Tag Archives: physical therapy

Growing A Family’s Health

By: Laura Basi, PT, MPT

Physical fitness is important for everyone, including children and adolescents with developmental disabilities.  Running is a great weight-bearing aerobic activity. It promotes cardiovascular and respiratory endurance, bone health, lower extremity strength and endurance, symmetry of movement in both upper and lower extremities, and emotional regulation.  Wheelchair racing promotes cardiovascular and respiratory endurance, upper extremity strength and endurance, and upper body symmetry.  These are all areas that children with developmental delays and disabilities can improve on. 

“Gross motor skills like jumping and running, and object control skills like throwing and catching, are the building blocks upon which more complex physical activity can be learned as children grow, so the sooner kids work on being active, the better.” From parents modeling physical activity help kids with developmental disabilities improve motor skills).

Our community program, Hustle for Your Health, helps children reach their fitness goals. Each week includes an outdoor aerobic activity in the form of running and walking or wheelchair propulsion, basic strengthening exercises, and stretching to cool-down. At the end of the program, children will be prepared to complete our Run for the Kids: Superhero Hustle to run or walk a 5k distance and are encouraged to participate in other local races too.

I have heard from countless families that are amazed at their child’s commitment to health during and after the 10-week program. Below, I share some tips to help all children grow their enthusiasm for wellness.

Growing a Child’s Love of Physical Fitness

  1. Make it fun. Choose activities your kids like. Some kids enjoy walking, running, and biking, but others may get more out of obstacle courses, climbing trees, hopscotch, rollerblading, dancing or a game of kickball in the yard.  The goal is to promote a love of movement.
  2. Variety is the spice of life. To prevent boredom, change things up. Tour the neighborhood using different modes of transport – walking, scootering, biking, skating; you can even make a walk feel different by bringing a ball to dribble while walking or by challenging your child to run to the next tree, skip to the next fire hydrant, leap across the next driveway, etc.
  3. When building endurance, add in activities for “active rest.” Lengthen a jog or a bike ride by bringing along a frisbee so that you can take a break in the middle of your run/ride to toss a frisbee before heading back home. Your child will have maintained being active for a longer period of time and be able to handle a longer distance with a built-in break.
  4. Stuck inside?  Get your body moving by:
    • Making up a dance routine.
    • Setting up an indoor obstacle course
    • Creating movement themed minute challenges. How many times can you…. in a minute? 
      • I.E: Run up and down the stairs, do sit-ups, do jumping jacks, push a basket of laundry across a room, run laps throughout your house.

Growing your child’s fitness and love for activities like running, biking or yoga, has a positive impact on their overall body health but also improves attention, mood and more. But one of the biggest factors in growing a child’s fitness was parent modeling according to a recent study published in the Disability and Health Journal. Caregivers and parents that model physical activity helped encourage their children to be active and created a supportive environment for children with developmental delays and disabilities. The study also mentions that starting this early, around preschool age, takes advantage of the fact that younger children are already spending significant time watching and copying parents.

During the State of Illinois’ stay-at-home order, children have more opportunities to spend time with their caregivers and model their activities. There are plenty of fitness activities the family can do together. Our annual Run for the Kids: Superhero Hustle helps many children at Easterseals make a goal to cross the finish line with their first independent steps, with a walker, or after reaching a new distance. Their goals help inspire other family members to join in their training and reach new levels of health. The new Superhero Hustle date is August 1, which gives participants three months to work on a new wellness goal.

Our goal is to help you reach yours! Set your intention for the next 3 months. What will your family accomplish by August 1? Will you run a 5K for the first time? Do 100 jumping jacks? Start each day with mindfulness and yoga? Tell us! To get started: 

  1. Register today at eastersealsdfvr.org/runforthekids.
  2. Set your wellness and fundraising goals.
  3. Share your progress with family and friends and encourage their support
  4. Make plans to “cross the finish line” on August 1 

One of my personal goals as a physical therapist for children with developmental delays and disabilities is to not only help improve their physical health but the entire families. Our Run for the Kids and Bike for the Kids events are opportunities to grow our family’s fitness with a very supportive community group.

