Learning pyramid and posturology: posture as a load-bearing level

Learning pyramid and posturology: posture holds up the upper levels

In the Williams and Shellenberger learning pyramid, posture appears at two levels: postural security at the third, postural adjustment at the fourth. Postural control draws on the foot, the vestibule, vision and proprioception, weighted according to the situation. Posturology, a clinical practice developed in France around these sensors, has a disputed level of evidence.

Hello to you, the movement professional,

4:30 p.m., last hour of class. In the third row, a student has slid down in his chair: pelvis at the edge of the seat, back rounded, head resting in his hand like on a lamp stand. He may be listening. His pen, for its part, hasn't moved in ten minutes.

Set beside it the end of a match. The player who ran upright in the first half has drooping shoulders, hands on his knees at every stoppage, his stance widening. On a restart he arrives late and his pass falls short.

We say both are tired, and that's true. But look at the order in which things give way: on the field, posture often gives up first, the back before the pen, the stance before the pass. The learning pyramid helps read that order, and research on postural control helps verify it.

Posture and learning: where posture sits in the pyramid

Look for the word "posture" in the Taylor and Trott pyramid, taken up by Williams and Shellenberger: you find it twice. At the third level, postural security describes the body's confidence in the face of gravity; Ayres described its flip side in 1979, gravitational insecurity, in the child who experiences every loss of balance as an alarm. The article on sensorimotor development in the pyramid goes through this level box by box. At the fourth, postural adjustment refers to the corrections that keep the body stable while it acts.

Two boxes out of twenty-two: on the diagram, posture looks like one skill among others. In the life of a child or an athlete, it works more like a floor, because writing or listening to an instruction is done from a body that holds. When that floor demands effort, the level above pays the bill. That is our reading, which the pyramid does not demonstrate.

Postural control: the sensors of the foot, the inner ear and the eye

To stand upright, your nervous system constantly looks for the vertical, and for where your body sits relative to it. Fay Horak (2006) distinguishes orientation, which aligns the head and trunk with gravity, the support surface and the visual surround, from balance, which stabilizes the center of mass. To do this, the brain combines somatosensory, vestibular and visual information, with a weight that depends on the task and the context. Horak's postural model has its entry in the glossary, and the distinction between postural control and balance has its own article.

The sole of the foot works like a scale. Anne Kavounoudias, Régine Roll and Jean-Pierre Roll (1998) vibrated the skin under the front or the back of the sole in ten standing people. The whole body leaned, always opposite to the overpressure the vibration simulated. The authors speak of a "dynamometric map" of balance.

Vision stabilizes too: when Paulus, Straube and Brandt (1984) degraded visual acuity, instability increased, and central vision weighed more than the periphery. The vestibule picks up head movements and the direction of gravity, the reference for posture. Proprioception, carried by the proprioceptive sensors of the muscles and tendons, locates the segments relative to one another. To take these senses one by one, go through the sensory foundation of the pyramid.

The right-hand column is our own mapping, which the diagram does not draw.

Sensory weighting: the brain switches its reference sensor

The sensors don't vote equally. Robert Peterka (2002) tilted, in small unpredictable rotations, either the visual surround or the platform under the feet of standing people. The larger the disturbance grew, the more they relied on their vestibular information; people who had lost vestibular function on both sides could not manage. Peterka speaks of sensory reweighting, which our letter on sensory reweighting and performance takes into the field.

You can feel it right away. Standing with feet together, close your eyes: your ankles work harder, your toes search for the floor. That is the principle of the Romberg test. Then step onto a thick foam mat, which blurs the information from the support points, and close your eyes: the inner ear becomes your most reliable reference.

For a coach, a posture that holds on a hard floor, eyes open, at rest, therefore says little about how it holds when one input is blurred. Compare two situations: all inputs reliable, then one input blurred.

