Clinical pathway

Balance

The student is unsteady in PE, on the playground, or in transitions, especially when also looking at something.

Step 1

Occupational performance problem

The student is unsteady in PE, on the playground, or in transitions, especially when also looking at something.

Step 2

Clinical reasoning

  • Test balance with eyes open and eyes closed, then with a head turn — the difference is the visual contribution.
  • A sudden change in balance, or balance loss with headache or nausea, is a referral first.

Step 3

Likely limiting level

  • Level 5: Functional Integration

    Vision, vestibular, and proprioceptive input must integrate under load.

  • Level 2: Visual Efficiency

    Gaze stability during head movement supports steady posture.

Step 4

Intervention options

Nothing tagged for this step yet.

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Step 5

Movement-based options

Nothing tagged for this step yet.

Step 6

Teacher strategies

  • Predictable transition routes with visual landmarks.
  • Seated alternatives during unstable-surface PE tasks until stability improves.

Step 7

Parent carryover

  • Single-leg stance games while brushing teeth or waiting.
  • Curbs, low walls, and playground equipment as everyday practice.

Step 8

Progress monitoring

  • Seconds of single-leg stance, eyes open and eyes closed.
  • Falls or near-falls reported per week.

Step 9

Reassessment

Re-screen the limiting level after 6–8 weeks of consistent intervention. If the occupational problem has not changed while the contributing level has, look upstream for a different limiting factor. If neither has changed, or symptoms are worsening, refer out rather than continuing to treat.