By Natan Gendelman, D.O.M.P
Learning to stand, and eventually walk, is a major achievement in a child’s progress. Each step is important, and whether or not a child has Down syndrome or another condition, properly preparing him for the steps to come will help prevent compensatory movements that may hinder his function in the future. To avoid these from occurring and to best move a child forward in his development, here’s a few things to keep in mind in regards to a child’s treatment. Ultimately the goal is to assist a child in learning to perform everyday functions for himself, by himself.
1. Know the importance of trunk control
From my standpoint and experience, developing a child’s trunk is very important. Since the trunk acts as the pillar which supports the movement of the limbs and head, when left unaddressed a child may develop compensatory movements that will be more difficult to correct later on in life. For children with Down syndrome, this can be an issue as they often have hypotonic trunks. When steps are not taken to make improvements in this case, it can start a vicious cycle of irregular movements that carry through every aspect of a child’s daily function.
2. Work from the ground up
As mentioned earlier, the importance of trunk control can be seen once a child begins moving. My standpoint has alway been that, when working with kids, walking and standing are meant to be a child’s last developmental milestones. Before a child can take his first few steps, he will need to have gone through the stages of learning how to roll, sit, and crawl. I call this “working from the ground up” because the strength he acquires comes from activities and functions a child learns while he is still on the ground. Each milestone builds on the ones before it, and the muscle tone and movements he acquires in the process will play an important role in his future development. Only then can a patient be taught how to successfully stand and eventually learn how to walk.
Final thoughts
As my final advice to anyone whose child is moving through developmental milestones: I suggest that you be patient, and resist the urge to try and help your child perform functions before he is ready. Whether or not he is experiencing extra challenges along the way, you and your child will still need to go through the same steps–it just may take longer. While this may take more time for some than others, be sure to stay optimistic, believe in your child, and look forward to what he can accomplish in the future.
About the Author: Natan Gendelman, PT
Natan Gendelman is licensed as a physical therapist in Russia and Israel. After moving to Canada, he was certified as a kinesiologist and osteopathy manual practitioner. Natan has more than 20 years of experience providing rehabilitation and treatment for conditions such as cerebral palsy, autism, Down syndrome, pediatric stroke and acquired brain injury. He is the founder and director of Health in Motion Rehabilitation, a Toronto-based clinic whose main objective is to teach their patients the independence necessary for success in their daily lives.
Regarding developmental milestones and the neuroplasticity of the brain, can delays in a child’s development be improved upon as in the brain’s ability to improve the processing speed needed to manage life as an adolescent and then an adult. I think it is awesome that your clinic’s goal is in teaching independence.
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The idea that a child needs to move progressively from rolling to sitting and crawling and then into standing is an assumption that has never being tested, and based on our current knowledge of motor control and learning perhaps it is one that needs to be challenged.
I think that the most important idea that has come out of the new neuroscience of movement is that control is specific to the activity: so control in the crawling or sitting position does not carry over to trunk control in standing – it has to be learned all over again.
A toddler may never have crawled but is wanting to pull up into standing and stand with support is really not interested in learning to crawl. He wants to stand and that is what he is willing to practice over and over again.
Getting the toddler to explore different actionson the floor is good for developing variability and his ability to solve movement problems. You may be able to get him to clamber up onto the sofa which will require a lot of solving the movement problem on his part. But crawling – well he is quite past that.
What is important once he does learn to stand is provide him lots of opportunities to explore different ways of moving in supported standing – and in this way introduce opportunities for exploring the stability boundaries, variability and problem solving, which will increase feed-forward control, prediction and anticipation of expected perturbations that arise from his actions.
None of these aspects of motor control are transferred from one posture to the other – they need to be learned for each new posture. This is why task based training is important.
Lets challenge old assumptions and start to use the new neuroscience of movement findings to improve our clinical decision making.