Toddlers/Toe Walking

Question 1

What are some hallmark, general behaviors of toddlers?

Answer 1

• like to follow and be followed
• like exploring
• need redirection
• “NO” and “MINE” are big words

Question 2

What are the advanced gross motor skills toddlers are working on?

Answer 2

• running
• jumping
• kicking
• throwing
• catching

Question 3

T/F: Toddlers gain full ROM in their LE’s by the end of age 2.

Answer 3

true for AROM, not PROM

Question 4

When do toddlers gain full ROM of their UEs?

Answer 4

by end of year 1

Question 5

When do toddlers develop heel strike?

Answer 5

18 mo

Question 6

What strength is developing at 13 mo?

Answer 6

proximal shoulder strength

- shoulder girdle/RTC to push/pull toys

Question 7

At what age do we get increased abdominal strength, as well as hip abd/add and glut strength? What is this used for?

Answer 7

18 months -> used for transitions and walking up/down stairs

Question 8

Muscle strength in what area is seen at 24 mo? What is it used for?

Answer 8

quad and trunk strength: used for jumping

Question 9

When do children begin throwing?

Answer 9

13 mo: think about their strength gains they get at this time

Question 10

If a child is having difficulty going up/down stairs, what muscles could you work on?

Answer 10

hip/glut strengthening, quad strengthening

Question 11

If a child isn’t jumping, what muscles need strengthening?

Answer 11

trunk and quads

Question 12

When do toddlers begin to run?

Answer 12

13 mo

Question 13

By what max age should late walkers be walking?

Answer 13

18 mo

Question 14

When a 13 mo child is walking, what things should you look at in your eval?

Answer 14

• are they able to slow down and keep balance?
• are their feet sensitive to varying textures? sensory intolerance?
• can they run?

Question 15

T/F: Eye-foot coordination is developed by 2 yo.

Answer 15

false, just beginning

- but hand-eye coordination is well developed by 2 yo

Question 16

T/F: Primary fine motor skills are developed by the first year.

Answer 16

true, allows building of coordination through 2 yo

Question 17

At 3yo, do children have the skills needed to play soccer?

Answer 17

yes, hand-foot coordination is more developed then

Question 18

What are the 5 general things that toddlers are gaining in development?

Answer 18

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

Question 19

By 15 mo, how far should a toddler be able to walk without support?

Answer 19

10 ft

Question 20

Describe the walking capability of a toddler at 15 mo.

Answer 20

• able to slow down easier and keep balance (starts at 13 mo)
• fast walking cadence wise
• backwards and sideways walking beginning

Question 21

How far should a 13 mo child be walking without support?

Answer 21

at least 5 steps

Question 22

When does a child start to explore going down stairs independently? How much can they do?

Answer 22

15 mo: start to creep/crawl down a few stairs

Question 23

What would be a good way to get a child to do sideways walking?

Answer 23

hold their hands and tell them to “do what I do”

Question 24

How do children begin to throw at 13 mo?

Answer 24

flinging with elbow: may do better in sitting

Question 25

How do children catch a ball at 13 mo?

Answer 25

carrall it with both legs and hands in sitting | - cannot do standing yet

Question 26

When does heel-toe gait begin?

Answer 26

18 mo

Question 27

Describe stair navigation improvements from 13 to 18 mo.

Answer 27

13: crawling up stairs 18: marks time up/down with hand held

Question 28

When can a toddler start to throw overhand more?

Answer 28

throws overhand 3' at 18 mo (vs flinging at 13 mo)

Question 29

What does running look like at 24 mo?

Answer 29

running on toes in 10' intervals

Question 30

Describe kicking skill development in toddlers.

Answer 30

- 15 mo: raises foot to make contact with ball | - 24 mo:

Question 31

Describe running development in toddlers.

Answer 31

13 mo: starts trying to run 18 mo: immature run, hurried walk 24 mo: runs on toes for 10' intervals

Question 32

When does a child begin to pull toys behind them while walking?

Answer 32

18 mo

Question 33

When is a child able to walk up/down stairs with hand-held support? What about railing support?

Answer 33

18 mo (crawling at 13 mo) hand held 24 mo railing

Question 34

When is a child able to stand on 1 foot?

Answer 34

24 mo: stands 1 foot for 1-2 sec

Question 35

What can a 24mo do when walking on a line?

