We are thrilled to share this piece that recently aired on ABC news. Anne Buckley-Reens program “Get Ready to Learn: Yoga therapy in the Classroom” is successfully being implemented into schools in the US and the UK, with great results.
Barbara Joseph, NYC School Administrator and GRTL program facilitator states: “The impact of implementing the Get Ready to Learn Program across our entire district with students with significant disabilities ages 3-21 over the past year has had tremendous results in decreasing behaviors that interfere with learning and increasing appropriate behaviors to enhance each students ability to learn more effectively. Teachers, administrators, students and parents have reported significant changes in both the classroom environment as well as student performance. Parents are reporting that their children are reacting to their environment in ways they haven’t demonstrated in the past. At the onset of the program we knew that the daily implementation of this movement program would have a positive impact on student progress but the data is reporting gains beyond our expectations.”
Any ideas on how to improve gait and balance in an 11 year old with dystonia? Backwards gait is OK but forward stepping is very ataxic and asymmetry increases with increased speed. Nothing seems to help consistently. HELP!!
Dystonia, for me, is one of the most difficult tone issues to work with, around, through. I always feel sort of lost and like I’m grasping at straws. Here’s where I would start: muscle length and muscle strength. What’s short and tight? What’s long and weak? I would guess that the flexors are stronger in relation to the extensors, since backward walking is better than forward. Is one side more dominant than the other? Stretch what’s tight, and strengthen what’s weak. This might be a case where, to improve walking, you take a few steps back and just strengthen. Look at the hip extensors and lateral musculature specifically.
Biofeedback and the use of mirrors during treatment can help to give the patient an awareness of his or her movement patterns, which may aid in some postural corrections.
If there is a muscle imbalance due to dystonic spasms in the opposing muscle, modalities could be indicated. This could include NMES to the antagonistic muscle groups (which oppose the dystonic, spasming muscles) to increase muscle strength. Kineseotaping to both inhibit and facilitate may be a valuable tool. Although this child is a little old (for social reasons), compression and strapping garments (like TheraTogs) may also be useful.
Tone management (like Botox injections that would specifically target muscles) may be indicated, and are often prescribed in dystonia. Patient and family education on tone management is important.
Dystonia is a very difficult condition to treat. If you have other ideas or suggestions, please feel free to comment. I’d love to hear about what has been successful for you.
As a physical therapist and a pediatric one at that, I get numerous referrals every year for children who toe walk. Often, that is the only information provided from the physician. Early on, I would look at these children and think, “Where to start?”
As with most cases, a good history is critical. Does the birth history suggest a neurological insult? Is there a history of autism or sensory processing disorder? Is there a structural deficit?
Following the history, evaluation is next. What is the range of motion and muscle tone?
When the child has a diagnosis of cerebral palsy, the treatment path is generally straight forward, including tone management, range of motion, and bracing. However, when there is no diagnosis, things are trickier. And this is where I used to get stuck. Especially if the range of motion and muscle tone were within normal limits. With some children, it’s easy to see that toe walking is a result of sensory-seeking. Walking on the toes provides increased proprioceptive input through the leg joints, thereby giving more feedback about the child’s position in space and his or her relationship to the floor. Sometimes, toe walking is the result of sensory avoidance, as the walker does not like input on the bottom of his or her foot.
Those are the “easier” sensory things to tease out. What about the children who are intermittent toe walkers? Or those who are not apparently sensory seeking or avoiding? Another aspect to consider is the integration of primitive reflexes. Children with unintegrated primitive reflexes, especially the tonic labyrithine reflex, can demonstrate toe walking as a sign. The retention of reflexes can also indicate an immature or neurological system that is under stress. The stress can activate the sympathetic nervous system, making the child function in a “fight or flight” state. A primary sign of the fight or flight state of arousal is toe walking. Other signs of this heightened state of arousal is increased respiration, decreased attention, increased visual scanning, and agitation.
Also, in the absence of sensory issues, a suggestive birth history, or a diagnosis of cerebral palsy, other neuromuscular disorders (Muscular Dystrophies, even in females) should be considered. This is especially important to follow through with when treatment does not change the toe walking, muscle length or muscle tone.
*********
Why is it important to address toe walking? An equinus gait is energy-costly, as it causes the ankle and knee joints to lock out, thereby preventing the transfer of energy in the form of momentum through the legs. The forward movement of the body that is normally achieved by a heel-toe gait is absent. Additionally, toe walking causes compensatory strategies throughout the rest of the body that can lead to long term imbalances and eventually pain and dysfunction.
