Toddlers/Toe Walking Flashcards
What are some hallmark, general behaviors of toddlers?
- like to follow and be followed
- like exploring
- need redirection
- “NO” and “MINE” are big words
What are the advanced gross motor skills toddlers are working on?
- running
- jumping
- kicking
- throwing
- catching
T/F: Toddlers gain full ROM in their LE’s by the end of age 2.
true for AROM, not PROM
When do toddlers gain full ROM of their UEs?
by end of year 1
When do toddlers develop heel strike?
18 mo
What strength is developing at 13 mo?
proximal shoulder strength
- shoulder girdle/RTC to push/pull toys
At what age do we get increased abdominal strength, as well as hip abd/add and glut strength? What is this used for?
18 months -> used for transitions and walking up/down stairs
Muscle strength in what area is seen at 24 mo? What is it used for?
quad and trunk strength: used for jumping
When do children begin throwing?
13 mo: think about their strength gains they get at this time
If a child is having difficulty going up/down stairs, what muscles could you work on?
hip/glut strengthening, quad strengthening
If a child isn’t jumping, what muscles need strengthening?
trunk and quads
When do toddlers begin to run?
13 mo
By what max age should late walkers be walking?
18 mo
When a 13 mo child is walking, what things should you look at in your eval?
- are they able to slow down and keep balance?
- are their feet sensitive to varying textures? sensory intolerance?
- can they run?
T/F: Eye-foot coordination is developed by 2 yo.
false, just beginning
- but hand-eye coordination is well developed by 2 yo
T/F: Primary fine motor skills are developed by the first year.
true, allows building of coordination through 2 yo
At 3yo, do children have the skills needed to play soccer?
yes, hand-foot coordination is more developed then
What are the 5 general things that toddlers are gaining in development?
1) full ROM in UE/LE
2) proximal and core strength
3) coordination
4) tolerating input to feet, body awareness
5) controlling speed of movement
By 15 mo, how far should a toddler be able to walk without support?
10 ft
Describe the walking capability of a toddler at 15 mo.
- able to slow down easier and keep balance (starts at 13 mo)
- fast walking cadence wise
- backwards and sideways walking beginning
How far should a 13 mo child be walking without support?
at least 5 steps
When does a child start to explore going down stairs independently? How much can they do?
15 mo: start to creep/crawl down a few stairs
What would be a good way to get a child to do sideways walking?
hold their hands and tell them to “do what I do”
How do children begin to throw at 13 mo?
flinging with elbow: may do better in sitting
How do children catch a ball at 13 mo?
carrall it with both legs and hands in sitting
- cannot do standing yet
When does heel-toe gait begin?
18 mo
Describe stair navigation improvements from 13 to 18 mo.
13: crawling up stairs
18: marks time up/down with hand held
When can a toddler start to throw overhand more?
throws overhand 3’ at 18 mo (vs flinging at 13 mo)
What does running look like at 24 mo?
running on toes in 10’ intervals
Describe kicking skill development in toddlers.
- 15 mo: raises foot to make contact with ball
- 24 mo:
Describe running development in toddlers.
13 mo: starts trying to run
18 mo: immature run, hurried walk
24 mo: runs on toes for 10’ intervals
When does a child begin to pull toys behind them while walking?
18 mo
When is a child able to walk up/down stairs with hand-held support? What about railing support?
18 mo (crawling at 13 mo) hand held
24 mo railing
When is a child able to stand on 1 foot?
24 mo: stands 1 foot for 1-2 sec
What can a 24mo do when walking on a line?
walks with one foot on 4” line for 6’
At 24 mo, what is a child’s throwing skill?
throws a tennis ball underhand 3-7’
How old is a child who catches a large ball against their body?
2 yo
How old is a child that kicks a ball 3ft by walking into it?
18 mo
lifts foot to make contact at 15
Describe kicking skill development in toddlers.
15 mo: raises foot to make contact with ball
18 mo: kicks ball 3’ by walking into it
24 mo: kicks ball 3’ more in midline
What jumping skill is seen in 2 yo?
- jumps up 2in with feet together
- jumps of stair with one foot leading
Describe catching skill development for toddlers.
13 mo: corralling ball when in sitting
24 mo: catches large ball against body
How old is a child that throws a tennis ball underhand for 3-7’?
24 mo
Describe throwing skill development for toddlers.
13mo: flinging
18mo: starts throwing ball overhand 3’
24 mo: throws tennis ball underhand 3-7’
A child doing a hurried walk for a run is how old?
18 mo
How old are children when they can push/pull objects?
13 mo: developing proximal shoulder strength to do so
When is walking backwards mastered?
2 yo (starts at 13-15 mo)
When does a child pull toys behind them while walking?
18 mo
When do toddlers get better at stopping/starting gait?
18 mo (begin trying at 13 mo, but can’t stop w/o losing balance)
What muscles assist a toddler in standing balance, but are weak during gait at 13-18mo?
abdominals
When does concentric dorsiflexion begin for gait?
13-18 mo
- think about heel strike: starts at 18 mo
T/F: Toddlers now have a narrower BOS that is less than the width of their shoulders.
true
A child who maturely weight-shifts in transitions to stand and and creeping up stairs is how old?
18 mo
T/F: Toddlers have more mature weight shifts in static standing now.
true
T/F: Toddlers have immature weight shifts in running at 24 mo.
true, think about the fact that they just have developed this skill really
A child who is beginning to arm swing is how old?
18 mo
A child with increased arm swing as well as counter-rotation of the trunk is how old?
24 mo
Discuss rotational ability in a 13 mo.
- able to rotate well over one leg on floor
- good transitional movements on floor
- no arm swing or rotation of trunk yet, walking is still new with maturing weight shifts
Discuss the gait of a 24 mo. (5)
- arm swing and trunk counter-rotation occuring
- running on toes for 10’ intervals with immature weight shifts
- able to walk backwards and sideways well
- increased stride/pelvic mobility
- good hip/knee control
What are 13mo’s able to do during gait that requires UE strength?
push/pull objects
What are the main skills we’re working on with toddlers?
walking running jumping catching throwing kicking climbing stairs
What are the 3 reasons kids walk on their toes?
1) sensory issues
2) underlying diagnosis (MD)
3) idiopathic
What are the expected treatment outcomes for ITW?
1) At least 10 deg DF with KE
2) Heel strike 75% of time
3) Age appropriate gross motor/balance skills
Why do we attack ITW with more aggression these days?
- avoid lacking ankle ROM in adulthood
- allow for development of mature gait
- reduce need for invasive treatments later on
- prevent pathological outcomes in adulthood
How would you screen for ITW?
1) check DF with KE
2) check AROM of ankle with knee flex/extend
3) ask about sensory sensitivity
4) check for CNS issues (tone, clonus, DTRs)
5) presence of equinus or ortho condition
6) communication in ages/stages
T/F: ITW is not painful.
true, shouldn’t be
At what age does a child have active DF?
18 mo
What percent out of 100 that a child toe walks qualifies a child as idiopathic toe walking?
> 25%
What test is recommended for use to assess ITW?
observational gait scale
What is a perfect score on the observational gait scale?
22 (11 on each leg)
What should be included in your assessment of ITW?
1) observational gait scale
2) physical assessment of gross motor skills
3) CNS screen
What kind of gait should you measure when using the observational gait index?
their typical gait: if they’re toe walking more than 50% of the time, encourage them to do this (even if parents remind them to get heels down)
What are some common PT interventions for ITW?
1) HEP: PF stretch, trunk and LE strengthening (ant tib)
2) Manual therapy
3) Serial casting/night splints
4) Auditory feedback to get heel down
