Monthly Archives: March 2016

Toe Walking in Toddlers…is it Normal?

By: Bridget Hobbs, PT, DPT

Walking on the balls of the feet or “toe-walking”, is quite common in children just learning to walk. The good news is that many children out-grow it within a few months of walking.  However, if your child is toe-walking beyond the age of 2, it is worth talking to your pediatrician about it, as there may be an underlying cause associated with this.

There are a few main reasons why children toe-walk:

  • Shortened Achilles tendon

A shortened Achilles tendon (bottom part of the calf) can cause less flexibility at the ankle, making it more difficult for a child to get his heel down when walking.  When this is thetoe walk case, physical therapy can help stretch the calf muscle group and strengthen muscles in the core and front part of the lower leg. This therapy can help the child learn to walk with a more typical “heel to toe” walking pattern.  Sometimes your therapist will recommend a brace to wear during the day and/or at night in order to help get a child’s heel down when walking and stretch the Achilles tendon at night.  In some cases, a series of casts may be used to help gain range of motion at the ankle.  Surgery may be recommended for correction in rare cases or when “toe-walking” persists into later childhood.

  • Sensory Processing

“Toe- walking” can also be a sensory-seeking behavior. Children who need more proprioceptive input will lock their knees and ankles. Children may also lock these joints to feel more stable and better prepare them for physical activities, such as running. Some children walk on their toes as they are hypersensitive to different textures or temperatures on the floor. “Toe-walking” can become a habit and if done frequently, can lead to tight Achilles tendons. This is why, if you or your pediatrician feel like your child has sensory concerns, that they are evaluated by an occupational therapist to help with strategies.

  • Underlying Medical Diagnosis

If “toe- walking” persists beyond the age of 2 or if it is accompanied by muscle stiffness, difficulty with communication or language delays, coordination problems, or if your child toe-walks just on one side, it is a good idea to speak with your pediatrician about it so you can find out if there is an under-lying cause.  Diagnoses including Cerebral Palsy, Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie Tooth and Tethered Cord have all been linked with early “toe-walking”. Some (but not all) children with Autism and other Pervasive Development Disorders (PDD) have also been noted to toe-walk.Caroline-PE Selected Photo

  • Idiopathic “Toe-Walking”

Idiopathic “toe-walking” is used to describe a child who toe-walks without any known reason.  Children who walk on their toes may have frequent falls, lean more forward when they walk, and show more difficulty with balance. “Toe-walking” may also be hereditary, where more than one child in the family toe-walks.   Early recognition and intervention is fundamental to prevent a shortened calf muscle and help develop a normal walking pattern and balance reactions.

Many children “toe-walk” as they learn to walk, and with a proper heel-to-toe walking pattern, they learn fairly quickly. However, if you are concerned that your child is toe-walking beyond the age of 2, or is showing other difficulties with development, it is important to speak with your pediatrician.  They may refer you to a physical or occupational therapist who can further assist you and your child.

Learn more about Physical Therapy services at Easter Seals DuPage & Fox Valley: http://eastersealsdfvr.org/physical.therapy.

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Knowledge is Key

By: Amy Liss, Relationship Coordinator

Every month we seem to have a day that brings awareness to a specific disability. For example Friday, March 25, is National Cerebral Palsy Awareness Day encouraging people with cerebral palsy to share the many things they enjoy and can do using the hashtag #CerebralPalsyCan.

11182119_10104980955721620_7285392519176070049_nWhile I think these days are great, I personally believe that every day should be Awareness Day. My dream had always been to be an elementary school teacher. Although I may not be teaching in a classroom, my goal is to “teach” every day. Whether I’m giving a speech in the community, giving a tour of our building to someone that hasn’t heard of Easter Seals and its mission, driving up and down our hallways meeting new families, or engaging in conversation with long-time friends, I feel that I am always trying to educate.

For those of you reading this that may not know me, I’m 33 years old and have Spastic Quadriplegic Cerebral Palsy. There are many different types of Cerebral Palsy. I am lucky to be able to speak and have a mind that works pretty well most of the time. 🙂

Next time you come in contact with a person with a disability, here are 5 things I believe you should keep in mind:

  1. Just because a person is nonverbal doesn’t mean they don’t understand what you are saying. Treat them normally. Talk to them at a level they understand. Do not talk down to them.
  2. Most people with a severe disability need a companion to help them. It is important that you remember to talk to the person and not to their companion. For example, people tend to ask my companion questions instead of directing them towards me. They say “does she like college basketball?” If the question was formed, “do you like college basketball?”I could talk for hours about March Madness.
  3. I’mMarchMadness.jpg an identical twin and I have a younger sister who is 28. My family did a wonderful job of including me in all family activities. Throughout my life, I’m grateful that I’ve always been accepted and included. Sometimes your special needs child can occupy a lot of your time and that is understandable but it is important to remember that siblings need attention too. Try to spend one-on-one time with each sibling. In my family, we call these “you & me kid days.”
  4. Patience is crucial. Sometimes others don’t take the time to get to know people with disabilities because it may take them longer to do things. If you take the time to get to know someone with a disability and include them in your group, you may quickly notice that we’re more alike than different.
  5. Be as open as possible. Tell others about you or your child’s disability. That’s how we educate.

amy group.JPGYou may be surprised at how much YOU can teach!

Amy works as the Relationship Coordinator at Easter Seals DuPage & Fox Valley. Learn more here: http://eastersealsdfvr.org/about.