Boy with Speech Language Pathologist in Tele-Therapy

Tele-therapy at Easterseals

By: Valerie Heneghan, M.A., CCC-SLP/L, Director of Speech-Language, Feeding, and Assistive Technology

Tele-therapy for All! 

Easterseals DuPage & Fox Valley has been at the forefront of serving children and their families in a way that meets their current needs through clinical expertise, a team-based approach and integrating technology to ensure maximum independence. As an organization, we have been offering tele-therapy opportunities for the past 10 years as a service delivery model to those it would serve optimally (i.e., a generalization of skills to home environment, transportation issues, medically fragile or at-risk health, to accommodate busy schedules, etc.). 

In response to COVID-19, all 87 therapists were trained to transition to tele-therapy services within two days with support from experienced tele-therapists within the agency.  

How Does Tele-Therapy Work? 

Once evaluated to determine eligibility for skilled therapy services, your therapist would follow up to plan your child’s tele-therapy session and schedule a time to meet. They will work with you to review treatment plans and establish your priorities. 

Laptops or desktop computers are preferred for best overall experience. But tablets, iPhones and Android phones can work too as long as the device has a working microphone and camera. A stable internet connection is needed via a hard-line/Ethernet cord, WiFi or using your cellular plan (your standard data rates may apply). Screen sharing is available to increase participation, engagement and utilization of resources throughout the session. 

Boy in Physical Therapy with Tele-Therapy

Tips for Making the Most out of Online Therapy

  1. Get comfortable with the technology: Immerse yourself in the platform you are using. There are often a lot of features available such as audio adjustments and visual displays, screen sharing, chat features, etc. The more comfortable you are with these features the easier it may be to modify or troubleshoot if a technical problem occurs.
  2. Make a plan: Plan out a time and a designated space in your home that would work best for your child. Have the computer, phone or other device propped up on books or a stand that has a wide view of the room. If possible, the therapy time should be away from other family members or pets. Work with your therapist ahead of time to prepare a few materials or resources like balls, pillows, mats, or games. 
    • Ex: For a young child, find a space where the child can sit comfortably to view the screen but also has space nearby for movement breaks. Bring your child’s favorite toy to show to their therapist and board game to keep their engagement with the parent between exercises. 
  3. Be flexible: When plan A doesn’t go accordingly, be willing to change course.  
    • Take the child’s lead and adapt as necessary. Let the therapist guide you in facilitating therapy strategies through real-life reactions and experiences. 
    • Use items in your home to replicate therapy equipment. Ex: Use couch cushions and pillows to create new surfaces for climbing and crashing. 
  4. Make it fun: Be creative and try new things! You may be surprised by new interests and breaking from the same routines. See how much your child can do! 
  5. Make it matter: Use this as an opportunity for your therapist to see your child in your home to incorporate therapy strategies and techniques in your daily routine. Let your therapist see what is important to your child and how to motivate them to achieve their treatment goals. 
    • Ex: A child is experiencing difficulty with mealtime; let the therapist observe seating and position at the table, mealtime structure, and how you communicate to your child during a typical mealtime. Pick a food that is important to your family and ask about strategies to incorporate it into your child’s diet. 
  6. Give your therapist feedback: It may be more difficult to pick up on social cues, be direct about what went well and what could be improved. Share ideas and problem-solve together to plan for the next session.   

COVID Response

As we try to be one step ahead of the COVID-19 crisis and care of your child, we are committed to keeping our programs running. Our tele-therapy services are available to maintain your child’s therapy schedule, help your family navigate this new routine and manage the difficult emotions that may come with it.  We can also help parents that have a concern about their infant or toddler’s development now. There is no need to wait, as the early stages of a child’s life are the most important in their development.

We are pleased that tele-therapy has already helped many children eat a new food, stay active, and improve their regulation and play skills while building a stronger relationship with their caregiver. 

