boy with truck

W-sitting and the Young Child

Chances are, if you know what W-sitting is, you or someone you know sits just like that. Occupational, physical, and developmental therapists often express their disapproval whenever they see a child sit in this position. More and more parents are catching on to the fact that this is a posture to keep their children out of. The most common questions they have are 1) why is it so bad? and 2) what is there to do to help change this habit?

What is W-sitting?

Many children with low muscle tone, decreased core strength, increased joint laxity, or hip instability, will sit and play with their knees together, bottom on the floor, and feet out to both sides.

Why do some children like to sit this way?

Simply put, a young child’s joint and bone structures will allow them to sit in this position. Certain medical diagnoses, such as Down syndrome and femoral anteversion, are often associated with this preferred sitting posture. In this position, children are more comfortable and don’t have to work as hard to hold their trunks upright. Instead, they are spreading their lower limbs out over a wider base of support, thus relying on their joint structures and not their muscles, to hold them up to play.

Why do therapists recommend against it?

While the knees together and feet out position is fine as a transitional position, our hips are not designed to be in the W-sitting position for a long period of time. Prolonged sitting in this position places significant stress on inner hip muscles and joint structures. The young musculoskeletal system will then develop in such a way that just creates more and more instability of the hips. If a child gets used to sitting and playing in this position, weaknesses and orthopedic misalignments will only travel up and down the musculoskeletal chain. Children who W-sit well into their preschool to school years often experience decreased trunk strength, poor attention, in-toeing, poor posture, clumsy coordination, and frequent loss of balance.

How to help a child out of the position?

Many parents would tell me that they are at their wits’ end, constantly instructing their child out of the W-sit position.  While repetition and consistency are key, habits are difficult to change, especially with verbal reprimands alone. Change things up and give your child other sitting postures as options:

1) The most common alternate position is with feet crossed and knees apart. “Criss-cross applesauce” is what we usually tell children when we see them W-sitting. They respond well to this simple cue.

2) Side-sitting is a great alternative if sitting with knees out is too difficult. In side-sitting, both knees are bent, weight is shifted to one hip, and both feet are out to the same side. This takes away stress from the hip joint structures, allowing for easy transitions in and out of sitting.

3) Long sitting with feet forward and back supported is a great way to stretch out those hamstrings and keep hip/knee joints in neutral.

4) If a child has a hard time sitting and playing, I let them kneel with their feet tucked together under their bottom. As long as they don’t slowly shift back into the W-shape, kneeling is a great position to strength their hip and core muscles.

5) Half-kneeling with one foot tucked and the other foot flat on the ground will keep the hips in neutral alignment. In this position, muscles will be active and hip joint structures will not be put under damaging stress.

6) Finally, squatting or sitting on a low chair will also help keep a child out of W-sit during play.

If you are still looking for ways to keep your child out of this injurious habit, talk to a therapist. Physical therapists will come up with ideas and exercises tailored to each individual child and find the best ways to improve his or her posture and alignment.




Dizzy Kids

What Is The Vestibular System

Most kids learn about the 5 basic extrinsic senses of sight, sound, taste, touch, and smell. Many, however, are not as familiar with two hidden intrinsic senses: the vestibular and proprioceptive senses. The vestibular sense is one of the first to develop in a growing fetus and is stimulated by the movement of a carrying mother’s body. By only 5 months in utero, this system is well developed and provides a great deal of sensory information to a growing fetal brain. This system is very important to a child’s early development. Its role is to relay information to the brain as to where a person is in space, as related to gravity; whether they are moving or still, if they are moving how quickly, and in what direction. The vestibular system gathers that information from a set of fluid filled canals and a sac-like structure in the inner ear. These structures respond to movement, change in direction, change of head position, and gravitational pull.

  4 Ways the vestibular system may impact your child:

1. The vestibular system coordinates eye and head movements. Without this coordination, it may be challenging for children to complete everyday activities such as copying from a white board in their classroom, following a moving object such as a softball through the air; or visually scanning across a page to read. The vestibular system helps the brain to register and respond to whether the object the child is looking at is moving or if their head is moving.

