Participants
The study group comprised 8 children and
adolescents, seven boys and one girl, who had all
completed the Retraining for Balance therapeutic
program (see the “Design” section) at the move-
ment school The Vestibularis Institute. The mean
age of the children was 8.75 years (SD = 3.77,
age range = 5 to 17) at the start, and the training
period was 38.88 months on average (SD =
15.73). The participants were from the middle
areas of Sweden, and all had been referred by
one or both parents. The number of visits to
complete the training program was 16.63 on av-
erage (SD = 3.66). Four of the children exhibited
delayed language development, as reported by
their parents, a reliable marker of a need for sen-
sorimotor training [48-50]. One child had been
diagnosed as having attention-deficit hyperactivi-
ty disorder (ADHD).
The parents provided the reason for the re-
ferral to the training, and four of them reported
“concentration problems”, two indicated “motor
difficulties, clumsiness”, one “reading difficul-
ties”, and one “learning difficulties”. Following
the training program five of the parents reported
that the children showed a “marked, positive
change”, while three of the parents indicated that
the children showed “some positive change”.
The children were also given a comprehensive
sensorimotor test, Retraining for Balance-
Physiological Test, RB-P [3,4], on which their
deviation from appropriate age levels on each
subtest was noted on a quantitative, 5-point scale
ranging from 0 to 4. Similar 5-point scales were
used by McPhillips and Sheehy [51] and by
Goddard Blythe [52]. The test is used to measure
the sensorimotor maturity of the participants with
regard to primary reflexes, postural reactions,
gross motor milestones, and vestibular ability.
The subtest was created on the basis of research
and documentation of the motor development of
normal and developmentally delayed children
[14, 18, 22, 53] and consists of 41 different tests
in the latest version [55]. Several of the tests
were selected from the manual Towards Deve-
lopmental Re-Education [56] and others came
from other sources or were developed at Vestibu-
laris [55,57]. The average score gained by the
eight children on the RB-P – where a lower score
is an indication of better performance – was
83.58 (SD = 29.35) at the start of training and
9.67 (SD = 15.04) upon completion. A Wilcoxon
Signed Ranks Test indicated that the difference
was significant (Z = -2.52, p = 0.012) indicating
an enhanced sensorimotor ability. For more spe-
cific information on participants see Table 1
Table 1 Retraining for Balance: Summary
Child Age
Gender Length
Visits
1
17
Boy
20
10
Журнал проблем эволюции открытых систем
Вып. 12, Т.1, 2010 72
2
10
Boy
21
13
3
5
Boy
34
17
4
7
Girl
69
17
5
6
Boy
44
20
6
7
Boy
47
21
7
10
Boy
34
16
8
8
Boy
42
19
Table 1a Retraining for Balance: Summary
Child Problem with
RB-P in RB-P out
1
Dyslexiy
39.62
0.00
2
Learning
61.04
2.31
3
Concentration 105.21 45.19
4
Motor
120.77 12.46
5
Concentration 86.17
0.00
6
Concentration 93.90
7.45
7
Concentration 52.56
1.54
8
Motor
109.34 8.43
Design
The participants completed the training
program Retraining for Balance – Methods (RB-
M) [3,4]. The method consists of seven parts. For
more information see section below “Retraining
for Balance”. The training was carried out at
home under the guidance of the parents. The
treatment period was close to three years on av-
erage, and the participants did the exercises for
about 15 minutes per day. Throughout the train-
ing period progress was assessed at visits to The
Vestibularis Institute at 8-week intervals. At each
visit relevant sensory and motor abilities were
assessed and the participants showed how the
training was conducted at home. Thereafter a
new training program was introduced. Each time
the children and their parents reported on the
results of the training and meticulous notes were
kept. In this way, records were created with per-
sonal flow charts describing the experiences of
the training of each participant as well as the
perception of the training by the parents.
Retraining for Balance
The Retraining for Balance method [3,4]
consists of seven parts:
(a) Fetal and infant movements Specific
stereotypic movement sequences with the pur-
pose of integrating remaining primary reflexes.
