Submitted by L.H, Physical Therapist
| Before | After |
|---|---|
| Trouble walking on stairs | Able to walk up and down stairs |
| Could not jump | Able to jump |
| Unable to ride bike | Able to ride bike |
| Too cautious to play on slides or bouncy houses | Slides down slide and play in bouncy house |
| Foot turned in | Foot no longer turned in |
Ellie is a 30-month old girl who was referred to Physical Therapy by her pediatrician with concerns that her left foot was turning in, she was clumsy, she had difficulty walking on stairs, and she could not jump. Mom also reports that she was very cautious and that she would not go down a slide or into a bouncy house. She had been referred to orthopedics and the doctor had no concerns with her lower extremities or her development. Mom was frustrated because her intuition told her something was not right.
I began treating Ellie using my traditional treatment strategies. We worked on core strength on a ball, practiced stepping up a step during play activities, worked on timing and jumping activities with every game imaginable, even a mini trampoline. Four sessions went by and there was really no improvement with her coordination or motor skills. She tried so hard to jump, she just couldn’t do it, and she couldn’t initiate single leg stance movements with her left leg.
This case was really frustrating to me because her deficits were pretty minimal compared with most kids I see, I really thought she would respond quickly and she’d be done. Thank goodness, I happened to be taking this [Brain and Sensory Foundations] course while seeing Ellie!
On our first session (of the new strategy), I tried the [innate] Rhythmic Movement with her in supine. She LOVED the movements and allowed me to do them for several minutes. I instructed her Mom in the movements and asked her to do them for 30 seconds, several times throughout the day. Honestly, I introduced the Rhythmic Movements because I was at a loss.
Initially, I didn’t think she was a kid that needed them, then as I learned more about it, she had so many symptoms: clumsiness, difficulty on stairs, low tone, etc.
Session 2
Ellie met me at the door, very chatty and excited. Then she laid down in position so that I would do the rhythmic movements with her! They made her feel so good!
Because she had low muscle tone, she sat in the W position, she had difficulty with directional movements, and difficulty with stairs, I decided to check her TLR [Tonic Labyrinthine Reflex]. While she was standing, I asked her to look down and her whole body swayed and she moved her extremities. I asked her to look up and she could not. I was not overly concerned because the TLR in extension integrates after age three, but I did feel like she should be able to at least attempt to look up.
To address the TLR, we continued with Rhythmic Movement 1 and we did the developmental movements, “flying” on the ball as well as “Seal”. Mom agreed to do these activities with Ellie throughout the week.
Session 3
Ellie met me at the door and was again eager for Rhythmic Movements [from the Brain and Sensory Foundations course]. Mom reported that they had been doing the movements and that Ellie loved them.
Mom mentioned that they had been trying to teach her to ride a bike but they were having a hard time. I decided to check her ATNR [Asymmetrical Tonic Neck Reflex] due to her coordination issues.
At this visit, Mom and I both noticed that she was able to walk up and down the steps much better! Her efforts to jump were also showing improvement but she was not close to mastering it yet. We also worked on bike riding, she required moderate assistance to pedal in the form of verbal cues, tapping on quadriceps, and straps to keep her feet on. Her family agreed to work on the Rhythmic Movements and developmental activities while continuing to give her opportunities on the steps and bike.
Session 4
At this session, Ellie couldn’t wait to show me that she could now jump on the trampoline! She was still a bit stiff but she was getting air! She was also able to do the steps leading with her left foot when she was thinking about it. She was able to pedal her bike with straps on her feet and assistance to steer.
I continued to see Ellie for 4 more sessions and by the time Ellie graduated from our program at age 3, she was an expert at jumping, walking up and down stairs, riding her bike without the assistance, and her foot no longer turned in. She also enjoyed the local playground with her dad and was able to slide down the slides and climb on the climbers.
[Edited for length and clarity, emphasis added]