2. The vestibular system also helps to develop and maintain normal muscle tone. Muscle tone is the ability of a muscle to sustain a contraction. Without a proper functioning vestibular system, it may be challenging for a child to hold their body in one position. These children may oftentimes prefer laying on the floor instead of sitting up during circle time or leaning on their elbow or hand while seated at their desk.

3. The vestibular system also impacts a child’s balance and equilibrium. As your child moves throughout their environment, so does the fluid in their inner ear canals. As the fluid in their inner ear moves, your child’s brain is receiving information as to the position of their head in space. Depending on that signal, the brain then sends a message to your child’s body signaling it to move in a way that will help them to respond to and compensate for any planned or unplanned movements.  Without efficient vestibular processing, your child may appear to be clumsy and have trouble staying on their feet during routine play.

4. Finally, the vestibular system helps a child to coordinate both sides of their body together for activities including riding a bicycle, catching a ball, zipping a coat, or cutting with scissors.

If you suspect that your child is having difficulty processing sensory information by way of their vestibular system, do your best to be sure that activities including a lot self-propelled movement are incorporated into their day. Activities may include swinging, sliding, or using other equipment at the park. Do your best to avoid activities with excessive spinning or twirling as movement in these planes can have negative effects including over-stimulation, lethargy, or changes in heart rate or breathing. It may also be challenging for your child to pace themselves during these quick paced movement patterns. Encourage activities in which your child lays on their belly to participate in games or play with toys. Throughout your day, take note to see if your child seems better able to focus after completing physical activity or partaking in activities that get them up and moving.

The vestibular system may be less commonly discussed than other sensory tracts, but its impact on your child’s ability to complete day to day activities are vast.


Baby crawing

Common Physical Therapy Red Flags at Pediatrician Well-Visits For Baby’s First Year

First time parents don’t quite know what to look forward to when visiting their pediatricians during their child’s first year. Other than immunizations, growth measurements, and nutritional concerns, what else is there to discuss? Each well-child visit is a brief meet-up to assess the child’s growth and development. A red flag is an early warning sign that something is not developing typically and need to be addressed by a specialist.

Below are some physical development related red flags to discuss with your doctor on each of your child’s well-visits. Any one of them could warrant a follow-up visit to a physical therapist to ensure appropriate gross motor development. Early detection and early intervention is important and many red flags should not be dismissed.

1 month

– If your baby prefers to sleep with his or her head turned to one side, be mindful of a flat spot that might start to develop. Switch the side she lies on in her crib and alternate the direction of stimuli.

– Babies at this age should hold their limbs and trunk in some flexion, with random movements here and there. If your baby prefers to lie limply on his back with every limb spread out, pushes into extension with trunk and limbs that seem to stiffen up with every movement, or show difficulties with moving his or her head side to side, bring it up with your pediatrician.

2 months

– If you continue to notice a flat spot or a head turn preference when your baby sleeps on her back at month two, it might be good to bring it up with your doctor.

-At this time, babies are gaining more and more strength in their neck muscles.  In sitting, their heads are more upright though continues to bob. If you don’t see your baby using his or her neck muscles at all, it may be a sign of slow development.

4 months

-This is the month of increased symmetry. If your baby continues to prefer to sleep, sit, and play with head only to one side, try to encourage him or her to play with their head in midline.

-A baby on his tummy at 4 month should be able to push up onto his arms and hold his head up.  Red flag behaviors to ask your doctor about include: difficulty lifting head up, stiffening in his legs with little or no movement, pushing back with his head as opposed to lifting it forward when trying to roll, and fisted or lack of arm movements.

6 months

-At 6 months, a babies are sitting up and holding themselves up in sitting. They can also roll without help.

-Red flags at this stage are signs that point to difficulties with these tasks, such as: no trunk or head control in supported sitting, increasingly stiff back and legs, or inability to bring arms forward to reach for toys.