We understand the immense stress of balancing your child’s needs with the demands of work and school while also keeping your family healthy. We are here to ensure that each child and their caregivers have the support they need to adopt this technology and continue therapy progress. 

While much has changed, our commitment to you remains. If you have any needs, we are actively monitoring our main phone number, 630.620.4433 and info@eastersealsdfvr.org. Contact us at any time (please include your full name, child’s name, phone number and email) and a member of our team will return the response within one business day. 

How to Help A Clumsy Child

By: Cassidy McCoy PT, DPT

Developmental Coordination Disorder (DCD) is a delay in motor skill development or a difficulty with coordinating movement that makes a child unable to perform common daily tasks. This delay is not due to an identifiable medical or neurological condition that would explain their coordination problems.

Children with DCD are frequently described as “clumsy” or “awkward”, but typically have normal or above average intellectual abilities. However, their motor coordination difficulties may impact their academic progress, social integration and emotional development.

DCD is commonly associated with other developmental conditions such as learning disabilities, attention deficit disorders, speech-language delays, and emotional/behavioral problems.

Meeting Challenges
Photo by Ann Mehrman

Children with DCD generally have difficulty with activities including, but not limited to, climbing up and down stairs, tying their shoes, riding a bike, or doing buttons on their clothing.

How does a child with DCD present?

Typical Presentation:

  • Decreased balance
  • – Decreased bilateral coordination
    • Skipping
    • Jumping jacks
  • Decreased ball handling skills
  • Decreased high level balance skills
    • Hopping
    • Balance beam walking
  • Decreased postural control
  • Decreased proprioception

Other areas of concern may be handwriting, executive function, and initiating social interactions.

How to help

Because children with DCD typically have normal to above average cognitive skills, using a cognitive approach to improve their motor planning can help to ingrain motor skills to make movements more automatic. This cognitive approach helps by working on breaking down a motor skill into smaller pieces, as well as, having the child verbalizes the activity before performing, and reporting on the outcome of the attempt.

Example: GPDC

  • Goal: What am I going to do?
  • Plan: How am I going to do it?
  • Do it: Perform the skill
  • Check: How did the plan work?

Other Activities

Core strengthening is important for children with DCD. You must have a stable trunk/core to appropriately move your arms and legs. Improving core stability will improve balance, postural control, and proprioception, leading to improved coordination.

Some activities to improve core strengthening:

  • Heavy pushing: fill a laundry basket to weight it down and have you child push it across the floor. Carpet flooring will add extra resistance from friction.
  • Hannah_TClimbing: climbing up onto furniture or onto playground equipment while maintaining their abdomen off the surface and arms extended.
  • Wheelbarrow walking or planks: putting weight through extended arms will help to increase abdominal engagement and strength.
  • Standing on unstable surfaces: Standing on various surfaces such as: pillows, cushions, foam mat, or BOSU ball helps to improve postural control. They can perform a variety of activities on these surfaces including balancing with eyes closed, squatting to pick up a toy from the floor, catching/tossing a ball, or reaching up overhead for an object.

Click here to learn more about Physical Therapy programs to improve strength, balance and coordination at at Easter Seals DuPage & Fox Valley.

References:

  1. https://canchild.ca/en/diagnoses/developmental-coordination-disorder

All About Adaptive Bikes

By: Bridget Hobbs, PT, DPT

img_7454.jpgWant to see pure joy in a child’s face?  Put him on a bike!  Children of all abilities love the freedom, weightlessness and fun that bicycles (and tricycles) provide.  Just like children, bicycles come in all varieties and can be adapted for children with special needs.

Bicycle riding provides not only the physical benefits such as leg strengthening, increased balance, coordination and endurance, but also the social benefits of riding with family and peers.  Below are just a few examples of modified cycles that are made to assist children with special needs in their bike riding goals.

bike

Adaptive tricycle: The three wheels on this tricycle provide a wide base for increased stability which helps children feel safe not only when riding the bike, but when getting on and off it as well.  The high back and seat belt also provide proper trunk support to help a child stay upright and midline.  There are also Velcro foot holders to prevent feet from sliding forward.

