Printable View
Hello everyone,
I am currently working with children who have autism and a lot of these children are toe walker.I am trying to do a bit more in depth reserch on this, but unfortunately I haven't found much information on the web which is a bit more specific on this matter.
I anyone has more specific information or is also working in this field I would be very grateful for any help.
Thanks :p
Dear Wullie,
This is an interesting question that I have been busy looking into from another perspective.
In the last weeks two papers have been published about sensory processing and toewalking and the processing of sensory information in children with autism spectrum disorders (ASD).
1. Abstract | Idiopathic toe walking and sensory processing dysfunction article on Idiopathic toe walking and sensory processing dysfunction in the online Journal of Foot and Ankle Research 2010, 3:16doi:10.1186/1757-1146-3-16
2. Autism linked to multisensory integration
A new study by researchers at Albert Einstein College of Medicine of Yeshiva University has provided concrete evidence that children with autism spectrum disorders (ASD) process sensory information such as sound, touch and vision differently than typically developing children.
The thought has crossed my mind that the reason why children (not only those with autisme) toewalk could possibly be because of a need to "stimulate" their own sensory systems.
I would like to hear what others think about this idea.
Esther
i agree with you, since these kids have behavioural crisis,many of them are hyperactive and have attention deficits, which makes them overactive and hence to receive early sensory stimulations they tend to walk in this manner and since they have attention deficits it becomes difficult to mend their gait pattern..........
people, kindly share ur views or if wana rectify mine and enlighten me with sum better concepts,ur most welcome!!!
dear Shruti,
I have not found any literature to back up this idea. Have you?
Esther
Dear Shruthi and Ester,
I am not surprised to see these kids are toe walkers. Sensory processing dysfunction is the reason for that. Sensory Integration explains the reason for this, Proprioceptive needs for the children is one reason, however other reasons can be determined. First there is a need for a detail sensory assesment for this kid.
Regards.
Dear Dinesh,Quote:
Originally Posted by illuminatidinesh
The point is that this "sensory processing dysfunction" has been hypothesized for so many decades. I have met many SI trained therapists saying the very same. I have read mrs Ayres book BUT there is no scientific evidence to back this theory up as far as I know.
If there is, I would love to know. Please share with us.
Esther
hi dinesh,
im working on a child ,he is autistic with a vry weird gait pattern....he walks with his one leg forward and one backward(like a dance step).esp. wen a music is on he walks faster in the same manner....he seems restless too as he keep crying all the time....very few things attracts him n calms him down like music,COOL air(A.C).DO u think some physical therapy might help him improving his this sort of pattern or occupational or sum play therapy is going to be the ultimate plan of treatment
i wud also like to know what all points shud be undertaken while sensory assessment of children with toe walking
Additional Comment I forgot:
we'v been discussing about the theories behind "toe walkers in autism" only, dont u people think we shud next switch onto its treatment now!!!!!!
Dear Ester,
The problem is that we have a very few theoritical evidence in the field of Sensory Integration and same Goes for NDT. That doesnt mean they are not effective. From what I have seen from my experience SI does have a huge impact on these children. Many have improved drastically. But then it is your judgement to take it.
Again What I feel is that there are experiments being conducted around the world, the problem is that various variables cannot be controlled.
Therapist like myself depend on the experience of Jean Ayres and Erna Blanch.
Regards.
Additional Comment I forgot:
Hi Shruthi,
From What I have seen from ur post is that he seems to have sensory problem indeed. Let me post this question 1)How do know he is Autistic? ( who diagnosed that) 2) Is he a ADHD? There is a fair chance he could be. But I am forced to accecpt with wat u say.
U were asking for the special PT,OT tech? He could benifit from SI.
The problem is we dont go for specific assesment for toe walkers, rather only a generalised SI assesment. May be that can give a detailed analysis of his condition.
Regards
i also asked one thing frm u.........i.e, the course uv done aftr ur bachelors frm? please provide me the details.......
how can toe walkers be treated......kids m talkn bout
Dear Shruti,
I understand your frustation at not getting a straight answer.
Children and adults suffering from severe autisme are a very difficult group to treat. In these cases, as with other mentally challenged, we cannot expect to be able to change a lot. We often see very strange gait patterns in the mentally challenged patients.