9 months

-A 9-month-old can sit and reach for toys without falling. He can move easily from lying down on his back or his tummy to sitting on his bottom.

-If your 9-month-old sits with his trunk leaning forward, doesn’t reach out to play with toys, uses one side more than the other, seems to drag one side to move, doesn’t crawl, and cannot take any weight on his feet when you prop him up, please bring it up with your pediatrician at his 9 months well-visit.

12 month

– Of course every baby develops differently. But by 12 months, a typically developing baby should be able to pull to stand and cruise along furniture. She might be able to stand alone and take independent steps.

-What we as physical developmental experts look for is fluidity of movement. If a child has difficulty getting to standing because of stiff legs, extended trunk, weakness on one side, or pointed toes, that is cause for a more in-depth look. If your baby only pulls up to stand with his arms instead of using his legs, it is definitely good to make your pediatrician aware.

-If your child sits with weight mostly to one side, needs her hands to maintain sitting, holds any part of her limbs stiffly in extension or flexion, or has difficulty moving between positions by her 12 month visit to her pediatrician, please ask about a physical therapy follow-up.

18 months

-A big indicator of need for physical therapy is if a child still cannot stand or take steps independently by 15 months.

-Red flags at the 18 months well-visit include: inability to stand and step independently, frequent falls while standing, poor standing balance, difficulty squatting, or walking predominantly on toes.

 

The warning signs and red flags mentioned above are meant as a guide to parents. If your child is showing these signs and is not achieving his or her gross motor milestones on time, do not focus so much on a medical diagnosis. What is important during the first year is that your pediatrician is aware of differences in your child’s development and recommend specialist follow-up as needed.

To see what your child should be doing at later stages in life, download our Gross Motor Milestone Checklist here.




 

boy learning to walk

Gait Development In Children

A majority of my clientele are babies just learning to walk, toddlers who are delayed in their walking, or preschoolers who are showing an abnormal gait pattern. Years ago, when I worked in the rehabilitation and hospital settings, most of my patients were trying to regain their ambulatory abilities after an injury. Needless to say, walking is an important part of growth and locomotion. It is a complex task that requires musculoskeletal and neurological system maturation and cohesion.

Development of Gait:

The components of typical adult walking include 1) stability in stance, 2) sufficient foot clearance, 3) appropriate positioning of foot for initial contact of the next step, 4) adequate step length, and 5) energy conservation. Depending on the age or type of injury, a person’s walking ability might be impaired in any of these factors. Physical therapists work to address each component to encourage efficient and safe walking.

At age 1, children are just learning to walk and are still working on their standing stability. When they first start walking, their arms are held up high in protective guard, and they walk really fast so as not to lose their balance.  They rely on a wide base of support to maintain their stability. They often put their feet down flat on the ground and they do not spend as much time on each leg when clearing their feet for the next step.

About 6 months later, children will often start walking with a more natural gait, with arms down in a reciprocal swing, and with heels hitting the ground first.  Because of the structure of toddlers’ bones and joints, they still stand with a wider base of support than adults do, but are in the process of narrowing their stance.

In preparation for running efficiency and coordination, children who are two years old will have better ability to stand on one leg while clearing the other foot, and they are better at lifting their legs up and forward during walking. Base of support will continue to narrow during this stage.

By three years of age, children have gained the strength, upright posture, and limb coordination to walk similarly to adults. They might still stand and walk with different joint motions than adults, but this is more due to structural differences than anything else.  As their muscles and bones mature, children’s ambulatory abilities will improve as the forces of gravity and daily activity slowly elongate and strengthen the structures needed to perform adult walking. Of course someone who is seven years old cannot walk with the same speed and step length that an adult can, but they come pretty close.

The orthopedic and neurological changes that occur in a baby to enable him or her to walk are complicated.  It takes years and lots of practice for a mature walking pattern to develop in a child. Parents often ask whether or not their child is walking “normally.” That analysis depends on the child’s age, medical history, and family history. Studies have shown that adult gait is present in children by 7-8 years of age. A child can come into physical therapy with a variety of deviations (from flat feet, in-toeing, to toe-walking, to frequent falling). It is only through careful observation and assessment of their gait cycles that physical therapists can help these children achieve the optimal pattern.

