Archives For exercise

Let’s Talk About Toes

April 17, 2014 — 5 Comments

This is a guest post by Shannon Kinne, a student physical therapist assistant who is on her last clinical rotation with me.  Enjoy her blog on Toe Walking and comment below on your thoughts and ideas about Toe Walking.  A special thanks goes out to her adorable niece, Madison!  Thanks for being our model!

Toe walking in children can be normal as a child is developing from infant to toddler.  Developing children up through approximately age three can have the inability to strike first with their heel during their gait cycle (medical term for “walking”) as they learn to walk.  You may have seen older children still walking on their toes.  There is not one solid answer for this; therefore, it is important to look into the reasons that may contribute to toe-walking.

Toe Walking

It is important to know that even if a child continues to keep walking on their toes as they get older, it does not mean they have an underlying serious condition.  Children older than three who do not show signs of neurological, orthopedic or psychiatric disorders may walk on their toes due to generalized stiffness of connective tissue, muscle weakness, nerve related issues or a mixture of them.  The main cause for concern in these cases would be muscle soreness, tightening and pain in the calf and in their Achilles tendon.  Constant shortening of the Achilles tendon and/or gastrocnemius and soleus muscles (calf muscles) could turn into contractures (shortening and hardening of a muscle) if left untreated.

Treatments for these types of conditions can depend on the severity of the problem.  Physical therapy and even at home stretching can help to re-train a muscle and assist them into a more normal walking pattern.  Some fun stretches for kids could be animal walks.  For example; ask your child to do a “bear walk” across the room by coming up onto all four extremities, and attempting to keep their heels pushed down towards the floor as they walk.  You can see the stretch they will achieve as this also puts the child’s foot into a more flexed position.  In more severe cases, a child may require casting or splinting to keep the ankle in a more neutral position allowing a constant stretch and re-training of the muscles.  Surgery has also been an option for some children when lengthening of the tendons and muscles are required.

Madison's Bear Walk Position

In some cases, toe walking can be the result of a neurological disorder.   Often they continue to have full range of motion in their ankle; however, they may be experiencing some form of developmental delay.  There seems to be a high incidence of toe walking with children who may have cognitive or mental disorders.  Children with autism often experience sensory issues in which the brain does not receive feedback telling the body which motion they are performing or position they are in.   Cerebral Palsy and Muscular Dystrophy are other known neurological disorders to cause a child to walk on their toes.  Cerebral palsy is caused by a brain injury or brain abnormality which can affect the body’s control of muscle tone, strength and coordination.  Increased tone or spasticity in a muscle does not allow relaxation of the extremities which can cause the child to come up onto their toes.  With muscular dystrophy, this rare disease causes muscle fibers to break down and muscle weakness which can attribute to the toe walking, and can be one of the early signs and symptoms as they begin to walk.

How do you think toe walking can affect a child in the long run?  What ideas do you have to incorporate “fun play” into the process of rehabilitation?

 

References:

Engelbert R, Gorter J, Uiterwaal C, van de Putte E, Helders P. Idiopathic toe-walking in children, adolescents and young adults: a matter of local or generalised stiffness?. BMC Musculoskeletal Disorders [serial online]. March 21, 2011;12:61.

Anderson, J. M. (2011). Idiopathic Toe Walking. Cincinnati Childrens Hospital Medical Center, 1-17.

Childrens Hospital of Wisconsin. (2014). Muscular Dystrophy. Childrens Hospital of Wisconsin.

Nair, D. (2013). Toe-Walking in Children Could be Sign of Developmental Delay. Mental Health: Counsel & Heal.

Stephen M Edelson, P. (2014). Toe Walking. Autism Research Institute.

 

The purpose of this blog is to provide resources for parents who want to carry over therapy activities with their child at home. The information provided here does not replace therapy or medical care provided by a qualified therapist or medical professional.
 These activities are safe for most children. However, some activities or materials may be inadvisable for children who have certain allergies or medical conditions. It is recommended that you consult your child’s medical provider or therapist before engaging in the activities you have selected.

In Gait/ Walking, Gross Motor Skills , , , , , , , , ,
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How to Convince Kids to do Exercises

August 1, 2013 — Leave a comment

I had a close friend of mine (who is a PT also, primarily works with adults) contact me the other day asking, “Tricia, how do convince a 10-year-old to do exercises?” Now there’s a question! Kids can be very motivated . . . for what they want to do, not necessarily what any adult wants them to do. The said adult could be their parent, grandparent, therapist, teacher, babysitter, etc.

Jenga

I have learned a couple tricks to get the results I need out of children. These ideas are of course age-sensitive, as well as maturity-sensitive.

If the child is a teenager, or at least wants to be older, I always try to pull the athlete talk. I ask them what sports they are interested in. Once they have told me their sport of interest, I tell them that in order to be the best athlete they can be, it is mandatory to exercise to create a strong core, desired flexibility, hand-eye coordination, etc. I tell them that all athletes, whether high school, college or professional, exercise and train regularly. I’ve had several kids, that as long as I remind them of this every now and then, it keeps them fairly motivated.

Of course, the sport talk sometimes only goes so far. I frequently incorporate an obstacle course or game into my exercises. Games with pieces, such as Jenga, Connect 4, Checkers, etc. work great to have your child use stairs, or a stepper (on a stepper, you could do forward steps, backward steps, or side steps), walk along a balance beam (a 2×4 board works good for this), or heel raises to reach up high for each game piece.

With a game like Candy Land, I will place the cards across the room and have the child do animal walks to pick each card. Animal walks can include penguin walks (walking on heels), frog jumps (squat jumps), crab walks (hands and feet with stomach facing the ceiling), inch worm (on hands and feet with stomach down, walk hands out first to lengthen body, then walk feet to hands to shorten body), bear walks (walk on hands and feet with stomach facing floor), duck walks (“walking” in squatted position), tip toe quiet like a mouse, or jumping like a bunny.

Kyler Balance Beam

If you are working on an exercise that requires multiple sets of 10, you could have your child perform 10 sets of the exercise (straight leg raises, bridges, hamstring curls, etc.), then they can take their turn with a game, or blowing bubbles, or whatever activity they enjoy doing. Then repeat.

One trick, I mean “idea”, is to not call them exercises. When it’s time for exercising, say, “Let’s play a game!” Or call it something that encourages your child – basketball training, animal tricks, etc. One of my kiddos always says when therapy is over, “Thank you for dancing with me today!” (even though we may not have “danced”). 😉

These ideas should jump start your child’s exercise routine.

What have you done to encourage your child to perform exercises? Share your ideas in the comments below. You never know, your idea may help another parent or therapist!

The purpose of this blog is to provide resources for parents who want to carry over therapy activities with their child at home. The information provided here does not replace therapy or medical care provided by a qualified therapist or medical professional.
These activities are safe for most children. However, some activities or materials may be inadvisable for children who have certain allergies or medical conditions. It is recommended that you consult your child’s medical provider or therapist before engaging in the activities you have selected.

In Gross Motor Skills, How To, Toys , , , , , , ,
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