Resources
Toe Walking
Walking on toes is common amongst children on the Autistic Spectrum. It is likely to be a sensory issue but if left untreated it could become a physical problem.
Children who walk on their toes can develop tight calf muscles on the backs of their legs and have decreased movement of their ankles. In addition, the muscles on the front of their legs may become weak.
A daily exercise program can be very helpful. The goal is to stretch the calf muscles and strengthen the muscles on the front of the legs.
Children who walk on their toes can develop tight calf muscles on the backs of their legs and have decreased movement of their ankles. In addition, the muscles on the front of their legs may become weak.
A daily exercise program can be very helpful. The goal is to stretch the calf muscles and strengthen the muscles on the front of the legs.
Stretches and strengthening exercises
Calf stretch
· Have the child lie on his back on a comfortable firm surface.
· With his knee straight and leg supported on the bed, bring the child’s foot upwards, toward his head, bending his ankle.
· Hold the stretch at the end of the movement (that is, as far as the child’s range of motion will permit) for 15 to 30 seconds. This should not be painful for the child.
· Bring the child’s foot back to a normal position. Repeat the exercise 10 times on each leg, daily.
Calf stretch
· Have the child lie on his back on a comfortable firm surface.
· With his knee straight and leg supported on the bed, bring the child’s foot upwards, toward his head, bending his ankle.
· Hold the stretch at the end of the movement (that is, as far as the child’s range of motion will permit) for 15 to 30 seconds. This should not be painful for the child.
· Bring the child’s foot back to a normal position. Repeat the exercise 10 times on each leg, daily.
Achilles tendon stretch
· Have the child lie on his back on a comfortable surface such as a firm bed.
· With his knee bent, bring the child’s foot upwards, toward his head, bending his ankle.
· Hold the stretch at the end of the movement (that is, as far as the child’s range of motion will permit) for 15 to 30 seconds. This should not be painful for your child.
· Bring the child’s foot back to a normal position. Repeat the exercise 10 times on each leg, daily.
· Have the child lie on his back on a comfortable surface such as a firm bed.
· With his knee bent, bring the child’s foot upwards, toward his head, bending his ankle.
· Hold the stretch at the end of the movement (that is, as far as the child’s range of motion will permit) for 15 to 30 seconds. This should not be painful for your child.
· Bring the child’s foot back to a normal position. Repeat the exercise 10 times on each leg, daily.
Sit to stand
· Have the child sit on a children’s sized chair or stool.
· Place your hands below his knees, providing a moderate, constant pressure downwards as a cue to keep his heels on the floor.
· Have the child practice standing up while keeping his heels on the ground.
Make this exercise fun by playing a game of high five, blowing bubbles, reaching for objects, working in front of a mirror, or singing songs.
Calf Stretch
· Have the child stand approximately two feet from a wall. Place both of his hands at shoulder height against the wall.
· With his right knee straight, have him step towards the wall with the left foot. He should lean in until a stretch is felt in the back of the right calf. Make sure he keeps the heel of the right foot on the ground.
· Hold the stretch for 15 to 30 seconds.
· Repeat the exercise 10 times on each leg, daily.
· Have the child sit on a children’s sized chair or stool.
· Place your hands below his knees, providing a moderate, constant pressure downwards as a cue to keep his heels on the floor.
· Have the child practice standing up while keeping his heels on the ground.
Make this exercise fun by playing a game of high five, blowing bubbles, reaching for objects, working in front of a mirror, or singing songs.
Calf Stretch
· Have the child stand approximately two feet from a wall. Place both of his hands at shoulder height against the wall.
· With his right knee straight, have him step towards the wall with the left foot. He should lean in until a stretch is felt in the back of the right calf. Make sure he keeps the heel of the right foot on the ground.
· Hold the stretch for 15 to 30 seconds.
· Repeat the exercise 10 times on each leg, daily.
Other exercises
Squatting can also be encouraged by sitting on a small ball
while keeping both heels down on the ground. The child can practice
standing up and sitting down on the ball while keeping his/her heels down.
- Marching on the spot. Have the child bring his knees up high and then land with a flat foot.
- Walking uphill.
- Walking on uneven surfaces such as in a playground or sand.
- Walking on the heels only. Keep the toes off the ground at all times.
- Stand on heals. Incorporate a game of ball.
- Stand with front of foot on a wedge and heals on floor. Throw/catch a ball/ throw a ball into a hoop.
