Toe walking is a pattern of walking wherein a child walks on the balls of their feet, with no contact between their heels and the ground. As our Fort Myers physical therapy team can explain, it’s common among children who are learning to walk, but most kids outgrow it after age 2, when they assume the typical heel-to-toe gait.
However, when toe walking persists beyond that, it could be a sign of an underlying medical condition, such as cerebral palsy, muscular dystrophy or a spinal cord abnormality. (Children with autism spectrum disorder and related conditions often toe walk more frequently, but there isn’t any direct link between the two conditions. There is some speculation that it’s related to sensory issues.) Sometimes, the causes are idiopathic, meaning we don’t know why it happens.
In any case, regardless of the cause, toe walking can result in complications. Children who spend a lot of time on their toes can develop stiffness, tightening and pain in their Achilles tendon and calf. In turn, this can lead to poor range of motion in the ankle, which is going to have a snowball effect. This can be treated by our Fort Myers physical therapy and occupational therapy teams.
Proprioception is a medical term that refers to the body’s ability to sense itself. It is the sense that allows us to perceive the location, movement and action of our own body parts and their relation to external objects and forces around us. Our FOCUS physical therapists usually explain it with a simpler term: Body awareness.
Proprioception is what enables us to judge how we move and position our limbs, how much force to use and how best to balance. An example might be one’s ability to kick a ball or walk without looking at your feet, move a spoon to your mouth without looking at it or touch your nose even though your eyes are closed. It’s closely tied to our ability to control our movements, and it’s guided by the body’s receptors (skin, joints, muscles) that connect to the brain via the nervous system. Vision can play a role in proprioception, but it’s not inherently necessary. In fact, some evidence suggests it’s already present in newborns.
Many things can impact proprioception. Drinking alcohol is one example. (That’s why one of the standard field sobriety tests involves testing the ability to touch your nose while you’re standing on a single foot.) Some injuries and certain medical conditions can impact it too. Our physical therapists at FOCUS have treated many kids whose parents and caregivers report them to be “clumsy,” “uncoordinated” or “sensory seeking.” They might report their child is pressing too hard on the paper when writing or unable to apply the right amount of pressure for tasks like brushing their teeth or hair.
Often what these kids are experiencing is proprioceptive dysfunction.
Identifying, Treating Pediatric Vestibular Dysfunction Involves Occupational, Physical Therapy Collaboration
Once upon a time, vestibular dysfunction in children was thought to be exceptionally rare. Our occupational and physical therapists know, however, that pediatric vestibular disorders, which affect as many as 35 percent of adults, are increasingly being identified earlier than ever. Symptoms include chronic dizziness and imbalance. In children, vestibular system disorders can also cause problems in early development, impacting:
- Ability to maintain an upright position when sitting;
- Delays in crawling and walking;
- Difficulty with steady vision when moving the head (for example when copying words or letters at a chalkboard when seated at a desk);
- Diminished balance and motor function.
Long-term, this can have significant and painful social, educational and economic impacts for kids. Professionals on our FOCUS Fort Myers occupational and physical therapy teams are committed to identifying and addressing these issues early on, promoting the highest possible level of relief and function and ultimately mitigating the worst adverse impacts.
What is the Vestibular System and How Do I Know if My Child’s is Dysfunctional?
Many parents think of crawling as the simple progression between head up/rolling and standing up/ walking. But as our FOCUS Fort Myers pediatric physical therapists can explain, crawling is in fact a major motor milestone requiring strength, coordination and motor planning. It is the first step toward independent mobility, which in turn will open new worlds and discoveries as well as lead the way to increasingly more complex movement.
Crawling is one of those skills that requires a child to use both their mind and body. The muscles in the arms, shoulders, neck, back and core need to be strong enough to support one’s weight. Vision is also key, as both eyes are needed to focus on a single target. Mentally, a crawling child is working to memorize facts and build navigation skills (“How can I get past the chair and around the coffee table to get to the toy box?”)
Although every child develops at a varying pace, most babies learn to crawl by about 6 and 10 months. Some babies breeze right on past crawling and go straight to pulling up and walking (read more below about our physical therapists’ take on this). So while each baby is different, we do encourage parents to ask their pediatrician or one of our FOCUS Fort Myers pediatric physical therapists if your baby hasn’t shown steady progress in becoming mobile by the time they reach 12 months. It may also be worth asking if early intervention is needed if his or her “crawl” tends to involve dragging one side of the body.
Premature babies (aka “preemies”) born earlier than the 37th week of pregnancy, are more likely to survive today even compared to the 1990s – and they are more likely to have less severe disabilities. That’s according to research published in the British Medical Journal. Globally, about 15 million babies every year are born before the 37th week, placing them at higher risk for conditions like cerebral palsy, delayed language, speech and motor skills. Study authors further concluded preemies who receive early intervention therapy have a much better chance of catching up to their peers.
Preemies are already starting out behind the curve. The earlier a baby is born, the higher the risk of serious illness and disability. The U.S. Centers for Disease Control and Prevention reports preemies who survive those early weeks and months in the NICU (neonatal intensive care unit) may still struggle with breathing trouble, intestinal/digestive problems (including feeding and swallowing) and developmental delays. About half of all children born more than eight weeks early or at a very low birth weight develop problems with language, learning and executive function.