An example of such a movement is “The Knot”
[3,4,58,59]. Each participant lies on his/her back
with the arms stretched out at a 90 degree angle,
blindfolded and with his/her head on a thick pil-
low. The head, arms, and legs are slowly lifted at
the same time, after which the chin is brought
toward the chest, the arms are crossed over the
chest, and the legs are crossed in the air. Then
there is a return to the starting position.
(b) Vestibular stimulation Wave-like mo-
tions and rotations with the purpose of facilitat-
ing the integration of the primary reflexes. An
example of such a movement is “The Rotation”
[3,4,16, 58, 60]. The participant sits on a rotating
chair with his/her legs in the tailor‟s position,
and with his/her arms across the chest. The par-
ticipant is rotated both clockwise and counter-
clockwise at different speeds. A blindfold is used
during most of the training sessions but is re-
moved toward the end of the training [61].
(c) Auditory, perceptual stimulation Audi-
tory perceptual stimulation constitutes a com-
plement to the vestibular training [62-67] for the
purpose of strengthening the dominance of the
right ear [68,69]. The participants listen through
headphones to especially composed (custom
made) music during rest [70] for 10 minutes per
day for an average of 25 weeks. The music was
recorded in such a way that the right ear was sti-
mulated more than the left ear.
(d) Tactile stimulation Exercises with the
purpose of first stimulating the deep tactile sense
of the skin and then stimulating the surface. An
example of how the deep tactile sense of the skin
may be stimulated is “The Clip” [3,4]. The par-
ticipant lies on his/her back in his/her bed and
the parent squeezes one body part at a time and
mentions its name. The surface tactile sense is
stimulated through light brushes or through light
massage.
(e) Gross motor basic movements/ miles-
tones An example of such a movement is rolling
[71]. The participant lies on his/her back on the
floor with his/her arms stretched above. The roll-
ing then takes place through head lifts and a
shifting of weight.
Журнал проблем эволюции открытых систем
73 Вып. 12, Т.1, 2010
(f) Sports-related gross motor exercises
Exercises at a functional level, that is, standing in
an upright posture. Correctly performed exercis-
es require a motor level of development toward
increased mobility of the wrists and ankles and
stability of the stretching patterns of the body.
An example of such a movement is using a skip-
ping rope.
(g) Complementary play exercises Games
with the purpose of either preparing the partici-
pant for one of the chief exercises of the method
or bridging some of the main movements. An
example of such a movement is “Wrestling in
prone position” [3,4]. The participant and a par-
ent lie across from one another on the floor. They
grasp each other‟s hands and wrestle.
Procedure
In a previous study [8], in which a total of
232 children and adolescents received sensori-
motor training in accordance with the method
Retraining for Balance, positive sensorimotor
(physical) and psychological effects were shown.
In all cases the parents of the clients allowed The
Vestibularis Institute to keep the records and
other documents, thereby consenting to future
evaluations and publications. In order to gain a
more thorough understanding of the effective
mechanisms of the treatment, the current qualita-
tive study was conducted by examining a sample
of the participants. It was done by randomly se-
lecting eight cases from the 232 children. The
empirical data consisted of the records contain-
ing the flow charts and the notes from each re-
turn visit. Given that the children sometimes
found it difficult to verbalize their experiences,
the parents‟ reports were of significance. In tradi-
tional phenomenological methodology the expe-
riences of the clients themselves constitute the
basis. In the current study experiences in the
third person are thus also included. Dennett
[72,73] referred to that procedure as hetero-
phenomenology. Gallagher [74] argued that there
is no difference between third person reports and
phenomenology in a traditional sense.
Processing the Data
The Empirical Phenomenological Psycho-
logical Method (EPP-method) devised by Gun-
nar Karlsson [75] was used in processing the da-
ta. The method consists of a multi-stage analysis,
including techniques for dividing texts into
smaller so-called “meaning units” (MU). This
division is not based on grammatical rules, but
entirely on content which the researcher discov-
ers and where there is a suitable shift of meaning.
Thereafter the units are transformed so that the
psychological and contextual implications are
stressed making it possible to analyze the units
when dealt with outside their original context.