Postural control and attention: standing upright has a cost

Back to the student, head in his hand. Holding a posture takes up a share of attention, which according to Horak (2006) depends on the difficulty of the postural task and the person's capacities. The relationship is nothing like a straight line, though. Oliver Huxhold and colleagues (2006) had young and older adults stand, once focused on their balance, once with an easy mental task. With the easy task, the center of pressure moved less in both groups. With more demanding tasks, it moved more in the older adults, with no increase in the young.

The authors propose a U-shaped curve: a little mental load lets posture organize itself, too much load competes with it. Caution all the same: according to Fraizer and Mitra (2008), the results of dual-task studies often diverge, partly because their protocols differ. In children, the article on perceptual-motor development shows that walking demands more attention at younger ages.

For the student, our field hypothesis: when sitting costs him effort, his body looks for passive supports, the backrest, the desk, the hand under the chin, and what he spends on holding himself up is missing for the instruction. The episode on posture and concentration talks about a cognitive tax. Nobody has measured it in the seated student: Huxhold tested standing adults, and the transposition remains to be verified.

Posture and gaze: the body steadies itself to see better

The link works the other way too. In Thomas Stoffregen and colleagues (2000), standing participants fixated a near or a far target, sometimes blank, sometimes covered with text where they counted certain letters. Their sway decreased in front of the near target and during the search in the text. For the authors, the body reduces its sway to make the visual task easier.

Keep this in mind in front of a shooter taking aim or a child copying from the board. The study involves standing adults: it's up to you to watch whether their posture settles when the gaze is doing fine work. The other side of the link, vision that stabilizes, is covered in vision and balance.

Posturology: a clinical field with a disputed level of evidence

In France, the word "posturology" refers mainly to a clinical practice, spread from the work of Jean-Bernard Baron and Pierre-Marie Gagey; the latter co-authored a reference manual with Bernard Weber. It looks at the inputs of the postural system, in particular the foot, the eye and the masticatory system (the jaw and teeth), and proposes acting on them, for example with so-called postural insoles.

Its questions overlap with those of research, and the debate concerns the step from a measurement to a decision. Take the jaw file. In their review, Daniele Manfredini and colleagues (2012) note that posture platforms have not consistently found a link between posture and dental occlusion, probably because of the many compensations of the neuromuscular system. They conclude that no evidence establishes a predictable relationship between the two. For postural insoles, we found no good-quality systematic review establishing their value.

Effects in some people are possible; the link between a sensor, a measurement and a lasting effect remains to be demonstrated. Your most solid position: work on the postural control you can test and retest in the task, without promising to "correct the posture." The episode on the regulation of posture develops this idea.

Observing posture in context: fatigue, dual task, surface

Without a force platform, all you need is a reference movement and conditions that load posture. Start with fatigue. Thierry Paillard's review (2012) reports that short, intense general exercise increases sway beyond the lactate accumulation threshold. Exhausting local exercise disturbs it as soon as it costs 25 to 30% of maximal strength, and a moderate but prolonged effort can be enough. So look at the same movement at the start and at the end of the session, which the article on muscle fatigue and proprioception complements.

This grid is a LabO RNP field reading, with no value as a validated assessment tool.

For the dual task, add a countdown to the movement, by ones and then by threes, since an easy task can improve steadiness. For the surface, go from hard floor to foam, then close your eyes. Change only one condition at a time, otherwise you won't know which one mattered.

Some signals fall outside your role: dizziness, repeated falls, balance that degrades for no apparent reason, a child whose sitting posture weighs on schooling. The assessment then goes back to the physician, who refers to a physiotherapist, an orthoptist, an occupational therapist or a psychomotor therapist.

What posture says about the levels above

Posture runs through the pyramid, from the senses of the second level to the top, where it ends up visible on a classroom chair or at the end of a match. For the overview, go back to the complete learning pyramid.

In Neuro-Postural Reprogramming, we start from this reading: find the condition that makes posture give way, stimulate the input concerned, check with a retest. That leaves the end-of-day student. "Sit up straight" pushes him to think about his posture, which is the condition in which, in Huxhold, standing adults swayed more than with an easy task. Our hypothesis, to be tested in the seated student: this instruction costs him more attention than it frees up.