- Practicing squats. With feet flat on the floor, hip width apart, have the child slowly lower his body all the way to the floor by bending at his knees and hips but keeping his chest upright.
- Scooter races on a smooth surface are a great way to make the child’s muscles stronger. Have the child sit on the scooter and use their heels to propel themselves forward.
Squatting can also be encouraged by sitting on a small ball
while keeping both heels down on the ground. The child can practice
standing up and sitting down on the ball while keeping his/her heels down.
W - Sitting
“W-sitting” is a position in which a child sits on their bottom, with knees bent, feet tucked under, and legs splayed out to each side in a W configuration.
The reality is that this position can cause orthopedic problems, delay development of postural control and stability, and delay development of refined motor skills. For these reasons, its use is strongly discouraged.
Excessive use of a w sitting during the growing years puts undue stress on the hip abductors, hamstrings, internal rotators and heel cords, leading to the possibility of orthopedic problems in the future.
In W sitting the major muscle groups are placed in a shortened position and this causes the muscles to begin to tighten This can lead to a permanent shortening of the muscle, which can affect coordination, balance, and development of motor skills.
W sitting widens a child’s base of support, resulting in less need for weight shifting, postural control and stability as they are playing, moving and reaching.
In addition to resulting in decreased trunk control, W sitting” does not require as much trunk rotation. Trunk rotation helps develop midline crossing and separation of the two sides of the body which is needed for needed for bilateral coordination.
Good trunk control and stability, midline crossing and bilateral coordination are needed to develop refined motor skills and hand dominance. Children require the opportunities to develop more mature movement patterns in order to develop higher level skills.
How to prevent W-sitting: It is best to prevent children from developing this habit. However some children have already established this as a preferred seated position.
§ When possible, anticipate and catch it before you see your child move into a W sitting pattern. If and when you do see your child in a W pattern, consistently encourage her to adjust to a different position by saying, “Fix your legs or good sitting.”
§ Make sure children know what some of their other options are so they can choose an alternative: Functional seated positions that will allow the child to develop trunk control and mature movement patterns include cross leg sitting, side sitting or long sitting.
§ When playing with a child on the floor, hold his knees and feet together when kneeling or crawling – it is impossible to get into a W pattern from there. The child will either sit to one side, or sit back on his feet, and from there he can be helped to sit over to one side. Try to encourage sitting over both the right and left sides to promote bilateral development. Using various patterns of movements and positions demand trunk rotation and lateral weight shifting.
§ Sitting against the couch while playing may be one alternative, as well as using a small table and chair.
Core strengthening
Core strength fosters all kinds of developmental skills from bilateral coordination, posture, and stability to balance and endurance. All of these skills build on one another, contributing to strong gross and fine motor skills and promoting healthy child development.
The core muscles are the muscles in the abdomen, back and pelvis.
Core strengthening activities
1. Roll gently back and forward
2. Throw and catch a ball
3. Pick up bean bags from the floor and place in basket
4. Pop bubbles
5. Sit on ball while completing a fun table top activity/watching TV/singing songs.
1. Walk on knees. Play follow the leader/ hunt the thimble in this position
2. Throw and catch a ball
3. Complete a fun table top activity
1. With the child lying on his back with his knees bent and feet flat on the floor ash him to push hard through his heels to raise his bottom up off the floor. Make sure that the head and shoulders remain on the ground.
2. Try having the child lift and lower with control. Up for a count of 3 and down for a count of 3.
3. Put ball/bean bag between the child’s knees and have them squeeze it while
4. Zoom some cars underneath — how many cars can you get under the bridge.
5. Find a few small, stuffed animals and walk them under the bridge — don’t squish the bunny!
6. For a BIG challenge, have your child place his feet on a pillow or small ball and try to maintain stability while bridging.
Child lies on his stomach on the floor and tries to lift his arms up off of the floor so that his upper chest comes up too.
Increase the challenge by:
1. Can he lift his legs? How about arms and legs at the same time?
2. Can he hold a ball between his hands or his feet while lifting up?
3. Place a stuffed animal on the child’s back and see if he can complete this exercise with enough control to keep the animal from falling.
4. Make it fun by having the child reach up for you to hand him pieces of a puzzle or to place stickers on the wall.
5. Make it even more fun by trying it on a swing or a peanut ball.
This is an overall core strengthener.
Child lies on his stomach on the floor with his hands flat on the floor at shoulder level and toes on the floor. On the count of 3, have him push up on his hands to straighten his arms and lift his whole body all the way to his toes off of the floor.