The analysis yielded 1,019 transformed meaning
units that in turn generated 29 categories. Each
category illustrated a special perspective of the
phenomena studied and was described in a syn-
opsis. To control for the reliability of the results
of the study, the Norlander Credibility Test
(NCT), designed for phenomenological analysis,
was used [76-78]. Two assessors then had the
task of independently assigning 50 transformed
MUs to 10 of the categories. The assessment of
one of the assessors corresponded to 84%, while
that of the other assessor reached 82%, yielding a
mean of 83%. An additional NCT was done with
two other independent assessors given the same
data but with the instruction to place five MUs
into each synopsis. The outcome was 80% for
one of them and 88% for the other person, yield-
ing a mean of 84%. Both of the results are in line
with previously published results [76-]. Finally,
the material was transformed from “situated
structures” into general themes or typological
structures. This was done through a procedure
whereby the three authors independently orga-
nized the synopses into general themes, then
jointly compared their solutions (which were
noticeably similar), and finally agreed on the
themes.
Results and Discussion
As the analyses proceeded three themes
emerged, each of which consisted of several cat-
egories: (a) The introduction of various sensori-
Журнал проблем эволюции открытых систем
Вып. 12, Т.1, 2010 74
motor exercises, (b) Regressions in terms of a
return to earlier behavior, (c) Transformations in
terms of positive development and change. The
three themes emerged regularly throughout the
entire study, and together they formed what is
here called the kinesthetic-vestibular develop-
mental model (see Figure 1).
The introductions are marked as points on
the developmental curve and represent the new
exercises provided at each return visit to the In-
stitute. In the current study it was not possible to
tell in advance how much time the client needed
to fulfill the goal of training. Some needed long-
er to inhibit the primary reflexes while others
matured more quickly. In accordance with the
average return frequency, every eighth week, the
model shows 16 introductions. The sensorimotor
exercises push the process forward and create
recurrent regressions (negative phases of devel-
opment), in which three more distinct regressive
periods can be discerned (R1 – R3). The periods
are accompanied by positive phases of develop-
ment where setbacks can be transformed into
successes (T1 – T4). The kinesthetic-vestibular
developmental curve, which was developed in
the present study, is reminiscent of the traditional
learning curve as described by, for example, Ba-
chevalier and Mishkin [80] and Fischer and Rose
[81]. A similar curve was also developed by
McGraw regarding physical development in
prone position [82]. The development of both
cognitive and bodily knowledge occurs in steps
with plateaus as well as periods of setbacks [44].
The process of change assumed to accompany
Retraining for Balance appears to produce acce-
lerated development through regressions, thereby
also improved conditions for learning. The insta-
bility and turbulence of the regressions are illu-
strated as wavy lines. Prigogine [83], Varela
[84], and Ho [85] described the flow similarly. In
order to gain a more thorough understanding of
the mechanisms of the process, each theme will
first be discussed separately.
Thereafter a discussion of the flow as a
whole and an interpretation of the results will
follow.
Figure 1. The participants needed close to 16 visits on average in order to complete the
treatment in accordance with the sensorimotor therapy program Retraining for Balance.
The visits (the introductions) are distributed along the curve above (I1-I16) and indicated
as dots. During the treatment period three regression periods, here illustrated as circles (R1-
R3), and four periods of transformation (T1-T4) were identified.
