Your vestibular system is your brain’s ability to use information from your inner ear, your eyes and your hearing to tell when and how your head is out of a centered and vertical position and where you are in space.  It is a joy to see babies tip upside down in standing, watch children twirl and fall down in laughter, and see ice skaters spin.  Being able to find that center, enjoy the feeling of being off-center, then return to vertical is what they are enjoying.

One of my colleagues is dealing with vestibular dysfunction after a head injury.  She is able to sit and eat her dinner without sliding off the chair, but don’t ask her to pick things up from the floor while tilting her head down to see the object.  She will get very dizzy.  Her vestibular system is off, but her proprioceptive system is just fine.

Kids that constantly seek spinning, get upset or disorganized after even the smallest move out of a centered position, or throw up after movement are having serious problems with vestibular processing.  Interestingly, the unsung heroes of the vestibular systems are the auditory and the visual systems.  They are big components of good processing.  Kids that are constantly distracted by background sounds, fall apart in large spaces or need to see the whole room before they can settle down calmly are probably experiencing vestibular processing problems.

Sound therapies for vestibular processing can make a huge difference, as can addressing ocular control (the movement of the eyes).  The Astronaut Training protocol is the best program that I have seen for intense vestibular treatment using all three components of vestibular functioning, but it is tough to administer correctly for very young children.  Not impossible, but much harder than for a cooperative school-age child.

This post was way longer than I expected it to be, but I kept writing because understanding how sensory processing works for practical issues like sitting for school or at the dinner table is really interesting to me.  I hope it is interesting to you as well!


Don’t live in the NYC metro area but want more information?

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By Cathy Collyer

I am a licensed occupational therapist, licensed massage therapist, and certified CBT-i sleep coach in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment. It has been a joy to help people of all ages improve their ability to grow and thrive! Occupational therapists are focused on enhancing a client's functioning in everyday life. We are practical healthcare providers, interested in teaching, adapting actions and environments, and building a client's useful skills for living their best life, regardless of their challenges. I am the author of five books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training the Autistic Child". I lecture on many subjects, including sleep, trauma, and development. Contact me to learn more about how I can help you achieve YOUR goals!

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