Look at posture at the moment the task loads it: that is where it shows you the level that carries it.

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Frequently asked questions about the learning pyramid and posturology

What is the link between the learning pyramid and posture?

The Taylor and Trott pyramid, taken up by Williams and Shellenberger, places postural security at the third level and postural adjustment at the fourth. Seeing it as the floor of the higher skills, because we write or listen from a body that holds, remains a practitioners' reading.

Which sensors take part in postural control?

The sole of the foot reports on support, the vestibule of the inner ear on head movements and gravity, vision on the visual surround, proprioception on the position of the segments. Their weight varies: the brain relies more on the vestibule as the surface or the visual surround moves more strongly (Peterka, 2002).

Does a mental task disturb balance?

It depends on its difficulty. In Huxhold and colleagues (2006), an easy mental task reduced sway compared with attention directed at balance, in young and older adults alike. More demanding tasks increased it in the older adults only, hence a U-shaped relationship between mental load and postural control.

Is posturology scientifically validated?

Its level of evidence is disputed. Clinical posturology, developed in France around Baron and Gagey, acts on inputs such as the foot, the eye or the jaw. For the jaw, the review by Manfredini and colleagues (2012) finds no evidence of a predictable relationship between dental occlusion and posture. Postural control itself can be measured and studied on solid ground.

How do you observe an athlete's posture in the field?

By loading it, then comparing. Observe the same movement at the start and the end of the session, with and without an instruction to remember, on hard floor then on foam, eyes open then closed. The condition in which the movement falls apart guides the work, to be confirmed with a retest.

A student slumps in his chair every day, or an athlete loses balance for no clear reason: who should you talk to?

The physician who follows the person, who will refer, depending on the case, to a physiotherapist, an orthoptist, an occupational therapist or a psychomotor therapist. The movement professional observes, describes the conditions and passes it on. LabO RNP is neither medical nor paramedical, and is a complement to a care pathway, never a substitute for it.

Sources

Taylor K., Trott M. (1991). Pyramid of Learning, diagram reproduced in Williams M.S., Shellenberger S. (1996). How Does Your Engine Run? A Leader's Guide to the Alert Program for Self-Regulation. Albuquerque: TherapyWorks.

Ayres A.J. (1979). Sensory Integration and the Child. Los Angeles: Western Psychological Services.

Horak F.B. (2006). Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age and Ageing, 35(suppl. 2), ii7-ii11.

Kavounoudias A., Roll R., Roll J.-P. (1998). The plantar sole is a "dynamometric map" for human balance control. NeuroReport, 9(14), 3247-3252.

Paulus W.M., Straube A., Brandt T. (1984). Visual stabilization of posture. Physiological stimulus characteristics and clinical aspects. Brain, 107(4), 1143-1163.

Peterka R.J. (2002). Sensorimotor integration in human postural control. Journal of Neurophysiology, 88(3), 1097-1118.

Huxhold O., Li S.-C., Schmiedek F., Lindenberger U. (2006). Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain Research Bulletin, 69(3), 294-305.

Fraizer E.V., Mitra S. (2008). Methodological and interpretive issues in posture-cognition dual-tasking in upright stance. Gait and Posture, 27(2), 271-279.

Stoffregen T.A., Pagulayan R.J., Bardy B.G., Hettinger L.J. (2000). Modulating postural control to facilitate visual performance. Human Movement Science, 19(2), 203-220.

Gagey P.-M., Weber B. (1999). Posturologie : régulation et dérèglements de la station debout (2nd ed.). Paris: Masson.

Manfredini D., Castroflorio T., Perinetti G., Guarda-Nardini L. (2012). Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading for. Journal of Oral Rehabilitation, 39(6), 463-471.

Paillard T. (2012). Effects of general and local fatigue on postural control: a review. Neuroscience and Biobehavioral Reviews, 36(1), 162-176.

By the LabO RNP team