Wednesday, March 2, 2011

Playing Footsie With Little Tootsies

Very often, the children I treat have balance and equilibrium problems.  They have an uneasy relationship with gravity and can't hold themselves up effortlessly against it.  They fall easily, and they fall flat and hard.  This is painful and scary, and makes them cry.  This has the effect of making them seem overly emotional to the untrained observer.

In the clinic, I often observe that they can't use their feet very well.  If I ask them to frog crawl, for example, instead of pushing their toes strongly into the floor in order to use their legs to propel their bodies forward, they will pull themselves along with their arms while their legs flail behind.  They'll be unable to spread their toes and dig them into the soft mats or into fabric swings to stabilize themselves while they are climbing.  When toes are so weak, they are not working effectively to brace the child's body against falling.

Since our feet are our primary contact with the earth, any problems with the way they function and bear our weight is going to have a profound effect on our stability and mobility.  Ever had a sore or broken toe?  Such a little bone, such a lot of pain, so much difficulty trying to find a comfortable way to hold ourselves as we limp around, so much compromise in our balance as we try to maneuver without using that one small part of a foot.

Many children with sensory integration issues are toe walkers.  There are several theories about why children walk on toes.  One is that they need the extra input of sensation that walking on the toes provides.  Another theory is that since the bottom of the foot is so sensitive, the child tries to prevent it from touching the floor.  Another possible reason is that there is a structural misalignment in the sacrum, which is shortening the resting lengths of the muscles and tendons in the legs and thus preventing the child from being able use the foot correctly.

In the past few months, I have begun incorporating foot work into my sessions and having parents do foot activities at home, and the results have been very encouraging.  Recently, one of my older kids, who has always had a hard time staying focused, commented that his feet felt much more settled.  Later his nanny reported that so did he.  He was, she observed, much more centered and grounded.  She was impressed with how much less effort it took for him to settle down to get his homework done.

Here are some things you can try at home to supplement your child's occupational therapy.

If your child is on a therapeutic brushing program, firmly and vigorously  brush the tops and bottoms of his feet.  This will help him tolerate shoes and socks better and to also tolerate the feel of his foot on the floor.

For a very young child, I play "This little piggy."  I grasp each toe firmly, push and pull it gently, and roll it back and forth between my fingers.  Instead of tickling the child at the end, I grasp the entire foot firmly and push into the arch, then into the heel.  {I do the same thing with older kids, I just don't use the rhyme... it's important to know your audience.}

Rub the entire foot firmly between your hands, kneading along the underside of the arch and the balls of the toes.  Twist gently in all directions.  Most children love this.

Take the child to the beach and have him walk barefoot in sand  -- this is best foot and toe exercise imaginable.

Have the child stomp on bubble wrap to pop it.  For extra input, cover the bubble wrap with funny foam or shaving cream.

Play walking games:  walk like a dinosaur, walk like a cowboy, walk like a monkey, walk as if you are made of feathers, walk as if you are made of lead, walk on the insides of your feet, walk on the outsides of your feet, walk on your heels, walk on your toes.

  Hop across the room.  Hop sideways.  Hop backwards.  Play hopscotch, and bend over on one foot to pick up the stone.  That works the balancing foot like crazy.

Have contests to see who can balance on one foot the longest.

Have the child jump on a trampoline or bosu.  Play catch or balloon volleyball or have the child throw things at targets while he's jumping.  This has the added benefit of stabilizing the eyes.

Have the child try to pick up objects between his toes.  Or give the child a crayon to hold between his toes and challenge him to draw a picture on some paper on the floor.  Have him use the other foot to stabilize the paper.

Build a squishy obstacle course with pillows and sofa cushions, and have the child walk on it.  For an extra challenge, have the child balance a ball on a tray as he's walking, and see if he can keep the ball from falling off as he maneuvers along the path.

Be diligent about making sure that the shoes your child wears fit correctly and are not interfering with his ability to move and use his feet.  Toddlers who are still learning to walk should not be in very stiff shoes, which compromise the natural workings of the foot.

Try not to immobilize your child.  Let him walk instead of taking a stroller whenever possible.  Take him outside to play every day and find things for him to climb on, like rocks, jungle gyms, and slides.  If your park has a sandbox, make sure he gets in there with his shoes off.

Go barefoot, or in soft slippers, indoors.

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