The Introductions
Starting treatment according to Retraining
for Balance entailed new and regular routines for
both children and parents. They were expected to
jointly spend 15 minutes per day doing various
exercises which at times could be both physically
Ph
ysi
cal
and
p
syc
ho
log
ica
l deve
lop
m
en
t
= Introduction
T = Transformation
R = Regression
R1
R2
R3
I1
I16
T1
T2
T3
T4
Журнал проблем эволюции открытых систем
75 Вып. 12, Т.1, 2010
strenuous and mentally tiring as illustrated by the
quotation: “when the fetal rock was repeated we
immediately noticed that our child changed atti-
tudes and started having peer problems”. At
eight-week intervals the program at The Vestibu-
laris Institute was modified, and children and
parents were given the opportunity to discuss
both successes and setbacks. New exercises were
introduced in accordance with the sensorimotor
maturity of each child as assessed on the tests
[55,57] and in accordance with what the parents
had experienced, in particular regarding the de-
velopment of their child. The analysis of each
individual flow chart indicated that when the
training program was followed, then new exer-
cises could be introduced largely similarly across
clients. The training programs had two major
elements. One was specific vestibular stimulation
in which the client was first rocked in the arms of
the mother and was then rotated on a rotating
chair. The other consisted of stereotypic, vestibu-
lar, and kinesthetic infant movements. In both
cases the children were blindfolded in order to
maximally stimulate the vestibular system. Hav-
ing the courage to shut out the external world
and be left to oneself was a challenge at first but
improved over time. During the first three intro-
ductions training consisted only of rocking in the
arms of the mother. The exercise was perceived
as something positive, but at times difficulties
stretching, general bodily distress, yawning, and
sometimes sweating were apparent. Despite the
difficulties, it was common for the children to
remind their parents and take the initiative to do
the training, suggesting that the children felt the
training was beneficial. At times the children
resisted training. Often the resistance appeared
when the children felt they were doing better, felt
more secure, and felt they did not need further
training. It also occurred during periods of de-
fiance. The children‟s fatigue also increased, re-
sulting in a greater ability to go to sleep at night.
Throughout the process the fatigue sometimes
increased but at other times disappeared, and
more energy was evident, “previously my child
did not feel like doing anything at all. Now he
wants to do everything.”
Regressions
During the training period physical and
psychological regressions appeared continuously,
but the analysis defined three periods of particu-
lar importance. Those periods were in the begin-
ning (R1), in the middle (R2), and at the end of
training (R3). Regardless of the children‟s age at
R1, R2, and R3, the parents felt that the behavior
of the clients was similar in each period. R1 oc-
curred in conjunction with the introductions 2, 3,
and 4 and typically entailed that the younger
children, especially at night, wet their pants and
older children exhibited mood changes. Difficul-
ties controlling the bladder occurred even before
the first return visit in some cases, “my child
started bed-wetting at night and it never hap-
pened before”. Even difficulties controlling the
bowels occurred. Periodically such difficulties
remained for a large part of the training period
but disappeared, in most cases, upon completion
of the training. R2, which occurred around the
introductions 7, 8, and 9, primarily involved an
increase in self-pity, sadness, and a wish to be
with the mother. The children might cry and be
sad without reason. The children who initially
were angry and frustrated began to tend to whine
during setbacks, “my child is sadder now. He
used to be more aggressive”. The parents also
noted that the children preferred to stay home in
their room rather than being outside playing with
peers. Favorite toys which had been discarded
were once again desired for support and security.
The need for proximity to his/her mother also
increased during this time. Sibling rivalry and an
insistence on fairness were evident. The in-
creased sensitivity of the period remained period-
ically during training but had disappeared at the
end of training. R3, which occurred around the
introductions 12, 13, and 14, involved a great
deal of defiance. The parents reported an in-
crease in self-assertion and sometimes exagge-
rated selfconfidence. Some children questioned
issues that were self-evident and often the de-
Журнал проблем эволюции открытых систем
Вып. 12, Т.1, 2010 76
fiance was directed at the mother. One parent
expressed the perception that “my child behaves
like a teenager”. The behavior then diminished
and was gone at the time of the completion of the
training.
The analysis also indicated that across the
training period additional regressions occurred.
The regressions appeared more randomly and did
not affect the developmental process in the same
way. One example was that the children‟s speech
deteriorated periodically only to improve later, or
they exhibited verbal tics such as onomatopoeic
words which appeared and disappeared during
the training period. Infant speech also appeared.
An additional example was that the need to suck
fingers and clothing intensified only to return to
normal later. A wish to sleep together with the
parents also increased during certain periods.