Using visual schedules: A Guide for Parents

By: Jessica Drake-Simmons M.S. CCC-SLP

Using visual schedules allows your child to see what is going to be happening in their day and the order of events.  Visual schedules can be customized to meet the needs of each child.  Getting started with a visual schedule can seem overwhelming, so this blog will help you recognize if your child would benefit from a visual schedule with ideas on how to get started.

7 Benefits of visual schedules:

  1. Provides structure and predictability:  Visual schedules prepare a child for what is coming up, which can reduce anxiety. 
  2. Eases transitions: Visual schedules are helpful in easing transitions from one activity to the next.
  3. Reinforce verbal instructions: Most children process visual information better than auditory information.  Words disappear after we say them and the visuals give language a lasting component. 
  4. Supports literacy development- Consistent exposure to written words can enforce reading of sight-words and provide an opportunity to practice reading through decoding.   
  5. Supports development of executive functioning: Visual schedules enforce planning, sequencing, completing tasks independently and the natural consequences of time management.
  6. Supports conversation skills: Many childrenn have difficulty recalling and retelling previous events.  Providing the visual framework of the schedule can help kids answer open-ended questions like: “What did you do today?” or “What was your favorite activity?”
  7. Helps caregivers:  Having a plan in place can be calming for adults.  Creating a schedule helps the caregiver prepare for the day and use time effectively.

Decide on the format

Visual schedules come in all shapes and forms.  When selecting a visual schedule format, consider which would be most functional for you to use, along with what would be most beneficial for your child.  Some schedule forms take more preparation while schedules like line drawn images or written words can be done quickly and on the fly. 

  Here are some different types of visual schedules:

all+picApps on phone/tablet   Tangible pictures with Velcro Line drawing images  Written words

Decide on the length The length of the schedule will be based on your son or daughter’s needs and abilities. Some children may be able to use a whole day schedule while others will be overwhelmed by this amount of information and will need to see just one or two items at a time.

First/Then-This can be an effective format to introduce visual schedules without overwhelming the child with too much information.  It can assist a child in getting through the non-preferred first activity by seeing that next, she will get a preferred choice.

day
Part of the day with more specific activities                                              Monthly Calendar

 

 

all day .jpg
Whole day with more general activities

It is beneficial to include your child as part of the process of creating the schedule.  The slowed down, one step at a time, verbal explanations paired with visuals helps the child understand and prepare for upcoming activities.  It can also be a nice opportunity for the child to have some autonomy and make choices about what their day will look like. Don’t feel that making a schedule means that you have to rigidly follow it.  Life is unpredictable and having a change in plans is something that we all have to adapt to.  The visual schedule can be a great tool to teach your kids about flexibility.

Learn more about Easter Seals DuPage & Fox Valley resources here: https://eastersealsdfvr.org/.

Go Ahead, Play with Your Food!

By: Maureen Karwowski, OT

In my house growing up, meals were serious business.  My parents had rules around “dawdling”, and playing with food was an absolute “no no”.  Now, in my work as a pediatric occupational therapist, I advise the families that I work with to break these rules (and for good reasons).

Many of the children that I work with have sensory processing difficulties.  Sensory processing challenges occur when a child has difficulty interpreting and responding to the sensory experiences in daily life. It is estimated that 1 of 20 children are impacted by a sensory processing deficit (Ahn, Miller, Milberger, McIntosh, 2004).

For some children with sensory processing difficulties, they have heightened sensitivity to textures, smells and tastes. These sensory over-reactions negatively impact a child’s ability to tolerate diets with a wide variety of textures, looks, smells and tastes.  I have clients who eat foods that are similar in color, for instance all shades of white (crackers and chips).  Other children eat foods that are munchable in texture, so graham crackers, chicken nuggets, and macaroni and cheese.  One little boy that I worked with could not even be in the kitchen while his mother was cooking because the smells were so offensive to him.    I remember clearly that he told me “food is not fun for me like it is for you”.  That was a profound statement from a child of 5 years of age.

Sullivan
Photo by Steven Van Dyke

The good news is that I have seen great results in helping a child to expand their diet with work in therapy, and with the parents’ work at home.  Many children do well with an individual while others do their best in a group with other children.  I always start with a thorough occupational therapy evaluation, and assess the child’s sensory processing skills, motor coordination and fine motor skills.  I work closely with speech therapists and a dietitian who specialize in working with children with feeding challenges. I want to rule out any oral motor and medical concerns before starting any kind of therapy with feeding.

The goal of my therapy sessions is to explore foods in a fun and low pressure manner. So dawdling and playing with food are an integral part of the work with my clients.  Picture making towers of cucumber slices, while my client knocks them over repeatedly.  Picture using those cucumber slices as goggles to look through.  How about blowing peas off the table and into a bowl?  I love making shapes and letters with cooked spaghetti noodles.  These types of games provide my clients with the sensory experience of the food, but in a way that is very low pressure.  The goal is not to eat the food initially, but to explore the foods in any way that the child can tolerate it.  As the child is more comfortable with the touch, smell, look and taste of a food, the more likely they would be to eat the food.

For parents at home, I do suggest a time where the parent and child are having fun with exploring food, in any way that they can.  I encourage families to have the child help with carrying food to the table, or pick out the vegetables at the market.  Can the child mash potatoes?  How about toss a salad?  A child is much more likely to explore a food if they know that their parent is not expecting them to taste it.

Consult your child’s therapist to determine if your child would benefit from a sensory approach to feeding or contact Easter Seals DuPage & Fox Valley for information about our summer feeding groups.

Marita Blanken_4 cropped MG_9142B

If you are interested in learning more about sensory feeding work you can look at the following resources:

header photos by Amanda Grabenhofer