Reference:

Stout, JL. Gait: Development and Analysis. In: Campbell SK, eds 3. Physical Therapy for Children. Philadelphia, Pa: WB Saunders Co,2004 :161-167.

Keen M. Early development and attainment of normal mature gait. Journal of Prosthetics and Orthotics 1993; Vol 5, Num 2, p 35. Available from: http://www.oandp.org/jpo/library/1993_02_035.asp; 2014 [accessed 31 March 2014]






Arm with kinesiotape

What is Kinesio® Tape and why is it used on children?

Physical therapists and occupational therapists often use Kinesio® Tape on their clients as an adjunct to therapy. So what is Kinesio® Tape? You might have seen this colorful tape on Olympic athletes in various locations and various patterns. It is an elastic tape that has multiple purposes depending on where and how it is applied. It is often used to reduce pain, swelling, improve strength, encourage optimal alignment, and decrease muscle fatigue.  Kinesio® Tape can be used at full tension like regular athletic tape. However, it is the elastic qualities of Kinesio® Tape that make it therapeutic.

Properties of Kinesio® Tape:

-Latex free
-Variable tension depending on function
-Adhesive is medical grade acrylic and heat sensitive
-Allows for free movement instead of restricted movement like regular athletic tape
-Similar elasticity as human skin, so it can stay on for days to maximize its full effect

Purpose of Kinesio® Tape:

-To hold a joint in optimal position to help an overstretched or overworked muscle to rest and return to its most efficient length.
-Keeping a body part in better alignment helps the muscles contract and work in a less stressful fashion during daily activities.
-To increase input to the skin around a specific muscle or joint. With this new proprioceptive input, more awareness of that body part leads to more strength.
-To help relax an overused muscle which helps reduce pain and swelling
-Improve lymphatic flow and reduce edema and bruising, allowing for accelerated healing

Who can benefit:

People with a variety of orthopedic, neuromuscular, or medical conditions, such as:

-Cerebral Palsy
-Conditions with weakness or paralysis of a certain body part
-Down Syndrome
-Gross Motor Developmental Delay
-Children with gait abnormalities such as toe-walking, flat feet, hyperextension, etc.
-Low muscle tone
-Decreased coordination
-Brain injury
-Torticollis
-Lymphedema
-Painful orthopedic injury
-Poor posture
-And many more…

Not only is Kinesio® Tape safe for use on children, I have found Kinesio® Taping to be extremely beneficial and valuable to my clinical practice.  This elastic tape can be left on for 3-4 days after application. Often times, I put it on at the end of a session to help my clients retain the gains we made during the session. In a way, it improves carryover from week to week, and brings the physical effects of therapy home. With babies, this “reminder” is especially important, as they are still working on their neuromuscular control and cannot make a conscious effort to contract a certain muscle or hold a specific position during their play activities. With children, the colorful tape gives them a fun visual cue to increase use of a certain body part and strengthen those all important neuromuscular connections.

Reference:

Kase, K, Martin, P, Yasukawa, A. Kinesio®Taping in Pediatrics. 2006. Kinesio® USA , LLC. 16-19.


types and presentations of cerebral palsy

Types and Presentations of Cerebral Palsy

In last month’s blog about cerebral palsy (CP), I talked about the neurological condition and what can be improved by working with a physical therapist. This week, I am going to delve deeper into the condition and explain why some kids with CP are so different from one another.

Cerebral palsy has many classification systems. Medical professionals use these systems to understand and manage a child’s symptoms and help plan their treatment.

As stated previously, cerebral palsy describes a brain lesion that occurred in utero or around the time of birth.   Much like a brain injury, CP can be classified based on severity level, location of lesion, body part affected, change in motor control, and how gross motor function is affected.