Transformations
The various periods of positive develop-
ment and change, which emerged either follow-
ing an introduction or following a period of re-
gression, were labeled transformations. During
those continuously recurrent periods sensorimo-
tor skills as well as psychological abilities devel-
oped. For the large part the process change was
gradual, suggesting that positive characteristics
were slowly reinforced over time. Even before
the first return visit, the participants exhibited a
sense of calm and an improved ability to settle in
the evening. “My son has calmed down and there
are fewer outbursts”, one parent reported. Even
when gross motor skills temporarily deteriorated,
there were generally significant improvements.
In several cases the children showed a
much greater interest in physical activity. When
the children felt in control of their body, they
enjoyed both physical education and sports out-
side school more. “My child participates more
actively. He is not just present”. Some children
occasionally felt a need for muscular exertion
and then appeared to enjoy combat sports. When
their legs cooperated, they found it easier to run
and dribble, and soccer then became more attrac-
tive. Fine motor skill abilities also developed,
facilitating writing and drawing.
Despite the fact that no specific oral motor
training was offered, some children improved
with regard to an ability to articulate along with
the improvements in gross and fine motor skills.
At the start of the training parents reported that
difficulties with concentration were a significant
problem. The analysis showed that the difficul-
ties were transformed into an improved ability to
concentrate, which in turn affected learning and
the ability to generally deal with the school envi-
ronment, “we have received great help both with
regard to the language delay and the difficulties
of concentration”. A reduction of restlessness
and distress was also noted during the process of
training. Periodically motor agitations negatively
affected school work for some children, but upon
completion of the training harmony and calm
were evident. For some parents, reading prob-
lems and other learning difficulties were the rea-
son for starting therapy. The analysis showed
that academic proficiency improved although for
some difficulties with mathematics remained, as
seen in the quotation, “math is still fairly diffi-
cult. Other than that my son has met all goals in
school”. As the children‟s energy increased and
their school work improved, homework im-
proved as well. Some children started to have
less trouble with play. Previously they had not
engaged in role play and used to have difficulties
playing with other children. During the training
period their social skills and inventiveness im-
proved. T4 resulted in such stability that both the
instructor and the parents felt that the training
process could be terminated. “Everything regard-
ing our daughter now feels good. We are ready
to go on”. One child said: “I feel the training has
been good for me”.
Generalizability
The process involved in Retraining for
Balance might be described as a flow in which
Introductions, Regressions, and Transformations
jointly pushed the individual toward an increased
sensorimotor (physical) and psychological ma-
Журнал проблем эволюции открытых систем
77 Вып. 12, Т.1, 2010
turity. Introductions of kinesthetic and vestibular
exercises initiated and sustained the processes
that resulted in negative outcomes (regressions).
What is meant by negative outcomes is a return
to earlier sensorimotor (physical) and/or psycho-
logical behaviors which were then exercised.
Engaging in earlier behaviors was at times per-
ceived as demanding or strange by people in the
surrounding environment. The negative deve-
lopmental stages were then replaced by positive
outcomes (transformations), where new beha-
viors perceived as more mature and age appro-
priate emerged.
In order to examine whether the results of
the present study could be generalized to a larger
group of children, the records of the eight partic-
ipants were compared to the records of the re-
maining 224 children and adolescents from the
earlier study of sensorimotor therapy [8]. Two of
the authors independently rated all records vis-а-
vis the kinesthetic-vestibular model of develop-
ment in terms of either “very good adjustment”,
”good adjustment”, or “doubtful or poor adjust-
ment”. The results, which were noticeably alike,
were then compared and agreed on. In order to
meet the criteria for a “very good adjustment”,
the records were required to clearly show the
three regression periods (R1 – R3) and the four
periods of transformation (T1 – T4). A “good
adjustment” allowed for the omission of one of
the regression periods, although the main ten-
dency of the developmental curve had to be
present. A “doubtful or poor adjustment” in-
volved the presence of only one regression pe-
riod and few transformations. The results indi-
cated that 63% of the children and adolescents
exhibited a “very good adjustment” to the kines-
thetic model of development, whereas 32% of
the records were judged to show a “good adjust-
ment” to the model. Only 5% of the records (i.e.,
11 children) were judged to show a “doubtful or
poor” adjustment to the model. It is worth noting
that the distribution above was obtained as early
as when a third of the records had been assessed,
suggesting that saturation had been reached [86].