Rhys

Tandem bicycles: Tandem bicycles allow for a parent to propel the bicycle with the option to turn the child’s pedals on or off, which enables a child to rest and enjoy the ride when they are tired. The tandem bicycle also allows for communication while simultaneously enjoying the benefits of exercise.

IMG_2952

Bicycle Trailer: A bicycle trailer is a good option for longer family bike rides where everyone in the family can be included.  The bicycle trailer allows for a lot of leg room and a child or adult can be easily transferred in and out of the trailer and positioned in many different ways.

cycle

Hand and Foot Cycle: A hand and foot cycle can be used for children who have lower extremity weakness, spina bifida, cerebral palsy or low muscle tone. This type of tricycle has the ability to be propelled with either arms and/or legs.   A benefit of this type of tricycle is that children can increase their range of motion in their arms as well as work on a reciprocal motor pattern of their upper extremities.

Your child’s physical or occupational therapist is a great resource to help you and your child learn what kind of bicycle or tricycle would be good for your child.   A few companies/websites that may be helpful in adapted cycles are below:

jonathan-goers-logo.png

Thanks to a generous donor, we are pleased to launch the Jonathan Goers Bike Club at Easter Seals DuPage & Fox Valley. This program was established to share Jonathan’s joy of biking with children who have developmental delays and/or disabilities and may not otherwise have the opportunity to ride or own a bicycle. The program will provide a child with an adapted bicycle free of charge.

Any family of a child with a developmental delay or disability is eligible to apply to this program. The bike must be returned to Easter Seals DuPage & Fox Valley if the child outgrows or no longer uses the bike. This will allow another child to enjoy the benefits of biking. Speak with your Easter Seals DuPage & Fox Valley therapist for more information on the application.

The first bike giveaway will be at our 2nd Annual Bike for the Kids event on September 17 in Elgin. Adapted bikes and trailers are welcome and all ages and abilities are encouraged to participate. Choose your distance from 100 Miles to the 2.5 Mile family ride. Learn more at www.EasterSealsDFVR.org/BikeForTheKids.

Begin to Bike

By: Cassidy McCoy PT, DPT

Summer is a great time of year to get back on your bike.  Here are a few key concepts to help your child ditch the training wheels!

The key to learning how to balance and ride on a two-wheeled bike is to ensure proper stability at the trunk, allowing your child to move their arms and legs freely for steering and pedaling.  Here are some tips to help bring the physical components of bike riding all together.

  1. Balance bike
    1. A balance bike is a bike with no pedals. A balance bike can be purchased, or balance bikeyou can simply remove the pedals from your child’s current bike until they get the hang of it.
    2. First, start with having your child sit on the bike, lower the seat so their feet touch the ground. Have them walk the bike with their feet to begin to learn how to balance without training wheels.
    3. As this gets easier, progress to using both feet at the same time to push the bike and pick their feet up off the floor to glide while maintaining their balance.
  2. Catching themselves
    1. Another way to work on balance is to teach your kids how to catch themselves by placing their foot down when they feel like they are tipping over. Hold the bike stationary for you child as they place both feet on the pedals. Let go of the bike, allowing it to fall to one side or the other. Your child should place their foot down in order to catch their balance.
  3. Steering
    1. Using cones or other objects, set up a pattern for your child to steer around. This can be done with a balance bike while scooting/walking it through or with pedaling if your child has mastered their balance.IMG_5042
  4. Start to Pedal
    1. When your child is ready to pedal, have them start standing with their feet flat on the floor. Have them lift one foot onto the pedal that is lifted at around 2-3 o’clock. As they push down on the pedal to get the bike going, they will lift their other foot onto the other pedal and push down to maintain momentum. If needed, you can help steady the bike by gently placing your hands on your child’s shoulder or the bike seat.

 

Bonus Pro Tip:

tricycleAvoid the discomfort of hunching over to push young riders along on their tricycles. Lace a sturdy rope around the bike’s structure, careful to avoid the spokes and pedals.  This allows you to help pull the trike along, adjusting the resistance to match the child’s ability.

