Hi Esther,

the girl has recently been examined by her physician and he diagnosed general hypotonia, ie. lack of strength. I only recently took over treatment from a collegue who left and her delay was referred to a test (forgot the name..) where she scored way below her age in several categories. This seems to be genetic as her mother and her cousin were/are having similar problems at that age.
The parents aren't too concerned and regard her as just a little behind expecting that she will undergo some developmental spurt later on and catch up. I agree but want to focus my treatment on helping accelerating her development as much as possible to prevent disadvantages in the near future, eg. not being able to keep up when playing with other children, etc.
She doesn't fall that much but she also doesn't really risk that as she's very fearful and careful, ?due to her lack of balance and coordination. One factor that seems to influence her stability is her excessive toeing-out, about 90 deg. as compensation for push off. Apart from the reduced stability this concerns me as it will influence her whole gait pattern, muscle balance over the hips, forces on the knees, etc. and it also causes reduced power of push-off and the resulting propulsion. I would like to train her calf muscles and 'teach' her proper toe-off to make her gait more efficient and therefore easier for her, to boost her confidence and enable her progress with this, she does enjoy walking a lot.
Maybe I do analyse this as I would in an adult, but what are the alternatives, ignore and wait&hope it will resolve by itself?
Thanks for the link btw, very interesting webpage!

-koni