“Nate, stand up”. Nathan is five, has cerebral palsy and takes a while to prepare to move his body. Thirty seconds or more can pass between the request to move and getting a response. He is quiet, then there may be a quiver of movement. Sure enough, after some patience, up comes the leg and he rises to standing with only a little assistance. In the context of the classroom, this extra waiting time is surely difficult. Nathan either arrives late to an activity or his aide is lifting and initiating for him throughout the day and a behavioral expectation is set up.
Children with motor planning difficulty need extra time to initiate and carry out their movement. Many of us live in a world where time is scarce and we don’t feel that we have time to wait. On the other hand, starting with the end in mind is crucial and takes a lot of training, repetition and patience. What have you decided to do when faced with this dilemma?
Continue reading “Are You Helping a Child Move Before They are Ready? Thinking About Latency in the Context of Movement.”
Alina loves going to school and spending time with her classmates. She is a first grader with hemiplegic cerebral palsy (GMFCS level 1). Alina’s typical school day involves getting up and down from circle time, getting in and out of chairs at various stations, and moving to get supplies. As a PT coming into the classroom for the first time, you are pleased with the number of activities she joins. However, her teacher shares concern that Alina struggles to keep up with the movement pace of the classroom. How can you compare Alina’s classroom mobility to that of her peers? Is there a test with norms that you can use?
TFTS-N Quick Facts:
- 5-14 years
- Stand-alone test for children in school environments
- Walking at a natural pace
- Timing begins at “go,” not when movement is initiated
- Tape 3m apart on floor
- Face validity: activity of transitioning to/from floor and walking short distance.
- Test-retest reliability: 0.871
- Intertester reliability: 0.988
The Timed Floor to Stand-Natural (TFTS-N) test measures time as a child transitions from floor sitting to standing, walks 3m at a natural pace, turns around, walks back to the starting point and then returns to floor sitting. The sitting position is tailor (criss-cross). Continue reading “How to Use the Timed Floor to Stand-Natural Test (TFTS-N)”
“Jack has had tummy time every day since he was three days old. At first he didn’t like being on his stomach, but now he is happy to play a while in this position. He is interested in lifting his head to get his mouth on his hand. It’s like a game to him.”
In tummy time, we want to see a progression of extension through the baby’s back over the first several months. I’m always in awe and a little surprised at the slow but steady day-by-day progression, especially in the first month. In the first days of tummy time the weight is on the baby’s face and it is not the most comfortable looking position, but exciting changes are on the way!
Continue reading “1 Month: Starting to Lift the Head”
Fin is 3 1/2 months old and is learning to hold a toy between his hands. He can tuck his chin and gaze at the toy in hands for a moment. Why is chin tuck considered an important early developmental milestone?
The three-month-old is discovering postural control in midline. One of the first stabilizing motions is the chin tuck. The baby is able to stabilize the head and trunk in midline and begin to touch his hands together over the chest. He will begin to spend moments looking down toward the hands as they are together. Continue reading “3 Months: Chin Tuck”
Walking from class to the school library, Josh falls to the back of the line. Shortly thereafter, a gap forms between Josh and the rest of his class. He is last to arrive and gets the half-functioning computer that everyone else avoids. As his PT, you are there to observe, problem-solve and treat. The computer lab is a half-minute walk from class. His teacher comments “Is that really as fast as Josh can walk? Has it always been that way?”. Do you have an answer for this question?
30sWT Quick Facts:
- Age 5-17
- natural environment
- walking at natural pace
Josh’s slow walking speed was a major concern at the begining of the school year. At that time you did the thirty-second walk test (30sWT) and the result was clear; he was below the 5th percentile for boys his age and off the low-end of the chart. Although you are having this conversation right now, you think he has improved because he has propulsion and a more efficient gait. Continue reading “How to Use the 30-Second Walk Test (30sWT)”
“Zahra has been practicing and yesterday she sat all by herself! Of course I had to put her in this position first, but she is so happy! She can’t take her hands off her feet or else she falls backwards. I put soft things all around her so she is safe, even though I’m still right there.”
Zahra is five-months old and has attained the developmental milestone of sitting independently. Her parents are proud and it is easy to see that Zahara is proud too. What are the building blocks for independent sitting? Continue reading “5 Months: Sitting”
“When Phoebe’s little legs are tucked under her body, I see how she was able to fit into the tiny space of the womb. At first I was concerned because I didn’t know why her legs were positioned like that.”
Babies born at gestational term have a tightness to their bodies called physiological flexion. Space was limited in the final trimester and the baby assumed the most compact position with arms and legs held close to her core. Physiological flexion provides some passive stability for the newborn baby to use for function. Practice will provide an opportunity to decrease muscle tightness through active movement. In turn, active movement provides sensory input and postural control. Development happens gradually, month by month with one skill building upon another. The posts in the milestones category describe the maturation of babies in the first year of life as they begin tightly flexed and learn to roll, sit, cruise and stand.
Continue reading “Why Do the Legs of Newborn Babies Look Bowed?”