Classification of CP Based on Level of Severity:

This is a common method of categorizing children with CP, used by doctors and parents alike, though it provides relatively little information. Parents and doctors use this classification system as a simplified communication tool to describe the exact level of impairment.

  • Mild: Having mild CP means a child can move independently and without assistance from people or equipment. He can complete his daily activities without any limitations.
  • Moderate: A child with moderate cerebral palsy will need braces, medical interventions, and adaptive equipment to do functional things, such as walking and keeping up with peers.
  • Severe: A child who will require a wheelchair and who will need quite a bit of assistance to accomplish daily activities is said to have severe CP. Often times, severe cases have multiple equipment needs, and simple things such as eating or sitting alone can be a challenge.
  • No CP:  Some children display cerebral palsy signs though the brain injury occurred after the time of birth, and therefore is classified under traumatic brain injury or encephalopathy.

Classification Based on Topographical Distribution (Body Part Affected):

When trying to plan treatment protocol for a child newly diagnosed with CP, many therapist and pediatricians like to know which body parts are affected and how they are affected. Is one limb weakened (paresis) or paralyzed (plegia)? How many limbs are affected that way?

  • Monoplegia/monoparesis – Only one limb is affected.
  • Diplegia/diparesis – When the legs and the lower body are more affected than the arms
  • Hemiplegia/hemiparesis – The arm and leg on one side of the body are affected.
  • Paraplegia/paraparesis – Only the legs are affected.
  • Triplegia/triparesis – When 3 limbs are affected, or 2 limbs and the face
  • Double hemiplegia/double hemiparesis – All four limbs are affected, but one side of the body is more affected than the other.
  • Tetraplegia/tetraparesis – All 4 limbs are affected, but three limbs are more affected than the fourth.
  • Quadriplegia/quadriparesis – All four limbs are impacted.
  • Pentaplegia/pentaparesis – All four limbs involved, as well as the neck and head.

Classification Based on Motor Control:

What is motor control? It is the body’s ability to voluntarily control limb and joint motion.  Muscles are controlled by the nervous system and abnormal contractions (too much or too little) often occur with brain lesions. Cerebral palsy is often a complex condition. It is possible to have variable muscle tone or a mixture of motor control presentations.

Spastic CP – indicates increased muscle tone, the most common type of cerebral palsy.
Non-Spastic Cerebral Palsy – characterized by low muscle tone or fluctuating muscle tone, or involuntary movements.

When muscle tone is affected, the movements and power needed to move the joints are often affected as well.

Hypertonia/hypertonic – describes increased muscle tone and is often associated with spastic cerebral palsy.  The child may present with stiff limbs, muscles that seem tight, or decreased ability to open his hands or straighten a limb.
Hypotonia/Hypotonic – often used to describe low muscle tone, and can be seen in diagnoses outside of CP. A child’s limbs or trunk may seem hard to control and “floppy.”

Some children’s cerebral palsy can actually be mixed in presentation, where some limbs are affected by spasticity and others are non-spastic.

Classification Based on the Gross Motor Function Classification System (GMFCS):

The last system of categorizing CP is a five-level system that describes the severity of impairment and limitations a child experiences with the condition.  Higher numbers mean a child is able to achieve less activities on his own.

GMFCS Level I – the individual walks without limitations
GMFCS Level II – walks with some limitations, including long distances, running, jumping, and balancing.  They may need devices when first learning to walk, up to age 4, and may need wheeled mobility when travelling long community distances.
GMFCS Level III – walks with an adaptive device.  Assistance is needed to walk indoors and wheeled mobility needed outdoors.  The individual can sit independently or with some external support.
GMFCS Level IV – the child is independent with powered mobility (motorized wheelchair) though need support when sitting. He may be unable to push himself in manual wheelchair.
GMFCS Level V – the individual shows significantly limited head and trunk control. Much of his mobility will need assistive technology or physical assistance.

A more expansive copy of the GMFCS system can be viewed here.

Why so many classification systems?