Increase the challenge by holding the pose long enough to roll 3 balls underneath.
Other general play activities that target core strengthening are:
The above information was compiled by the school physiotherapist Roesia Lordan in November 2014
In W sitting the major muscle groups are placed in a shortened position and this causes the muscles to begin to tighten This can lead to a permanent shortening of the muscle, which can affect coordination, balance, and development of motor skills.
W sitting widens a child’s base of support, resulting in less need for weight shifting, postural control and stability as they are playing, moving and reaching.
In addition to resulting in decreased trunk control, W sitting” does not require as much trunk rotation. Trunk rotation helps develop midline crossing and separation of the two sides of the body which is needed for needed for bilateral coordination.
Good trunk control and stability, midline crossing and bilateral coordination are needed to develop refined motor skills and hand dominance. Children require the opportunities to develop more mature movement patterns in order to develop higher level skills.
How to prevent W-sitting: It is best to prevent children from developing this habit. However some children have already established this as a preferred seated position.
§ When possible, anticipate and catch it before you see your child move into a W sitting pattern. If and when you do see your child in a W pattern, consistently encourage her to adjust to a different position by saying, “Fix your legs or good sitting.”
§ Make sure children know what some of their other options are so they can choose an alternative: Functional seated positions that will allow the child to develop trunk control and mature movement patterns include cross leg sitting, side sitting or long sitting.
§ When playing with a child on the floor, hold his knees and feet together when kneeling or crawling – it is impossible to get into a W pattern from there. The child will either sit to one side, or sit back on his feet, and from there he can be helped to sit over to one side. Try to encourage sitting over both the right and left sides to promote bilateral development. Using various patterns of movements and positions demand trunk rotation and lateral weight shifting.
§ Sitting against the couch while playing may be one alternative, as well as using a small table and chair.
Core strengthening
Core strength fosters all kinds of developmental skills from bilateral coordination, posture, and stability to balance and endurance. All of these skills build on one another, contributing to strong gross and fine motor skills and promoting healthy child development.
The core muscles are the muscles in the abdomen, back and pelvis.
Core strengthening activities
- Sit on ball with feet on floor and shoulder width apart. Provide assistance at the hips as necessary.
1. Roll gently back and forward
2. Throw and catch a ball
3. Pick up bean bags from the floor and place in basket
4. Pop bubbles
5. Sit on ball while completing a fun table top activity/watching TV/singing songs.
- High kneeling
1. Walk on knees. Play follow the leader/ hunt the thimble in this position
2. Throw and catch a ball
3. Complete a fun table top activity
- Bridging
1. With the child lying on his back with his knees bent and feet flat on the floor ash him to push hard through his heels to raise his bottom up off the floor. Make sure that the head and shoulders remain on the ground.
2. Try having the child lift and lower with control. Up for a count of 3 and down for a count of 3.
3. Put ball/bean bag between the child’s knees and have them squeeze it while
4. Zoom some cars underneath — how many cars can you get under the bridge.
5. Find a few small, stuffed animals and walk them under the bridge — don’t squish the bunny!
6. For a BIG challenge, have your child place his feet on a pillow or small ball and try to maintain stability while bridging.
- SUPERMAN POSE
Child lies on his stomach on the floor and tries to lift his arms up off of the floor so that his upper chest comes up too.
Increase the challenge by:
1. Can he lift his legs? How about arms and legs at the same time?
2. Can he hold a ball between his hands or his feet while lifting up?
3. Place a stuffed animal on the child’s back and see if he can complete this exercise with enough control to keep the animal from falling.
4. Make it fun by having the child reach up for you to hand him pieces of a puzzle or to place stickers on the wall.
5. Make it even more fun by trying it on a swing or a peanut ball.
- PLANK
This is an overall core strengthener.
Child lies on his stomach on the floor with his hands flat on the floor at shoulder level and toes on the floor. On the count of 3, have him push up on his hands to straighten his arms and lift his whole body all the way to his toes off of the floor.
Increase the challenge by holding the pose long enough to roll 3 balls underneath.
Other general play activities that target core strengthening are:
- Swimming
- Negotiating an obstacle course
- Swinging
- Animal Walks
- Row the boat
- Tug of war
- Climbing up a slide rather than sliding down
- Ball pool
- Scrambling out from a tight duvet
The above information was compiled by the school physiotherapist Roesia Lordan in November 2014