I spend a fair amount of time teaching hypermobile people of all ages how their sitting position affects their ability to write, keyboard, or do just about anything. And of course, we want hypermobile people to have a stronger core while sitting. But their chair can help them. It is not a crutch.
Yup. Use the chair. Correctly.
Understanding how to use the back support of the chair correctly is fairly simple, but really hard for hypermobile people to do. The reason it is so challenging has very little to do with being obstinate, forgetful, or in denial.
It has a lot to do with sensory processing and old habits (even for kids).
Hypermobility reduces sensory feedback from joints and muscles. This makes it harder to pay attention to posture while sitting. It is the equivalent of writing while wearing mittens.
Less sensory feedback frequently results in unconscious strategies to boost feedback. Wrapping legs around the chair’s legs. Leaning forward and resting the head on the palms. Folding one leg under the body while sitting. They do increase proprioception. They also put the spine out of alignment and reduce the use of core stabilizers.
From the moment a hypermobile person is born, they come up with compensatory strategies. Leaning. Twisting. Slumping. Getting up for no good reason, over and over. This means habits are formed before they know how to walk. By the time they get to school, they are simply “The way I am”. And hard to break.
If you or your child are hypermobile, there are a few hacks that work:
Practice. Even for a few minutes.
Write a note on the table or screen in front of you.
Make sure the chair is a good one.
Accept that fatigue destroys the best intentions. Allow movement breaks.
Get rid of the old idea that depending on the chair indicates poor postural control. Use the chair to perform the task. You can exercise later. This is not the time to exercise.
With pediatric occupational therapy going on at home using parents as surrogate therapists, it isn’t helpful to ask a parent to do too much repositioning of children with low tone. First of all, kids don’t like it. Second, kids really don’t like it.
I have never met a child that enjoys therapeutic handling, no matter how skilled I am, and I don’t think I ever will. They don’t know why we are placing their hands or legs somewhere, and they tend not to like to be told what to do and how to do it. The best you can hope for at times is that they tolerate it and learn that therapists are going to be helping them do what they want to do For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance.
Leaving a child in an awkward and unstable position isn’t the right choice either. They are going to struggle more and fail more when out of alignment and unsteady. If you know this is going to happen, you can’t let them stay that way because you also know that this will blow back in your face in the form of frustration, short attention span, and children developing a sense that whatever they are doing or whomever they are doing it with is a drag. A real drag.
So how can you improve the posture of a child with low tone without forcing them physically into a better position?
Respect fatigue. A mom told me today that her daughter’s telehealth PT sessions end in tears at least half the time due to exhaustion. That is simply unacceptable. Great therapists don’t leave kids that upset for parents to deal with after the session. They taper the session demands, and end on a good note. There are always other positions to play in or other things to do when a child has fatigued postural muscles. You know they are fried because if you present them with a fun activity and they simply cannot manage it, you aren’t being played. They are tired.