I have not experience in changing gait in this group and I have not read any articles on this subject, so I am sorry I cannot be of help in this respect. My question is why do you want to change the gait? Do you have a specific treatment goal in mind?
Esther
thanx for d reply......
y am aftr changing their gait is......more they walk on toes more r they prone2frequent falls......so is with tht kid also...he hs got so many stitches on his head,near lips......so his gait z becoming dangerous for him now........
dear Shruti,
I can give you a few suggestions:
you can try to:
1. put weights (half kilo for example) around his ankles, it is possible this will make him more aware of his feet and where he is putting them
2. try making cardboard or plastic clownsfeet, big feet that fit over his shoes, then show him how he can walk as charley chaplin... making them for yourself as well and doing this with music on will be great fun:D
3. you can also make big broader shoes, forcing him to abduct
4. Try placing feet on the ground he has to step on, if he finds this boring, make something he likes to stand on.
(I often draw them on paper, kids love the sound of walking on paper)
I hope one of these suggestions does some good.
Esther
thanx so much for the suggestions........iam applying weights and it z helping a bit.....will try othrs too
regards
shruti
dear Shruti,
Glad to help.
Please try and type complete words, a lot of the people reading this forum do not have english as their first language.... and yours is hard to read every now and again.
At least it is for me being an old bird :).
Look forward to hearing how things go.
Esther
what all words trouble u in my replies........i think i use complete words no abb.but anyws,i'll take care of it in future :)
Good job, Esther.Quote:
Originally Posted by estherderu
Just to reiterate, there is no evidence that suggests toe-walking is due to "sensory processing dysfunction." Nothing. Thus, clinicians that suggest children with toe-walking having sensory processing dysfunction are not practicing evidence-based and likely in error. Maintaining this logic, sensory intergration (SI) "techniques" likely would be incorrect and a waste of time for treatment of toe-walking.
Hi Bobby,
Have you got any comments or thoughts about my pondering...
" The thought has crossed my mind that the reason why children (not only those with autisme) toewalk could possibly be because of a need to "stimulate" their own sensory systems. ?
Esther
First Am surprised to see ur comment on Sensory Integration(U are such a n experienced person). Now U could be right here.... Yes these children are in need to stimulate their own sensory system. In this particular case I suspect he needs proprioceptive needs( if at all he really has SI issues).Quote:
Hi Bobby,
Have you got any comments or thoughts about my pondering...
" The thought has crossed my mind that the reason why children (not only those with autisme) toewalk could possibly be because of a need to "stimulate" their own sensory systems. ?
Esther
REGARDS
Additional Comment I forgot:
You are very quick to dismiss the thought without producing any proof of ur own claim. What we assume here is Sensory processing dysfunction could be a reason, there could be other causes too. There is no logic in ur speculation here, please read carefully again" toe walking in Autistic Kids" your reply could suit if the kid has only toe walking(the reason could be physical,neurological).Quote:
Good job, Esther.
Just to reiterate, there is no evidence that suggests toe-walking is due to "sensory processing dysfunction." Nothing. Thus, clinicians that suggest children with toe-walking having sensory processing dysfunction are not practicing evidence-based and likely in error. Maintaining this logic, sensory intergration (SI) "techniques" likely would be incorrect and a waste of time for treatment of toe-walking.
Additional Comment I forgot:
Dear Ester,
I saw ur suggestions to Shruthi... I myself could have suggested the 1 and 4 point.... Are you aware of the fact that these points has some valid sensory input to this kid which he seems to be lacking.....
Regards
dear dinesh,
I have found the information on the free access journal called journal of foot and ankle research the place to find out more about the foot and particularly the footsole.
Journal of Foot and Ankle Research
Yes it is alarming when one realizes that what one is saying ( and really believes true) might not be correct. We simple do not have any scientific evidence to back up the claims that mrs Ayres, theBobath's and Vojta made.
Of course, we have seen that the therapy works (sometimes) - we think...... but the fact that we do not know WHY its works should humble us into trying to find out.
