Teaching kids with cerebral palsy walking

  • October 2, 2017

My success rate teaching kids to walk significantly improved when I changed my goal setting method. Instead of step by step goals, I now have one goal: walking.

This allows me to focus mostly on activating and strengthening muscles and muscle groups that keep the body upright and move the body forward in a standing position.

The beauty of this approach is that the children learn to sit, crawl on their own or with relatively small intervention.

toddler walking


a 21 steps approach

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  1. Most important: Treat “the child” not the child’s body!
  2. Hear the parents! Teach and work with the parents. It is a team effort.
  3. Work on and with reflexes
  4. Establish cognitive drive
  5. Protect the ankles in weight bearing
  6. Turn off extensor or flexor tone
  7. Deactivate locking of the hips
  8. Establish strength into flexion of the spine (bending forward)
  9. Establish strength into extension of the spine (bending backward)
  10. Stabilize the rib cage (breath and stability)
  11. Activate and strengthen the low back
  12. Activate and strengthen the glutes complex (buttock)
  13. Activate and strengthen the quadriceps complex (thighs)
  14. Activate and strengthen the ankle complex
  15. Establish a push off
  16. Establish holding onto objects for safety
  17. Establish independent standing
  18. Establish walking with assistance or support in the front
  19. Deactivate child’s dependence on therapist and parents
  20. Establish independent walking
  21. Celebrate the small victories because the little achievements are what make up the final goal!



Is this list in order?


Yes and no.

1. I follow the natural chronological pattern as much as possible, but it is best to address the ankles, the head and everything in between on a daily basis.

2. It is impossible to work on everything in one session. It would be overwhelming for the child, and it does not fit in the time-frame of a session. 

3.  The child's understanding of the given skill and movement affects the order. The ability to execute a new movement is complex and hard.

For example, working on weight bearing is not attainable until a certain point in the development, but it is possible to introduce it with many hands. Sometimes it means three people, mom, dad, and therapist will support the child at the first attempts. 

4. There are certain steps from above that have to be maintained on a daily basis. I teach the parents my approach, and we establish a home exercise program to help the child practice the movements and skills. The parents work on several aspects:

baby rolloing

 

  • the repetition of an activated movement without which the movement would be lost
  • the prevention massages, mobilizations ext so the child’s body will be ready to learn new skills
  • maintaining the deactivation of extensor or flexor tone
  • maintaining the cognitive drive



The sooner, the better


We all heard that prevention is the best approach. And that the younger the child, the easier it is to learn the skills. With this I agree wholeheartedly.

However, we have managed, with dedicated parents as a team, to achieve standing, stepping and minimally supported walking starting therapy at 3 up to 8 years of age. It requires more work, more hands, and a longer time-frame but it is possible.


Best time to start

The ideal time to start is at eight weeks of age, or before three months. The next best is before the 9th month, and the last best is before the age of 15 months.

At 3, 9 and 15 months there is a cognitive change in the baby, and that makes it harder and harder to teach a habituated skill the new way.

Let’s assume you are worried about your baby’s development.

How can you help your child to walk?


Maybe your baby is premature, or sleeps too much, or has difficulty sleeping, or cries too much, or eats too little, or is too weak/floppy, or arching all the time or does not lift his/her head on time, or does not roll on time… the list is long. I addressed some possible issues in my blog on head control. 

mom holding newborn

What can you do?

  • Check your baby’s milestones on a monthly basis.
  • Don’t live comfortably with the “he/she will outgrow it” approach.

    Yes, some baby’s will outgrow their delays. However, starting therapy early will mean superb results and in a much much shorter time.

    Therapy does not harm the baby. There is nothing to lose starting therapy at eight weeks or as early as you notice any challenges your baby has.

    However, it is significantly more difficult for the baby to learn any skill starting therapy too late.
  • If you have any concerns, ask the medical community for their help, guidance, and opinions.

    Don’t ask only one person, one discipline.

    Collect multiple medical opinions. Compare the similarities and differences. Read professionally written books, websites. Then take action as soon as possible to help your baby.
  • Ask a Pediatric Physical Therapist to evaluate your baby as well. In the state of NJ, parents can take their baby to a physical therapist directly.

    I recommend finding a therapist who treats children primarily. Adult physical therapy is very different.
  • Consider taking your baby to Chiropractic and or Osteopath. Chiropractic and Osteopathic care after birth is a great way to realign the baby’s structures.

As always, your best approach is to educate yourself about infant development, milestones and possible concerns.

Remember, the information presented here CAN NOT substitute medical evaluation, medical diagnosis or medical treatment. Always follow your doctor's advice. The contents of this blog is informational only. It CAN NOT be used to substitute proper medical care.

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