 

Remember to always practice safe cycling. Wear a helmet, and obey the rules of the road.

 

Help your child develop their cycling skills at Easter Seals DuPage & Fox Valley’s Bike for the Kids on Sunday, September 17 in Elgin, IL.  This long-distance bike ride includes a 2.5 mile family ride, pedal parade and kid-friendly entertainment!

To learn more about Physical Therapy programs to improve strength, balance and coordination at at Easter Seals DuPage & Fox Valley visit:
http://www.easterseals.com/dfv/our-programs/medical-rehabilitation/physical-therapy.html

 

Climbing and Bouldering Therapy: The Benefits to Rock Climbing

By: Laura Van Zandt, OTR/L

This summer, physical and occupational therapists are excited to provide therapy on the walls as part of our summer outreach program “Climbing and Bouldering.” The varied terrain offers countless opportunities for physical and sensory challenges.

Rock climbing has so many benefits for kids of all ages and abilities.15_Patrick_Krueger

  • Strengthening and endurance: Climbing walls require strength and flexibility to
    successfully maneuver. Kids develop hand and finger strength as they grasp and hang onto holds of all different shapes and sizes. Some of the holds are tiny and don’t have much to grasp. Making your way up a climbing wall also requires a great deal of core strength and leg strength as your hold yourself in space. All that movement and use of your arms, legs, and core will help develop endurance for other gross motor activities.
  • Sensory processing: Kids get great proprioceptive input (sensory input to the muscles and joints) and vestibular (movement-based) experiences as they power themselves up and over while using the different holds as well as glide back down to the floor from the top of the wall! For kids who experience gravitational insecurity, rock climbing can be an extreme challenge but can be graded to meet their needs. For example, kids who are reluctant to climb high up on the wall can work on moving from side to side first. Children who also experience tactile sensitivities could also be help by all the proprioceptive input into their hands to help desensitize prior to working with different textures.
  • Motor planning and visual spatial/perceptual skills: Climbing is an awesome way to help kids develop motor planning skills. Indoor rock climbing is a great puzzle just waiting for your child to solve! The holds are all different shapes and colors. Most climbing walls also have colored tape markings that show climbers different paths they can take up the wall. This makes it easy to give a child instructions (e.g. “step your right foot on the blue hold” or “find the next hold with green tape next to it”) to challenge their abilities. Also, climbing walls usually have “routes” with
    a variety of difficulty levels, making it easy to adjust the activity depending on the skill level of the child.

    15_Brady Pembroke

  • Bilateral coordination: When kids are rock climbing, they must use both sides of their body together, usually in an alternating pattern — right hand and right foot move up to the next level, followed by the left hand and left foot. Also, kids have to learn how to differentiate between the movements on either side of their bodies. They stabilize themselves with one foot/hand while motor planning how to grasp onto and step on the next holds with their other foot and hand.
  • Confidence: Allowing kids to move outside of their comfort zone in a safe and controlled environment will undoubtedly help to build their confidence and promote development of positive self-esteem.

If you think your child might benefit from this outreach group, please visit our website for more information on Climbing and Bouldering Therapy and check out other Community Based Therapy Programs for Summer 2017!

Gross Motor Play- Why Some Kids Won’t Participate

By Laura Znajda, PT, C/NDT
Manager of Community Based Therapy and Continuing Education

Summer is the ideal time for outdoor play, and children who love to run and climb are in their element. But children with very mild developmental challenges– or even no diagnosed problem at all— can have a great deal of difficulty learning new motor skills and keeping up with their peers on the playground.  Some children are mistakenly thought to be “clumsy” or “lazy” when they don’t try the advanced motor skills other children their age are mastering.

Physical and occupational therapists sometimes receive referrals to work with these children to strengthen their bodies so that they can gain skills more easily and keep up with their peers.  However, there is more to motor skills than just strength.  Pediatric therapists must analyze a child’s performance and consider all factors that might be impacting their success:Hannah_T

Flexibility
:  We all need normal range of motion in our joints to perform daily tasks, but outdoor play can require extreme ranges of movement as kids stretch their limbs to make that great play of the game or to access new parts of a play gym.  A restriction in range of motion at the hip or shoulder might make climbing the slide ladder difficult.  A neck range limitation could make it challenging for a child to scan the playing field for a teammate that is open for a pass.

