Whatever you do, your body will learn to do better. If you are walking badly, your body will learn how to do badly better. Over a long period of time I have asked parents why they go to physical therapy. In one form or
Whatever you do, your body will learn to do better. If you are walking badly, your body will learn how to do badly better. Over a long period of time I have asked parents why they go to physical therapy. In one form or another the answer is nearly always “So that he/she can walk normally.” Here are some facts. Regardless of what you do or how you do it, all children with Hemiplegia will walk. If they do not walk, it is caused by another problem, not early onset Hemiplegia. The vast majority of children with Diplegia also walk. Walking is more delayed in children with four limb involvement, either Spastic or Athetoid Quadriplegia. But even in these more severely involved children, I expect all children with mild to moderate levels of severity to walk. This takes us down to less than 10 to 20% of children with early onset brain lesions that will not walk. The more severe the brain problem, the more interventions they may need to get up on their feet and moving. The point is that the majority of affected children will walk. The choice that both parents and therapists face is whether they learn to walk badly or they learn to walk well. In my experience, the earlier they walk, the more likely they are to develop significant maladaptive movement habits.
The stark reality is that the quality of movement that our current therapeutic interventions are producing is not “good enough” for the majority of children. Many attain function without alignment and that means pain later in life. (see: Is Malalignment Malpractice? and Poor Alignment Equals Chronic Pain) Next time you are at a doctor’s office or at your regular therapy center, look at the older children.
In the beginning, I was taught that cerebral palsy was caused by a permanent, irreversible brain injury. In the presence of a permanent brain problem, functional independence seemed to be a reasonable goal. Working under this paradigm, we have collectively settled for distortions of the body’s alignment in children with cerebral palsy. Then along came Human Neuroplasticity…a true game changer. As I got older, and my patients got older, I found more and more evidence that they were capable of complex motor movements. (The Boy Who Could Run Better Than He Could Walk) Once I worked out the difference between neurologic potential and early learned habit, I had to question the ethics of setting such low outcome parameters for children who would have demonstrable recovery later in their lives. (Recovery In Cerebral Palsy Takes Time and Fresh Thinking)
It is common wisdom that it is easier to prevent a habit than to change a habit. Older children, teenagers, and even adults can change these early maladaptive habits, but it takes a lot of work and a lot of interventions and a lot of time. So, the goal is not to walk early, but it is to walk well. I would like you to stop and look at this YouTube video. http://www.youtube.com/watch?v=uUgtzfvXr9g
It was filmed with an annoying radio commercial in the background, so turn down the sound. As you watch it, notice that at first he falls frequently and is not using his hands. He requires close supervision. Then he is filmed with a TheraTogs system in place. With the suit on, he is able to walk rapidly with better balance. He no longer falls, he gets farther away from supervision, and he is actually able to hold a toy and walk at the same time. You decide which gait you think the child should practice…the one with the TheraTogs system or the one on his own?
When a child has the base of a stable trunk, they are able to activate and strengthen the core muscles. It is hard for anyone to properly strengthen a muscle if it is either too short or too long. When children slump into a “C” shape, the muscles on the back are stretched and elongated and the muscles on the front, particularly the hip flexors, are shortened and weak. The reason professional athletes have strength training coaches and weekend warriors have personal trainers is to make sure that the body is in the correct position when the muscles are strengthened. It may be harsh to say it, but I think anyone who believes that they can be successful strengthening a baby’s muscles in an abnormal position is working in an alternate reality system.
I posted Billi Cusick’s letter to parents and therapists about postural control and its development. Please read it. The link is at the end of this post. She developed the TheraTogs system and is owner of the company that distributes it. This means tha