As our FOCUS Fort Myers therapy team can explain, early intervention therapy involves a combination of separate but interrelated services, tailored to meet the specific needs of each child, with the core aim of helping a child develop skills that will allow them to reach their full potential. This generally includes some combination of speech and language therapy, feeding therapy, occupational therapy and physical therapy. Although many preemies benefit from this therapy up to age 5 and sometimes beyond, commitment to therapy now reduces the struggles preemies will face down the road.
If there was ever such a thing as a real-life Santa’s workshop for children with disabilities, it’s probably a bit closer to the equator than the North Pole. At the University of North Florida, pediatric physical therapy students have been partnering with those in the school’s engineering program, pooling their talent to create specialized toys for children with special needs.
The Florida Times-Union reports the pediatric physical therapy students have been working to help develop solutions from battery-powered ride-on cars for children with mobility issues to voice-activated toys for children who need speech therapy to electronic fidget cubes for high school students with autism.
Our FOCUS Fort Myers pediatric physical therapy professionals applaud the UNF Adaptive Toy project, first started in 2014 to help meet the needs for toys for local children with disabilities. The program has already become a model for nearly a half-dozen higher education programs across the country, with professors of electrical engineering and physical therapy at the college leading the way. Since the program was first launched, it has produced 31 cars for children with special needs, and two new toys were added just this year.
The pediatric physical therapy and electrical engineering students are continually working to resolve glitches and dream up ideas for new toys, specifically for children who suffer from disabilities such as cerebral palsy, genetic disorders and spinal muscular atrophy.
Popularity of youth sports has exploded in recent years, and that’s great news for public health. However, it has also meant an uptick in child sports injuries – especially knee injuries like ACL tears. FOCUS Fort Myers physical therapy can help your teen get back on their feet – and hopefully back to their sport – often with a few months of treatment.
The Cleveland Clinic reports it’s not just boys but girls too who are suffering sports injuries, as their participation rates have spiked. The hospital reports male and female injury rates are about the same these days, with 40 percent of all child injuries requiring emergency department treatment now being sports-related, amounting to roughly 4.4 million annually.
Our FOCUS Fort Myers physical therapists know sometimes child sports injuries are worsened when coaches or teammates trivialize them, urging the youth to just play through the pain and stay tough.
Chronic constipation is a crappy problem – one common among all children, but especially prevalent among children special needs. Pediatric physical therapy at FOCUS Fort Myers may help, using exercises to strengthen pelvic muscles and improve posture.
We know this can be an uncomfortable issue to discuss, but if it’s causing your child pain and difficulty on a regular basis, it’s one that requires attention because it’s essential to good health. The Journal of Pediatrics reports constipation among children with autism is associated with increased emergency department visits and inpatient admissions. Depending on the underlying cause, pediatric physical therapy may help alleviate the problem. Occupational therapists, ABA therapists and even speech therapists can also collaborate on solutions.
Constipation involves either the inability to pass stool or problems that make it not as easy or frequent as one would like.
One analysis published in the journal Gastroenterology examined more than 50 school-age children suffering from functional constipation, all of whom were receiving the “standard” treatment for chronic constipation, which included potty training, education and laxatives. Half were randomly chosen to also receive pediatric physical therapy. Six months later, more than 90 percent of the children who got physical therapy no longer suffered from constipation, compared to about 60 percent of those who didn’t get physical therapy.
For scorching summer days, nothing compares to a splash in a cool pool – and Florida has plenty (1.1 million just in private residences alone, according to Florida State University data). For children with special needs and developmental delays, Fort Myers physical therapists know swimming has benefits far beyond simply tempering the heat.
The unique properties of water – the buoyancy, the resistance and all-encompassing nature – are proven to help improve muscle tone and overall strength, balance, posture. coordination, flexibility, motor planning, gross motor skills and sensory regulation.
In fact, physical therapists have developed an entire branch of treatment, known as aquatic therapy, which is know to be especially effective with younger clientele. Physical therapy can be hard work, tough on the joints and muscles. Working in the water serves as a sort of cushion, reducing discomfort and pain and making children less reluctant to fully engage. Also, it’s just fun to be in the water! Although FOCUS Fort Myers does not currently offer aquatic therapy, our physical therapists can offer parents and caregivers tailored exercise ideas to practice with their kids while playing in the pool. (Bonus: They’ll be having so much fun, they won’t even realize they’re “working.”)
A child who struggles to explore their environment on the same level of their peers due to a gross motor delay may struggle on other fronts too, including cognitive development and behavioral challenges.
Recently, the journal Physical Therapy published a study determining that gross motor delays were associated with problem daytime behaviors and quality of life issues for children with autism spectrum disorder. Researchers examined cross-sectional, retrospective data of more than 3,200 children between the ages of 2 and 6 diagnosed with ASD. They found that children who struggled more with gross motor skills had more daytime problem behaviors. So when the goal is targeting problem behaviors for children with ASD, researchers concluded it’s important not to overlook the possible need for physical therapy.
Children with a wide range of conditions and diagnoses may have gross motor delays, which are those skills involving the large muscles of the arms, legs and torso. Gross motor skill delays might become apparent when a child is learning to crawl, sit, walk, run, throw a ball or balance. All kids reach developmental milestones at varying increments, but those who are far behind can benefit from physical therapy to help them catch up.
Gross motor skill delays can be linked to any number of conditions – or may exist independently of anything else. Untreated, these delays can impact your child’s ability to reach their full potential.