Motor Planning:  Paraphrased from Jean Ayres, PhD, motor planning is defined as the act of planning movements inside the brain to complete a series of actions in the proper sequence.  Before a child even starts to move, the sequence of action is planned out in the brain.  When the child lacks experience with a particular skill, like pumping herself on a swing or hitting a ball with a bat, she might hesitate in order to give her brain time to make a plan for this novel task.  Typically, the time it takes to get started will decrease as the task becomes more familiar, but for some children this motor planning component does not come naturally and needs assistance.

Emmett_T.jpgBalance:  Children need to be able to balance on one leg long enough to lift the other leg to a raised surface or to kick a ball.  Even more importantly, they need dynamic balance—that is, control of their bodies while they are moving and balanced on one limb in order to reach out to the side to catch a baseball or make a soccer save.  A child with balance difficulties will seek out stable objects to hold when he has to lift a foot for any length of time or will avoid these activities altogether.

Coordination:    According to CanChild, a research center at McMaster University that organizes clinical  research concerning children with developmental conditions, coordination is a sequence of muscular actions or body movements occurring in a purposeful, orderly fashion (smooth and efficient).  We often think of coordination as the ability to use both sides of the body at the same time.  We need coordination to make the same movements with both arms and legs when we do exercises like jumping jacks.  And we need coordination to do different things with each body part, but all at the same time, such as dribbling a basketball while walking or running.  A child with coordination difficulties might need these advanced motor skills to be taught in a more graded manner before she can master them.Robbie_T.jpg

Motivation:  It might seem obvious that a child must be interested and motivated in an activity in order to be successful with it, however this important component of motor skill performance is sometimes overlooked.  Although research is inconclusive as to exactly how many repetitions are needed, we do know that a new skill requires at least hundreds of repetitions in order to become proficient.   If a child is not motivated to play a particular sport, he will not have the determination to practice a skill over and over and will not see the success that comes from that critical repetition.

Finally, strength is important. Just as necessary as all of these motor skill components; but not the only factor to consider when a child is hesitant or unsuccessful with outdoor play.

Easter Seals DuPage & Fox Valley therapists are expanding their ability to get to the bottom of why children don’t participate in outdoor play and develop new strategies to help them through a continuing education course taught by Lezlie Adler, OTR/L, C/NDT and Jane Styer-Acevedo, PT, DPT, C/NDT on September 22-23, 2016 at our Villa Park center.  Registration is open to all therapists at:  http://www.eastersealsdfvr.org/ce

References

Can Child, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada L8S 1C7  www.canchild.ca

Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 2005.

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.

Could Changing our Thinking about Ankle-Foot-Orthotics (AFOs) Help Children Walk Better?

By: Laura Znajda, PT

This is a question many in the pediatric therapy world have been pondering and practicing for a number years.  Elaine Owen, MSc SRP, MCSP has completed quite a lot of research through her work as superintendent and clinical specialist physiotherapist at the Child Development Centre in Bangor, Wales, in the UK.  Through her careful study of the gait cycle, she has inspired us to think differently about the way the segments of the foot and leg are aligned at various times in the cycle, and she encourages us to replicate normal gait more closely through the use of not just an AFO, but AFO/footwear combinations.

AFO
The Old Paradigm: 0 degree plantarflexion AFOs and Flat Shoes. Photo from Beverly Cusick.

In her paper The importance of being earnest about shank and thigh kinematics especially when using ankle-foot orthosis, Elaine points out that contrary to the common belief that the lower leg is vertical at midstance (the way many solid-ankle AFOs are designed), the lower leg is actually inclined 10-12 degrees at this time in the gait cycle, and this inclined position places the knee joint over the center of the foot, which provides stability in single limb stance.  This information begs the question, are we actually causing more work for our clients, as they struggle to move their center of mass forward over an unnatural vertical lower leg position?  Could we increase efficiency and more closely approximate normal gait by adjusting the pitch of the AFO at midstance through the use of specific footwear or external additions to the brace?