Answer 35

walks with one foot on 4" line for 6'

Question 36

At 24 mo, what is a child's throwing skill?

Answer 36

throws a tennis ball underhand 3-7'

Question 37

How old is a child who catches a large ball against their body?

Answer 37

2 yo

Question 38

How old is a child that kicks a ball 3ft by walking into it?

Answer 38

18 mo | lifts foot to make contact at 15

Question 39

Describe kicking skill development in toddlers.

Answer 39

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

Question 40

What jumping skill is seen in 2 yo?

Answer 40

- jumps up 2in with feet together | - jumps of stair with one foot leading

Question 41

Describe catching skill development for toddlers.

Answer 41

13 mo: corralling ball when in sitting 24 mo: catches large ball against body

Question 42

How old is a child that throws a tennis ball underhand for 3-7'?

Answer 42

24 mo

Question 43

Describe throwing skill development for toddlers.

Answer 43

13mo: flinging 18mo: starts throwing ball overhand 3' 24 mo: throws tennis ball underhand 3-7'

Question 44

A child doing a hurried walk for a run is how old?

Answer 44

18 mo

Question 45

How old are children when they can push/pull objects?

Answer 45

13 mo: developing proximal shoulder strength to do so

Question 46

When is walking backwards mastered?

Answer 46

2 yo (starts at 13-15 mo)

Question 47

When does a child pull toys behind them while walking?

Answer 47

18 mo

Question 48

When do toddlers get better at stopping/starting gait?

Answer 48

18 mo (begin trying at 13 mo, but can't stop w/o losing balance)

Question 49

What muscles assist a toddler in standing balance, but are weak during gait at 13-18mo?

Answer 49

abdominals

Question 50

When does concentric dorsiflexion begin for gait?

Answer 50

13-18 mo | - think about heel strike: starts at 18 mo

Question 51

T/F: Toddlers now have a narrower BOS that is less than the width of their shoulders.

Answer 51

true

Question 52

A child who maturely weight-shifts in transitions to stand and and creeping up stairs is how old?

Answer 52

18 mo

Question 53

T/F: Toddlers have more mature weight shifts in static standing now.

Answer 53

true

Question 54

T/F: Toddlers have immature weight shifts in running at 24 mo.

Answer 54

true, think about the fact that they just have developed this skill really

Question 55

A child who is beginning to arm swing is how old?

Answer 55

18 mo

Question 56

A child with increased arm swing as well as counter-rotation of the trunk is how old?

Answer 56

24 mo

Question 57

Discuss rotational ability in a 13 mo.

Answer 57

- 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

Question 58

Discuss the gait of a 24 mo. (5)

Answer 58

- 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

Question 59

What are 13mo's able to do during gait that requires UE strength?

Answer 59

push/pull objects

Question 60

What are the main skills we're working on with toddlers?

Answer 60

``` walking running jumping catching throwing kicking climbing stairs ```

Question 61

What are the 3 reasons kids walk on their toes?

Answer 61

1) sensory issues 2) underlying diagnosis (MD) 3) idiopathic

Question 62

What are the expected treatment outcomes for ITW?

Answer 62

1) At least 10 deg DF with KE 2) Heel strike 75% of time 3) Age appropriate gross motor/balance skills

Question 63

Why do we attack ITW with more aggression these days?

Answer 63

- avoid lacking ankle ROM in adulthood - allow for development of mature gait - reduce need for invasive treatments later on - prevent pathological outcomes in adulthood

Question 64

How would you screen for ITW?

Answer 64

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

Question 65

T/F: ITW is not painful.

Answer 65

true, shouldn't be

Question 66

At what age does a child have active DF?

Answer 66

18 mo

Question 67

What percent out of 100 that a child toe walks qualifies a child as idiopathic toe walking?

Answer 67

>25%

Question 68

What test is recommended for use to assess ITW?

Answer 68

observational gait scale

Question 69

What is a perfect score on the observational gait scale?

Answer 69

22 (11 on each leg)

Question 70

What should be included in your assessment of ITW?

Answer 70

1) observational gait scale 2) physical assessment of gross motor skills 3) CNS screen

Question 71

What kind of gait should you measure when using the observational gait index?

Answer 71

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)

Question 72

What are some common PT interventions for ITW?

Answer 72

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