Compressional Weakness and Weight Bearing
The effective elements of weight bearing precede any active movement. If weight bearing in a static position is impossible for a child, then it is obvious that any attempt at active movement will achieve a limited outcome.
How do we define weight bearing?
Weight bearing is defined as the ability of the bodily structure to hold or to bear its own weight in any given position. Yet, for individuals with compressional weakness, basic weight bearing is insufficient or impossible.
The gross motor development of the healthy child progresses from the horizontal position – lying where he or she is placed on the front or on the back – to the upright standing position and to walking. During this sequential development, the child begins to support and to carry his own weight from within and the necessity for having a large surface, or several points of contact between his own body and the floor diminishes.
This development characterized by the diminishing contact with the floor, is on the one hand a cognitive learning process, but on the other hand the result of internal structural ripening.
To illustrate this process we have added drawings and photos from Dr. Emmi Pikler’s and Anna Tardos book Lasst mir Zeit (translated: "Let Me Take My Time"). This book describes the independent motor development of healthy children.
One can see how the contact to the ground diminishes as the child gradually comes to the upright position.
Here we see the child lying on the back – large surface contact
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Zeichnungen: Klara Pap, Emmi Pikler Lasst mir Zeit, S.193 |
In elbow stance on the side
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Zeichnungen: Klara Pap, Emmi Pikler Lasst mir Zeit, S.197 |
In prone position
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Zeichnungen: Klara Pap, Emmi Pikler Lasst mir Zeit, S.200 |
Rolling
| Zeichnungen: Emmi Pikler Lasst mir Zeit |
Crawling
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Zeichnungen: Klara Pap, Emmi Pikler Lasst mir Zeit, S.211 |
Bear stance
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Zeichnungen: Klara Pap, Emmi Pikler Lasst mir Zeit, S.215 |
Standing
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Zeichnungen: Klara Pap, Emmi Pikler Lasst mir Zeit, S.216 |
In the photo below a child who is still in the “rolling” stage can be seen to practically lift himself off of the surface - even from this position.
| Foto: Marian Reismann |
In the following photos one can see how the need for bodily support from the ground diminishes as the ability to redistribute weight and bear weight from within the internal structures is developed.
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Foto: Marian Reismann | Foto: Marian Reismann |
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above Foto: Marian Reismann |
This is a continuous dynamic process that reaches a certain culmination when the child learns to walk, to run and to jump. But continuous improvement of the control over the movement system of the body can occur throughout life and is generally termed the acquirement of new skills.
Children who exhibit compressional weakness have exceeding difficulties with all of the elementary weight bearing stages.
Internal weakness can make even basic weight bearing on the thorax in prone position
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or the partially upright position – sitting
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or greater challenges such as high kneeling
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impossible tasks to achieve.
If the child is unable to maintain a given static position then progressing from one position to the next through a process of dynamic movement cannot be attained.
What happens when we try to put a child with compressional weaknesses in weight bearing positions?
The answer to this question reveals fundamental ABR principles.
Normal training for children with limitations in their musculo-skeletal system involves some type of repeated attempts at weight bearing. One tries to “teach” the special needs child to:
Stay on the side
Stay on the front
To sit
To hold the head upright
Especially for the level III, IV and V children, these attempts – despite all of the extra motivational efforts that are generally executed – usually have short lived results. The child remains in some wished for position for a few seconds, and then succumbs to his internal weaknesses – he flops again.
What has happened?
For a healthy person most of the weight bearing process is a “muscle free” activity. Instead of utilizing our muscles for activities such as sitting - or resting on the elbows, the combined buoyancy of the entire internal volume of visceral fascia serves to support us in any given position. The internal network of membranes and tissues filled with fluids and gases has an exceedingly strong hydrostatic strength. The strength of this system supports us in weight bearing, freeing up our muscles for the work of coordinating dynamic movements.
The skeletal muscles are very expensive structures for the body. They are highly specialized tissues that burn a great deal of metabolic energy and produce an equally high amount of metabolic waste. The body needs to find a way to rid itself of this waste. Not only do muscles tire quickly, but when they work overtime, they deteriorate.
When we try repeatedly to place the child with compressional weakness in weight bearing positions, we force the muscles to perform activities for which they are not made for. The, muscles, being originally designed for dynamic movement, can hold the child for short movements in a given position and then they soon tire and give out. If we induce the child repeatedly to take certain positions, the quality of the already shortened muscles deteriorates even further and they become more and more like tendons – i.e. become more spastic.
Therefore ABR seeks to help the child to overcome compressional weakness and achieve an improved weight bearing as the necessary requirements for improved functional performance.
How ABR reaches this goal, can be found under ABR Technique.