Most cerebral palsy specialists, health professionals, and parents will need guidance and direction when approaching a child with cerebral palsy. Knowing whether or not a child has low or high tone will determine equipment needs. Knowing the severity level will help physicians plan out need for future treatments and care options.  Understanding whether a child has spastic or non-spastic CP will help tell neurologists and neurosurgeons which part of the nervous system is affected. Having a better grasp on the type and location of lesion will help the medical team prepare for long term associated conditions of cerebral palsy, such as hip dislocation, scoliosis, joint contractures, or seizures.   It is important for therapists to know whether a child with CP has difficulties with muscle tone, muscle control, hand-eye coordination, balance, stiffness, or muscle strength.

The Gross Motor Function Classification System (GMFCS) is used by researchers and clinicians alike and is applicable to all types of cerebral palsy. While other classification systems describe what a child is limited by, the GMFCS places more emphasis on what a child can accomplish. Therefore, parents can use this system to understand how their children will progress over time.

Classification is very important in the treatment of the young child with cerebral palsy, and multiple classification systems help therapists and specialists create individualized plan of care for those children and families impacted by the condition.

Reference:
Types and Forms of Cerebral Palsy. MyChildTM at The Cerebral Palsy Organization website. Available from: http://cerebralpalsy.org/about-cerebral-palsy/types/; 2014 [accessed 18 March 2014]

World Health Organization Development Study Results: Gross Motor Milestones In the First Year

 

The line between typical and atypical development can be a hazy one. There are standards that pediatricians, physical therapists, and developmental experts use to monitor growth and deviations from the norm, which allow us to recommend interventions when appropriate.  In 2006, the World Health Organization (WHO) released a whole new set of standards for evaluating and assessing the development of children from birth to 5 years.

What makes this new standard a great tool to monitor the change and growth of infants? This standard is based on data collected from healthy children, over multiple years, in six diverse geographic regions including Southeast and Southwest Asia, Europe, West Africa, North and South America. What is exciting about the new evaluation tool is that now, pediatric specialists have more than just reference curves for physical growth, but curves for motor development as well.

The six gross motor milestones WHO examined in babies were the following:

1.    Sitting without support
2.    Standing with assistance
3.    Hands-and-knees crawling
4.    Walking with assistance
5.    Standing alone
6.    Walking alone

The “windows of milestone achievement” were organized into percentile rankings which pediatricians and physical therapists can use, much like a growth chart.

Without delving too deep into statistics and calculations, the typical age range (in months) for each milestone is listed below:

1.    Sitting without support: 3.8 – 9.2 months
2.    Standing with assistance: 4.8 – 11.4 months
3.    Hands-and-knees crawling: 5.2 – 13.5 months
4.    Walking with assistance: 5.9 – 13.7 months
5.    Standing alone: 6.9 – 16.9 months
6.    Walking alone: 8.2 – 17.6 months

The average (mean) age for healthy children achieving each milestones is as follows:

1.    Sitting without support: 6 months (with 1.1 month standard deviation, SD)
2.    Standing with assistance: 7.6 months (with 1.4 month SD)
3.    Hands-and-knees crawling: 8.5 months (with 1.7 month SD)
4.    Walking with assistance: 9.2 months (with 1.5 month SD)
5.    Standing alone: 11 months (with 1.9 month SD)
6.    Walking alone: 12.1 months (with 1.8 month standard deviation)

(Click here to view this information in chart form from WHO.)

What is most interesting is that about 90% of the children studied met their milestones in a common sequence, and only 4% of the children skipped hands-and-knees crawling.  (Read here about the importance of crawling.)

As you read over these standards and timelines, remember that every baby develops differently from another. If you see your baby fall behind on any of the 6 gross motor milestones above, mention it to his pediatrician, and she will most likely recommend a physical therapist to help him along.



Reference:
WHO Multicentre Growth Reference Study Group.  WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatrica, 2006; Suppl 450: 86-95.

The Power of Yoga for Children

Yoga has become an increasingly popular form of exercise over the past few years. So much so that on every street corner there seems to be a new yoga studio advertising a variety of classes and programs. Yoga is practiced by people of all ages and skill level. The benefits of yoga, especially for children, are countless. Below are four of the reasons children should practice yoga.