In this age of brain research the new developmental theories give us enough to think about. I think that more and more research is being done and new methods will be the result.
kind regards
Esther
I will be nice about the following:Quote:
Originally Posted by illuminatidinesh
Please be aware of your own behaviors as the oweness is on you to provide "proof" of your claims since you suggested children with autism and toe-walking have sensory processing disorders. I made no claims, but did say that there was no evidence to support such a statement that children with autism and toe-walking have sensory processing disorders. See bellow.
This is fact and cannot be disputed based on the scientific literature. Unless you have literature and sources that I don't. And I doubt that. Why would I provide any further if there is nothing else? Please don't reference 'logic' if you yourself have not discriminated the logic of my arguments and have not of your own. Please don't say I provided 'speculations' when I have not speculated at all. My arguments could be for either children with autism or children without autism and toe-walk. Thus, yours points are not germane.Quote:
Just to reiterate, there is no evidence that suggests toe-walking is due to "sensory processing dysfunction."
To reiterate a specific point- you have the responsibity to show evidence to support the following statements:
Please provide evidence-based support for these statments including toe-walkers having sensory processing dysfunction, how sensory intergration explains toe-walking, propioceptive needs for children toe-walking.Quote:
Originally Posted by illuminatidinesh
I will be waiting- as I watch the views of this thread continue to rise from 374.
Hi,
thanks to everyone for their threads, it's nice to get some feedback.
Most of the children I work with are non-verbal and don't follow instructions well or not at all.
I worked with a child on a spinning whell,he really enjoys being spun around.A couple of sessions and minimal verbal prompts. He still goes up onto his tip toes when spun around but manages to control and come back onto his feet.Furthermore has his gate improved and he's walking a lot less on his tip toes.
But I'm more than happy for any treatment suggestions that involve minimal instructions or any other suggestions.
Thanks everyone,
Ilka :)
Hi,
thanks for all the good answers....as I like all your points in respect to toe walking in autistic children.Due to not much reserch being done in this matter I like to hear all of your comments and ideas. Kepp going :-)
Every autistic child I worked with in regards to their toe-walking they also all had SPC and are seen by an OT. In co-operation we managed to reduce the time some of the children spent on their tip toes. The one's where physical change has already occured are a lot harder to treat.
We won't be able to stop most of our children from toe-walking; but we managed to reduce the amount they toe walk and the long turn effects is has on them,e.g. changes to the muscle/bone structure,main changes to the gait which brings them of balance and increases their risk to fall.
Thanks to everyone :-)
dear Ilka,
what do you mean by SPC?
I do not know what this abbreviation means sorry.
Esther
Hi Esther,
sorry about that, I ment SPD-sensory processing dysfunction.
Ilka:)
My mother worked as a teacher for her entire career and did some great work with autistic children near the end of her career. I found this thread very informative. Thanks to all involved!
-Chris
http://www.mavenlive.com
dear Mavin,
no thanks.
I hope you are not using this to promote your site?
Constructive reactions are always welcome.
Esther
Esther - I found the thread a very good read. Toe walking and autism isn't something I had made a connection between in past. But when I thought about the students my mother dealt with it seemed to be prevalent. You learn something everyday.
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
Exactly my view too...... There is saying about the Nervous system" We know a lot today, understand very little".Quote:
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.
I like to present some research evidence on this, will post as soon as possible.
I would be also interested in any research results in this field. Please keep us updated.Quote:
Originally Posted by illuminatidinesh
Additional Comment I forgot:
I would be also interested in any research results in this field. Please keep us updated.Quote:
Originally Posted by illuminatidinesh
Hi! I am involve in music and I found out that music could, in some way, help autistic child in improving their behavior. It could teach them how to communicate and to have better eye contact. As they respond well in music, it could also be used as an interface to help them do tasks that is not related to music like walking.
Dear Wullie,
Thanks for that... BUT who diagnosed these children as having a SPD, a therapists or a neurologist?
I hope the neurologist.... if not, what tests and assessements does the OT use to diagnose this condition?
I am seriously interested. Do really want to know more.
kind regards
Esther
Dear everyone,
Have found a number of answers to the questions regarding SPD in the following article by mrs Nancy Pollock from the canchild website.
