toe walking in children with autism

[SPPAWA]

I have read through the most of posts here on this page regarding toe walking being a product of sensory integration issues. This is an apparent source of controversy as there is no concrete evidence to support this. I think that we can all agree that increased output to the plantar flexor muscles of the foot and ankle would be responsible for producing the altered gait we see in "toe walkers" correct? I think we could all then agree that this may be a product of increased drive through alpha MN themselves to the plantar flexor muscles or promoted by a lack of decending cord mediated inhibition to these muscles secondary to a failure of more primitive vestibular reflexes not being damped or properly integrated from altered higher level brain centers. Such signs are again seen with "release signs" or, more specifically, in this case a "babinski response" which we all know so well. As an UMN lesion includes dysfunction in the cortex and not the cord and autism has been documented to have altered deep white matter patters (remember these are the heavily myelinated fibers) please see the following:http://www.jneurosci.org/cgi/content/full/27/43/11725 it would make sense that through the process of diaschisis descending modulation of the vestibular nuclei output would be impaired as well = increased tone to plantar flexors - similar to release signs seen in the cortically compromised ie. stroke cases. As for how to rehabilitate these, I have had some success with vestibular based rehabilitation using a swiss ball and stimulating reflexogenic eye movements, particularly those associated with output of the posterior semi circular canal system (down and to the opposite side). Building plasticity or encouraging integration with through these sensory modalities would appear to help integrate the sensory integration issue which is likely promoting these. As for whether there is a sensory integration issue at play here I feel it is imperative that we all realize the brain is a sensory driven organ. Without afferent input there is no efferent response. Thoughts are just internalized motoric behavior. Hope this helps.

SPPAWA