Monthly Archive

OT/PT Corner: Small Changes = Big Differences

16th September, 2012

by Stacy Menz, DPT, Board Certified Pediatric Clinical Specialist
I was just on vacation visiting my family while I recuperated and I was lucky enough to enjoy the beach for a few beautiful days.  Right before I flew home, I was able to walk about a mile or so on level ground without excessive fatigue in my hip.  At this point my protocol had me riding a stationary bike and using the elliptical a few days a week so my hip was getting the chance to build up some muscular endurance.  I was actually feeling pretty good about my progress.  Well, going to the beach gave me a chance to look at my progress again.  Yes, I was still doing really well but what I found was that just from walking about 200-300 yards across the sand (and mostly packed sand) to my beach chair and then back to the car (so 400-600 yards total), my hip muscles were exhausted that night.  In fact, they were still tired the next day and I had to take it easy.  It doesn’t seem like much of a change but adding the uneven surface to my walking, challenged my muscles in a way they hadn’t been challenged since the surgery and as a result they had to work a lot harder.
Now, relate this to your kiddo.  If they are walking all over your house without a problem and then you have them go to the park, well you may see some increased fatigue because they have to navigate different surfaces as well as be aware of their environment.  I know I’ve talked about feedback (reactionary) control and feedforward (anticipatory) control before but this is part of it.  When your child gets comfortable with one set of variables, such as walking on a hardwood floor in your house, they are able to be efficient with their movement because their body knows what to expect.  Now have them walk around the backyard or even some tan bark and if its a novel experience for them their body reverts back to reactionary where it has to figure out what will happen on this surface and then react to the changes.  After some time (usually not much for typically developing kiddos) their bodies understand what will happen and can anticipate and make changes efficiently.  For a kiddo that is not efficient yet, there will be more fatigue.
Just like with my hip, I was used to level ground and my hip muscles had become efficient at walking along surfaces such as the sidewalk.  When I changed to sand (even hard packed sand) my hip muscles had a new set of variables they had to react to and in the process of relearning how to anticipate, they fatigued themselves.
So, what’s my point.  I guess I am just trying to point out that making a small change can have a large impact on your child.  Sometimes we go for doing big sweeping changes to improve or progress their abilities when all it may take is something as simple as walking on the grass, or changing the size of the crayon/pencil they are using, or having them carry a toy while walking, or a million other seemingly small changes to challenge the body.
What has been your experience with this?
Featured Guest Columnist: Stacy Menz, DPT, Board Certified Pediatric Clinical Specialist
Stacy, Starfish Therapies’ founder, is a pediatric physical therapist with both a Masters and a Doctorate in Physical Therapy from Boston University and is a board certified pediatric clinical specialist. She stumbled into this field when she realized she would get to play with kids all day long! In reality, she loves making a difference in the lives of kids and their families. In addition to doing rehabilitative work with kids, she also promotes overall wellness and prevention of developmental delays through education. Stacy is actively involved in her professional organizations and is on the editorial board of Impact, the publication of the Private Practice Section of the APTA, and serves on the education committee of the Pediatric Special Interest Group for the California Physical Therapy Association. Stacy and her colleagues are also actively involved in research and have an article submitted for publication.
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