CanChild Centre for Childhood Disability Research
Esther
Hi Esther,
our OT is using the Sensory Profile (www.SensoryProfile.com) by Winnie Dunn, but all the children I'm working with are also seen by other professionals. Every child has a "sensory diet"(that's the outcome of the sensory profile) which they follow every day in school.
We have seen improvements in the children who are receiving Physio and at the same time following their sensory diet. It's just very complex as the children I'm working with are on the lower end of the spectrum and most of them are non-verbal and don't follow instructions or copy/mimic any movement.
Hope this is helpful
Kind regards,
wullie :)
Dear wullie,
Have you read Nancy Pollock's article? In it she refers to a dr heibroner and I have found the website. On it his perception of sensory processing disorders.
Why "Sensory Integration Disorder" Is a Dubious Diagnosis
Does make you think and wonder.
And... in the process, getting back to trying to our subject namely what to do about the toewalking... maybe we should rethink our treatment goals.
Esther
Hi Everyone,
I thought I'd add my bit. I'm an occupational therapist working with children with autism, some of whom toe walk. For starters, SPD is not yet a recognised diagnosis so while we may describe a child as having SPD, we do not diagnose them with it. A child's sensory processing and sensory integration is assessed by using the Sensory Integration Praxis Test (SIPT) or more commonly the Clinical Observations (a non standardised ax originally developed by A Jean Ayres). This information is collated with the results of the sensory profile mentioned previously and general observations of the child's function in different settings (school, clinic, home etc.).
I have been working on the hypothesis that toe walking is a sensory seeking behaviour, with the child seeking deep pressure, proprioceptive or vestibular stimulation (or all three). All of the children I see have significant sensory processing dysfunction and this hypothesis is in line with their overall sensory profile. In terms of treatment, I use a sensory diet along with the Wilbarger Brushing Protocol and I have also been using Kinesio Tex Tape to inhibit gastroc/soleus and facilitate tib. anterior. The sensory diet and Wilbarger Protocol improve a child's sensory integration and decrease sensory seeking behaviours. The Kinesio tape increases proprioception to the muscles as well as utilising the specific muscle application. Within treatment sessions we frequently use vestibular, proprioceptive and deep pressure stimulation.
I realise that there is no significant scientific research to support this, as I said this is just a hypothesis. I have however, seen a decrease in toe walking and improvement in gait stability in the children I have been treating.
Julia
Dear Julia,
thank you so much for your imput.
I have been researching the (kinesio) elastic therapeutic tape for a while now. Have come to believe that it doesn't always matter in which direction the tape is applied.
Have you tried different directions or just kept to the (kinesio) protocol?
I have been wondering if taping either only the tibialis or the triceps would make the same difference.
Have also thought about using other/nieuw tape applications. have done so and so far the results have been meager.
Could you tell me a little more about the number of patients you have used tape on and your success rate?
If you are interested in the "new" applicaties, please leave me you email address and I will send them to you.
kind regards
Esther
Hi Esther,
I'm relatively new to kinesio taping, I did the training in October so I tend to stick to the protocol when doing inhibition/facilitation taping. The taping I have done is with a very small number of children, about half a dozen although all showed a decrease in toe walking behaviour in some form. With some of the boys it was only immediately after the tape was applied and as the elasticity wore off, so did the effect of the tape.
One particular success was a boy (8yrs) with very severe toe walking who had been recommended for achilles tendon release surgery in 6 months due to limited ankle ROM and pain. For him I alternated between lower leg and upper leg applications (inhibit gastroc/soleous or hamstring, facilitate tib ant or quads). Through a combination of taping, sensory diet and the brushing programme we restored his ankle ROM to 90 degrees and he is no longer having tendon release surgery. He had a two week break from taping over the christmas period and mum noticed that his gait stability deteriorated over this time.
As I said, I've only done this with a handful of kids, it's more out of personal interest than anything else. If you could send me the details of the other taping methods that would be great, thanks. My email is [email protected]
Julia
Hope all is well, Esther.Quote:
Originally Posted by estherderu
I have heard all too frequently the theories and hypotheses for needing or wanting proprioceptive or vestibular input. There is no evidence to suggest toe walking is due to children's need to stimulate their own sensory systems. Therapists do way too much theorizing without much validity to them.
Kind of scary if our objectives are to help children. Very scary, actually.