1. Motor Planning

Yoga poses vary in complexity. While your child twists and turns their body to match the pose of the group, they are creating motor plans in their brain for these movement patterns. Creating and refining these plans are what help a child to improve their overall coordination. For children just learning the practice of yoga, try to practice poses where they hold the left and right sides of their body in the same position (down dog, cat, cobra). Once your child is able to efficiently assume these poses, try a few that require them to move the left side of their body differently than their right (triangle, tree, or warrior poses).

2. Strength and Endurance

Once your child has motor planned their way into a yoga pose, encourage them to freeze in that position for a predetermined duration of time without losing their balance or dramatically swaying from side to side. As their body endurance and balance improve, increase the duration they are required to sustain the position. Holding these static poses will help to improve your child’s muscle endurance.

3. Attention

Sustaining poses for predetermined durations can also help to improve your child’s attention. Holding the same pose with a steady and still body for even three seconds may prove to be a challenge. Try to choose a duration of time for your child to hold a pose that challenges their attention but that they also have a chance to be successful in completing. Once they master the ability to hold a pose for a shorter duration of time increase the challenge by a second or two to see if they can maintain a still and focused body.

4. Social Skills

Yoga can be a challenging form of exercise but it can also be a lot of fun. Working together with friends or classmates to practice and refine yoga skills offers vast opportunities for promoting social skills including flexibility of thought to participate group classes, active listening, turn-taking, imitating and replicating group dynamics, and identifying personal role in group activities.

In the coming weeks, especially while it’s still cold outside, look into kid-friendly yoga classes in your community. If you would rather, there are also some excellent videos and yoga cards that you can use in the comfort of your own home. “The Yoga Pretzel Cards” by Tara Guber and Leah Kalish are an excellent tool for practicing yoga with really colorful illustrations for kids to practice with. No matter the way or place you choose to do yoga, remember the cardinal rules for practice: breathe in, breathe out, and namaste.



 

Important Gross Motor Milestone: Jumping

Sometime between the 18th and 24th month, children start learning to jump. Eager parents often ask when to expect their child to jump with both feet off the ground. The simple answer is, every child is different. Of course, we as physical therapists and developmental experts will become concerned if a child is still making no attempts to jump by 2.5 to 3 years. However, what parents should know is that there are many reasons a child could be delayed on a particular gross motor milestone.

Usually, after 6 months of walking independently and participating in typical play (such as climbing on/off furniture, walking up and down stairs with help, and running on various surfaces) a child will have developed the strength and balance needed to jump without falling. When she first starts jumping, she might push off with one foot only and jump down from a low step without help.  By 2 years, a typically developing child can most likely jump forward 3-4 inches while maintaining her balance, with both feet.  She should also be able to bend her knees, with feet together, and propel herself upwards to try to touch something up high.

When to seek physical therapy interventions:

Around 2.5 years of age, if your child continues to show difficulty with jumping and shows any of the following, it is best to bring her into physical therapy so we can check out her alignment, strength and balance, and give her strengthening exercises as needed.

  • Asymmetrical jumping: A typically developing child does not show side-preference until preschool age. If you notice your child always pushing off and landing with one side, seems to drag one side or hold it stiffly, or if one side barely participates in the initiation of jumping, it’s good to mention it to your doctor at her 24 months check-up.
  • No power during push-off: If your child prepares to jump by initiating a squat but then her feet barely leave the floor, her leg muscles may not be strong enough yet to fully propel her weight forwards or upwards.  Or, she might not know how to best coordinate the beginning and end of the activity. If she prefers to step off a low surface or step over an obstacle instead of jumping, she is showing weakness in her legs, especially her thigh and hip muscles.
  • Frequent falls: If she crumbles to the floor or if her knees buckle every time she lands from a jump, or if she falls on purpose when trying to jump, your child may be showing that her body is just not ready for this milestone.
  • Increased anxiety or behavioral resistance to the task: Does your 3 year old hesitate with apprehension, ask to be picked up, or ask for a hand any time she’s encouraged to jump down or over something on the ground? Does she throw a tantrum or flops to the ground if you don’t help her?