AFO graphic
An example of a New Paradigm AFO. Photo from Beverly Cusick

Beverly Cusick, PT, MS, COF/BOC has done much to bring this, among other current concepts, to the attention of practicing pediatric therapists and orthotists.  In her paper, Help Patients Manage Equinus Deformity, Use Orthoses to teach children to optimize body weight carriage on the feet, Ms. Cusick describes a paradigm shift in brace design for children whose ankles are plantarflexed (toes pointed downward) while walking.  In addition to the concepts brought to light by Ms. Owen, Ms. Cusick considers the sensory benefit of gaining full heel loading in the brace as an essential component of the effort to improve postural control in standing and – when feasible – walking all day long. Modified AFOs combined with modified footwear can provide the wearer with a strong biomechanical training tool.

To get acquainted with these concepts, click on the references above and the Progressive Gaitways, LLC website:  www.gaitways.com.

To learn a lot more about how to bring them into your practice, attend a joint education course from Easter Seals DuPage & Fox Valley and Shriner’s Hospital presented by Beverly Cusick, PT, MS, NDT, COF/BOC in May:

For more continuing education information including the course schedule, please visit:  www.eastersealsdfvr.org/continuingeducation.

 

What’s Wrong with W-Sitting?

By: Bridget Hobbs, PT, DPT

Many parents and teachers know that w-sitting is bad for a child’s development, but they might not know why.   So, I am going to shed some light on what w-sitting is, what proper sitting positions look like and how best to encourage little ones to sit with correct posture.   W-sitting is sitting with bottom on the floor, knees in front and legs splayed out to the side, making a “w” or “m” shape depending on which way you look at it.

When babies are learning to crawl and transition in and out of sitting, they often go into w-sitting momentarily, which is completely normal and fine.  However, when a child sits in this position for longer periods of time, that is when you need to take action and help them to learn to correct their sitting posture.

Some children sit in a W because it is comfortable for them.   Other children with low muscle tone or weak core strength w-sit because it gives them a wider base of support to help keep their sitting balance.  This W-sitting position makes is difficult for a child to reach across midline and rotate their trunk which can lead to coordination and writing problems down the road.   W-sitting can also have negative orthopedic ramifications.  W-sitting puts strain on the knees and hips and can cause pain and tightness to these joints and muscles as well as to the back.  It also can affect the child’s sitting posture as it makes it difficult to sit up straight which is important for developing strong trunk muscles.   Children who have hip dysplasia also have a higher risk of hip dislocation if they w-sit.

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How to Help Your Child Correct W-Sitting

Correct sitting postures include: tailor sitting (cross-legged sitting), long sitting (sitting with legs straight in front of you), or side sitting (legs to one side).

Tailor Sitting                          Long Sitting                  Side-Sitting

To encourage your child to sit cross-legged, try verbal cues such as “criss-cross applesause.” “pretzel sit”or “fix your legs.” Some children respond well to a simple tactile cue, such as a gentle tap to their knees.  If your child needs more motivation, you can have them earn a sticker or a small treat for every time that you catch them sitting the correct way.

For pre-school and early grade school when children are often sitting on the floor, using cube chairs can be helpful for children that have a hard time sitting correctly.  An added bonus is that these types of chairs help kids who are fidgety or wanting to move around more likely to stay put for story-time.

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Cube Chairs

Proper sitting positions, such as tailor, long and side-sitting, help your child develop their core muscles by sitting up taller and enabling them to rotate across their body.  They also encourage proper weight shifting to allow a child to reach for toys outside of their base of support and also let a child use both hands at the same time on one side of the body.  If you are concerned about your child’s sitting posture, feel free to seek out a physical or occupational therapist at Easter Seals DuPage & Fox Valley for ideas and feedback on how to help your child play in different positions.