How to Use the 30-Second Walk Test

Walking from class to the school library, Josh falls to the back of the line and then a gap forms between him 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?

Josh’s slow walking speed and the effect it had on his school participation was a major concern when you met him 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.   Even though you are having this conversation right now, you think he may have improved because he has developed propulsion and better gait efficiency over the last four months . Continue reading “How to Use the 30-Second Walk Test”

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6 Months: Sitting

“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.”  

At six months Zahra has attained the significant developmental milestone of sitting independently on the floor. Her parents are very proud and it is easy to see that Zahara is proud too.  What are the building blocks for independent sitting? Continue reading “6 Months: Sitting”

Why Do the Legs of Newborn Babies Look Bowed?

“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.  This means that space was limited in the final trimester and the baby assumed the most compact position with arms and legs held close to her core.   Practice will provide an opportunity to decrease 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?”

How to Use the Pediatric Balance Scale

Elise is constantly falling during her school day.   She often has skinned knees and bruises.  Although she is 10,  she walks down stairs one step at a time.    As Elise’s physical therapist, what observational measure will you use to measure her functional balance skills?  How will you document her progress?  

Balance is defined as the ability to keep the center of mass over the base of support.

Postural control is the act of maintaining, achieving or restoring a state of balance during an activity.  

Link to Pediatric Balance Scale Score Sheet

Pediatric physical therapists informally evaluate balance and postural control in almost every movement a child makes.   Multiple body systems contribute to balance, making measurement of functional balance somewhat challenging.

Continue reading “How to Use the Pediatric Balance Scale”

6 Months: Pivot Prone

“My 6-month old daughter rocks on her belly and moves her arms all around.  It looks like she is swimming on land!  What is going on while she is playing like that?”

This swimming motion, common during the development of 5-6 month olds, is also known as pivot prone.   The first time you might see something like this would be during a Landau reaction.  The Landau reaction emerges at approximately 3 months as a reflex/postural reaction, allowing the baby to extend against gravity while held at the stomach.  However, by 5-6 months of age, the baby has taken this foundation movement and has developed the strength and flexibility to play with it in a variety of ways while on the floor.  These new sensations and movement keep interest in the activity.

What is happening during this motion?

Continue reading “6 Months: Pivot Prone”

5 Months: Rolling to Side

 

Q: What happens when a baby brings hands to knees and then weight shifts or looks to the side? 

A: Her whole body rolls to the side and she learns to control it and use it for function.

Around 5-6 months, this little one has learned to initiate some big movements like pushing up onto hands while on her stomach and grabbing knees and feet while on her back.  She is busy reaching and looking around.  Combining foundation skills such as hands to knees and weight shifts, larger movements begin to evolve, like rolling from back to side (otherwise known as supine to sidelying).

What is happening as she rolls from supine to sidelying?

Continue reading “5 Months: Rolling to Side”

6 Months: Sidelying With Pelvic Femoral Dissociation

Life is so exciting for the six month old; once she learns to roll to the side, it is fun to play in this position.   Beyond fun for the little one, what special things are happening with development at this stage?  After all, play is child’s work.

  • Mastering the balance of flexion and extension in the trunk:  she is able to play in sidelying without falling forward or backward.
  • Increasing shoulder girdle control and stability- allowing propping on one arm to play.
  • Emergence/increasing lower extremity dissociation: one foot can prop to meet the ground and stabilize in this position.  To do this, one leg must be flexed, the other extended while weight is increasingly shifted to the hip that contacts the floor.
  • Foot weight-bearing: bringing the foot to meet the ground and getting some weight on to different parts of the foot in order to prepare for standing.
  • Lateral flexibility and of the trunk/rib cage.
  • Lateral head righting against gravity.

From this position your little one can grab toys to mouth, providing a whole new level of independence for exploration!  All of these movements build the foundation for transitions that come in later months like progressing to side sitting, getting up on all fours and pulling to stand.