All of the above could mean something is keeping a child from jumping. There could be a visual discrepancy or a depth perception issue that can be addressed with occupational therapy, an anxiety/comfort matter that can be addressed by social work, or a deeper issue that can only be attended to after a thorough evaluation by a developmental expert.

What a Diagnosis of Cerebral Palsy Means for Your Child

For new parents whose children are diagnosed with Cerebral Palsy (CP) and parents whose children with CP are nearing school age, understanding the diagnosis, prognosis, and the interventions available is often their top priority.  Being a first-time parent is challenging enough, and for many parents looking for answers, a medical diagnosis provided by a doctor often leads to more questions.

What having Cerebral Palsy means for your child:

Cerebral Palsy is a broad term used to describe a neurological condition that impacts physical functioning in children. The presentation of CP in individuals affected is highly varied in terms of severity, symptoms, and deviation from typical development.  The condition itself is explained by a brain lesion that occurred in utero or around the time of birth (such as an in-utero stroke, brief oxygen deprivation before birth, or a birth trauma to the young brain).   The neuromuscular system is affected, leading to motor impairments that hinder a child’s voluntary muscle control. Put simply, a child’s ability to control his trunk and move his body parts become limited.

Muscles and our brain’s ability to control them are a huge part of our physical function, from our vision and speech, to our sense of balance. This impaired control and coordination of voluntary muscles affects children in a variety of ways, depending on the location, timing, and severity of the brain lesion.  Much like a brain injury can affect a mature individual’s ability to control his limbs, a lesion in the immature brain often leads to decreased postural control and delayed physical development.  The lack of motor control is not always, but is often correlated with cognitive delays and learning disabilities, speech delays, visual or auditory impairments, and seizure disorders.

There are many misconceptions in the general community about children with CP.  Many people think CP is associated with mental delays and poor independent functioning. This is simply not the case for everyone with cerebral palsy.  Cerebral Palsy is often classified in different ways based on the movement disorder (stiffness, rigidity, low tone, uncontrollable movement, etc) observed. No matter the diagnosis or presentation, a team of healthcare professionals is absolutely essential to improve the lives of children and families affected with cerebral palsy.  It is important to begin a treatment program as early as possible to ensure a child develops to his or her full potential.  Sometimes, a child with CP may need surgery, orthotics, assistive technology, early intervention therapy, or medications, to improve their function and independence.

The role of the physical therapist:

One of the first steps to take after receiving a diagnosis of cerebral palsy is to discuss with your pediatrician and your child’s medical team about the interventions currently available and the interventions needed long-term. Often times, physical therapy becomes an indispensable part of a child’s medical care. Physical therapists will develop a plan of care based on the child’s abilities.

Our goal as physical therapists is to improve a child’s independence by doing the following:

  • Teaching him to move and play while protecting his joints from abnormal movements/postures
  •  Helping him strengthen muscles that are weak, keep stiff joints mobile, and stretch out muscles that are tight
  •  Fitting him for special equipment to help him stand, walk, and participate in school and life activities as needed
  •  Working with his family and caregivers on adaptive techniques and changes to their home or school environment, to allow him to interact with other children and participate in daily tasks
  •  Addressing his limitations and movement disorders by improving his posture, walking mechanics, endurance, and pain
  •  Accommodating for his changing needs as he matures and as new challenges arise, and
  •  Providing the child and his family emotional support, healthcare references, and professional insight to help him transition into adulthood.

Every child with cerebral palsy develops differently. The importance of early therapy is to help a child live up to his full potential with this neurological condition.

Reference: Olney SJ, Wright MJ. Cerebral palsy. In: Campbell SK, eds 3. Physical Therapy for Children. Philadelphia, Pa: WB Saunders Co, 2004 :625-664.