These postural compensations will impact lower extremity muscle length, posture, core stability, and vision. The postural implications can also play a role in scapular and shoulder function, thus setting the child up for a life time of dysfunction.
What challenges are you finding with your toe walkers? Are you getting referrals for toe walking? How are you treating it?
Following the successful launch of our online course program last year we are thrilled to announce we have added six new online sessions.
We offer
Strategies to Implement in the Classroom
Professional Development On Demand
Convenient and Flexible Learning
Cost Effective Continuing Education
We are offering sessions (recorded live) from our highly acclaimed Annual Therapies in the School Conference. You can choose from six individual sessions, or choose the complete package of all six sessions; a great option to share with your colleagues or district:
REGISTRATION FEES: $134 per session $34 per additional CEU certificate (up to 19)
$599 for all six sessions $44 per additional CEU certificate (up to 19)
Each session meets the criteria for 2.5-3 contact hours (0.25-0.3 CEUs)
CEU certificates will be downloadable following successful completion of a post test. Individual registrations are available online. Please call the office with any questions and for group/district registrations or click here for a Registration Form and mail or fax in the form with payment
We know that for some of you, it may not be possible to attend every conference you would like, and for others, supplemental materials will enhance your learning when attending our highly regarded live programs. Still others have told us that they want to share the material they have learned at one of our live courses with their colleagues, administrators and the families they serve. That is why we have enhanced our new e-Learning program taught by leading experts in their fields.
We continue to strive to meet your needs as you develop your skills to meet the ever changing demands of health care and education. We welcome your suggestions for future online courses. info@educationresourcesinc.com
“The course was very informative and presented current research. Information was presented clearly and can be used in practice immediately. Presenter was knowledgeable and easy to follow”.
“I attended courses with Education Resources Inc in the past, this is my first online class with them. I liked greatly the technology used for this class made very accessible even from my mobile devices. Thanks”.
“This was a well-designed course with an extremely knowledgeable presenter. Information was presented at a even pace and clearly. Although I do not work in school environments, I will be able to transfer information from this course to my Early Intervention practice easily”.
So how do you improve head control? I have tried several courses and have left with no real answer to this question. Do you have any ideas?
Head control is a tricky thing. It is the result of the interplay of the vestibular system, the visual system, motor control, strength, muscle tone, and endurance. In theory, it is one of the first things to develop. Head control is developed through prone. The vestibular and visual systems are critical in developing the desire to lift the head and push up onto prone prop and eventually on to extended arms. At this point, the eyes develop convergence and divergence, and the Symmetrical Tonic Neck Reflex is used to assist in getting the child into quadruped.
I’m guessing that your patient is beyond this infant stage. Depending on the age of the patient, as well as the presence of co-morbidities, may impact your treatment strategies. A thorough visual assessment (by Developmental or Behavioral Optometry) is necessary to determine if the Visual Righting and the Vestibulo-Ocular Reflexes are intact. These are a major driving force in providing the motivation to lift the head to midline in the first place. Cortical visual impairments and visual field cuts can often result in a person holding their head out of midline, as that is how functional vision is accessed. It is important to determine where the functional visual field is so that you are not asking a person to function where he or she cannot see.
For strength development, go back to prone. Development of the back and neck extensors, as well as shoulder girdle strengthening, is critical in possessing head control in the upright position. If extensor control is not present to counter balance flexor strength (which is developed in supine), then functional midline co-contraction will not be realistic.
In terms of sitting, in order to gain head control, you must first tackle the pelvis. Trying for head control without a well-seated pelvis is like building a house from the roof down. The pelvis must be supported and neutral. Assuming that the patient you are looking to develop head control in is multiply impaired, in addition to controlling the pelvis, you are looking to fully support the trunk as well. This includes adaptive seating that supports the trunk laterally, and helps to correct any curves (forward/back as well as lateral). The feet and legs should be well supported to further provide a stable base of support. Remember, if you are asking a person to work on head control, then that is what they are working on. It does not include working on trunk control.
Over the past few years, I’ve used a few different trunk supports on wheelchairs that have helped to improve upper trunk and scapular position. These include the Stealth I2I head and neck support system and the use of two AEL Y-shaped trunk supports (one on each side). In the past, I’ve also used the Headmaster collar to work on very small range head control (lifting from the resting position on the collar to fully upright).
I would love to hear what other therapists are doing to work on head control. Please let me know, and Patricia, I hope this helps!
~Kathryn Biel, PT, DPT
]]>
Join Our Mailing List
Join our community to receive CEU course information to meet your professional development goals, hear the latest therapy tips, treatment ideas and connect with other therapists.