Conclusions
In general, the purpose of a qualitative
study is to develop an understanding of what is
going on [86]. Why? is never asked in a pheno-
menological study but answers are sought to
questions such as how? and what? [77]. In the
analysis of the current study a number of psycho-
logical and physical phenomena emerged during
periods of both regression and transformation.
As mentioned in the introduction, the concept of
regression has been defined in several different
ways and in some cases the concept carried a
negative connotation. The current analysis
showed, with the aid of the EPPmethod, that
there was positive development following the
reported regressions. Research from the Loeb
Center for Nursing and Rehabilitation in New
York has previously described similar results
[87]. Some regressions might appear extreme
but, as mentioned above, clients often took the
initiative to do the daily training which is inter-
preted as high motivation despite the efforts.
When it comes to “regression in the service of
the ego”, Kroebner [88] suggested „Playfulness‟
as a way to cope. Within the frames of Retrain-
ing for Balance, playfulness [3,4] as well as emo-
tional understanding from surrounding grown-
ups,
especially
the
parents,
is
stressed
[8,9,10,11]. During the continuously recurrent
periods of transformations, sensorimotor (physi-
cal) skills as well as psychological abilities de-
veloped. Findings which are in line with those
gained by Levin [26] and Jeannerod [89,90]. The
phenomenological method has previously been
of importance to psychology and psychiatry [91]
and has yielded knowledge about basic human
characteristics such as a sense of time, a sense of
being in the body, ”embodiment”, and inter-
subjectivity. Given this background, it is impor-
tant to note Husserl [92] and his observation that
the young child possesses an internal drive to-
ward an increased body control, and that such
control is acquired through repetition, that is,
movement makes the human self-constituting.
Using the concept of self-cohesiveness, Levin
Журнал проблем эволюции открытых систем
Вып. 12, Т.1, 2010 78
[26] speculates that the vestibulocerebellar-
cortical system is of importance when it comes to
the formation of early memories for further
learning. According to van Gelder [93], known
patterns function as keys in a system which open
up to recognition. Rothschild [31] emphasized
the ability of the body to store memories and the
ability of the sensory systems to elicit them. The
present study using the Retraining for Balance
method might contribute to psychology and psy-
chiatry by showing a novel way to reach „Winni-
cott‟s third space‟ [39]. According to Bergstrцm
[94,95] this “space” is similar to the limbic sys-
tem as described by MacLean [96]. The limbic
system is essential for successful bonding as well
as for social and emotional behavior [26] . The
regressions identified in our analysis may be part
of the “multitude” (manifold) of possible but not
yet fully realized sensorimotor (physical) and
psychological behaviors, which sometimes seem
necessary for transformations [97]. This notion is
in line with findings by Battegay [4] who argued
that regressions conceal a latent hope for the fu-
ture.
While in qualitative studies validity is em-
phasized and while human beings are unique,
phenomenological research findings are difficult
to replicate [86]. However, viewed together with
the results from a quantitative study on the same
cohort a more thorough understanding ought to
be reached. Results of the present study lead to
the conclusion that an important reason for the
positive development observed in the study of
the 232 children and young people (8) may be
that the body, through vestibular and kinesthetic
stimulation, was given new possibilities to open
up and recognize implicit/stored memories [98].
An example might be a quotation from one of the
children: “ I am grieving my grandmother’s
death” although she died many years ago. It ap-
pears as though memories from past develop-
mental phases are elicited (R, negative change)
through kinesthetic and vestibular stimulation(I),
and in this way immature sensorimotor and psy-
chological behaviors are given additional oppor-
tunities for realization, maturation, and develop-
ment (T, positive change). Sensorimotor therapy,
based on the kinesthetic-vestibular developmen-
tal model, might thus constitute a therapeutic
complement to other types of treatment − for
example, educational efforts, medication, and
cognitive behavior therapy.
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