Archives For physical therapy

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?



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.

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.


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.

What’s in a Bucket?

March 5, 2013 — 1 Comment

Everyone thinks you have to buy the most expensive, elaborate toys out there to provide well for your children.  I disagree.

What's in a bucket?

What’s in a bucket?

I think having a few strategic classics will provide endless opportunities for imagination, learning, creativity, and fun!  Today’s pick: a bucket!  Buckets come in all shapes, sizes, and colors, with handles, without handles, there are so many to choose from.  And what house doesn’t have a bucket?  If you don’t think you have one, look closer.  Mom’s Tupperware drawer is a good place to start.  The cabinet of pots have many sized “buckets”.  And dad’s garage must have a can or bucket of some sort that could be shared.  Here are the activities I have used with buckets, baskets, barrels, pots, and containers.

  • Throw a ball or bean bags into a bucket.  Or even better, play basketball!  To incorporate your child’s therapy goals into her play, have her stand on a “mountain” (aka: pillow, piles of blankets, sofa cushions, etc.) to challenge her balance while playing ball.  This can also be used to practice her catching.  You can stand by the bucket and toss her back the ball or bean bag.
  • Make “soup” in your bucket with play food or animals placed on other side of room.  I frequently have kids walk through an obstacle course for my bean bag frogs to make “froggy soup” and then we “stir” it up with a stick or dowel (or a pretend spoon if there is nothing else available).
  • What young child doesn’t love the anticipation of dropping a marble down a spiraled pop tube or even a paper towel tube?  It’s a great cause and effect learning tool waiting for the marble to hit the bottom of the bucket.  To slip in his therapy goals, have him reach way up high to grasp the marble or to put in the pop tube to encourage extending his back.  Or if he is working on strengthening his legs, have him reach up high onto his tippy toes for each marble.Buckets 021
  • If you have multiple buckets, you could stack them up, have action figures hiding inside and launch the flying monkey or roll a ball at it to knock them all over.  I have some kiddos I treat who will do anything to make something crash!
  • Play dress up!  Use a bucket as a top hat, or a purse, or a construction bucket of tools.  Your child’s imagination will take him on all kinds of adventures!
  • Go outside and play!  Take that bucket outside with a shovel or wooden spoon and dig, dig, dig!  Take it to the beach and make a sand castle, or collect sea shells!  Use the bucket to sneak up on someone and pour water on them on a hot summer day!
  • Help dad in the garage!  I know as a kid, my brother and I loved to hang out in the garage with Dad.  He would give us little projects, like sorting his nails, screws, and bolts.  Doesn’t sound like too much fun to us adults, but to kids, they love to explore the grown up world.  Have your kiddo sort anything into buckets or cans, whether it is nuts and bolts, beads, macaroni, beans, etc.

That’s just with a bucket!  Imagine what your kids can come up with.

What activities have you used with a bucket?  What are your kids’ favorites?  Comment to share!  And as always, have a great day!

“You are going to do this in my home?” Why yes, yes I am! I am now providing physical therapy services to children in their homes and communities! I am so excited about this adventure! There are so many benefits to having home-based therapy services and here are the top 10 benefits of having therapy at home:Kyler03

  1. Convenience! Your therapist comes to you, so you don’t have to round-up all the kids, pack them in the car, drive across town (or the vast desert in our case), and sit in a waiting room. He or she comes right to your door in the convenience of your home.
  2. What we do in therapy can be done at home! So many times in the clinic, parents think, “Well that’s wonderful you can get him to do {enter gross motor skill or task} here in the clinic, but how can I get him to do that at home?” The “clinic” now is your home, so your therapist can help you help your child succeed at doing {enter gross motor skill or task} inside your home. Your therapist will utilize what you have around the house to make you and your child succeed!
  3. Privacy! You won’t have to worry about running into that nosey co-worker in the parking lot wondering what you are here for. In the privacy of your home, only those you are closest to will be present for your child’s treatment.
  4. Motivating! You and your family can all be cheerleaders for success. Even the family dog can be used as a motivator during therapy sessions.
  5. Functional! If there is a particular task your child is having problems with at home, you can show your therapist exactly what that task is. Maybe she has trouble climbing into her bed . . . well, she can work on it in the real-life environment of her bedroom!
  6. Comfort! Many children may become nervous about going into a medical clinic because they associate it with getting shots at the doctor. Not so when the therapist comes to the home. Your therapist will be on your child’s turf instead of the other way around.
  7. Everyone can be involved! The entire family is welcome and encouraged to join in during therapy sessions. It makes it more motivating and natural when siblings are there to play with, or grandma can help with an activity.
  8. Community! Not only can you have therapy sessions at home, but in the community as well. Maybe the stairs going up into church are cumbersome . . . well let’s meet at church so your kiddo can work on that goal. Or your kiddo has trouble going down the slide on the playground . . . let’s meet at the park. There are endless opportunities: bowling alley, hiking trails, beach, school, grandpa’s house, etc.
  9. Collaboration! Does your child need new orthotics (braces)? Or a new wheelchair? Your therapist can meet you at the orthotist’s office, or help the wheelchair supplier with measurements and customization of your kiddo’s new wheelchair. It is very beneficial to have your health care providers work hand-in-hand!
  10. Safety and Health! Being in the comfort and safety of your home is vital for children who are chronically ill and fragile. When your therapist meets at your home, your child is not exposed to the germs of everyone who has been in the clinic waiting room. He or she is also not exposed to the extreme temperatures outside or the wind and allergens in the air during transport.

What benefits do you see with having therapy in your home? What locations in the community would be the most fun to meet for therapy? Comment your ideas! I would love to hear them!

Welcome to My Web Log!

February 25, 2013 — Leave a comment

_MG_4642Welcome to my very first post!  I am Tricia McNeil and my passion is in my profession as a pediatric physical therapist.  I just began my own business (called Therapy Accomplished, check it out!) providing pediatric physical therapy to children in their home or community environment.  It is quite the adventure I am starting!

In addition to starting my business, I decided that I want to start this Web Log {aka: Blog} to share information with others.  I plan to share a variety of information I have learned or researched that can help families, specifically families with a child with special needs.  I also want to provide a place for therapists to use to get ideas to encourage the children and families they treat.

This may include:

  • Great books for families and/or therapists,
  • Classes that are in the community for parents and/or therapists,
  • Community events for children,
  • The best toys,
  • The best (and worst) equipment for babies and/or children,
  • Topics on gross motor skills,
  • Fine motor skills,
  • Behavior,
  • Specific diagnoses in the media,
  • Etc.

It will definitely be a work in progress!

If anyone reading this knows me, they know I love to learn . . . about everything!  I love the process of learning and growing with the new knowledge I have gained.  I have so much to learn in the blogging world, as I am very new to it.   I hope to get others excited about the world of learning and obtain new knowledge that will help them succeed.

What information are you interested in learning about?  Or what is something new you learned recently that you wish you could share with the world?  Please leave a comment to share.  I’d love to hear from you and hope to see you here often.