Physical Therapy and Walking
Elizabeth Bakken, PT, DPT
Walking is a gross motor milestone children typically hit between 10-15 months old. If a child has delays in gross motor milestones, including walking, participation in physical therapy may be appropriate to help gain the strength, balance, coordination, and motor planning needed to walk independently. Gross motor milestones do build on each other in gaining these skills needed for walking, so if delays are noted, we typically want to treat and gain these gross motor milestones in age order. Physical therapy treatment will be individualized to assist with the child’s specific deficits found during the initial assessment. Physical therapy treatment will help a child gain the strength, balance, coordination, and motor planning needed to walk. Along with this, the physical therapist may discuss potential benefits of assistive devices or orthotics to assist the child with stability in standing and walking, if appropriate. This blog will discuss general tips and exercises that can be done to help encourage independent walking at home, but know not all children are the same and individualized treatment with specific exercises and guidelines for your child can be given following a PT initial assessment.
1. Transfers: performing transfers like sit to stands or floor to stand through half kneel helps a child gain the lower extremity strength needed for independent walking. Transfers through half kneel also assists with single limb strength and stability needed during walking while the opposite limb is in the swing phase.
2. Cruising: cruising or walking sideways along furniture helps a child gain the hip abductor strength needed for stability during a normal walking pattern. Cruising also helps a child gain stability in standing with two hand support and weight shifts.
3. Barefoot exploration: As children are first learning to walk, barefoot is best. Being barefoot helps children strengthen muscles in their feet and ankles, supporting the development of the arches of a child’s feet and increasing stability. Additionally, being barefoot increases a child’s sensory input and proprioception with navigating their surroundings.
4. Gaining stability in standing: With walking, a child needs to be able to stand independently on one leg with forward momentum, while the opposite leg is stepping forward, and maintain their stability. Gaining stability in standing first with reduced assist, weight shifts or balance challenges can help a child gain this stability. This may look like standing with two hands on a surface, to one hand on a surface, to standing independently, to standing on compliant surfaces, or weight shifts such as a modified single limb stance with the elevated leg placed on something like an airex pad or pillow.
5. Progressions of walking to encourage independence: As a child begins to walk, they may use a push toy or require two hand support. This can be progressed to one hand support or a modified hand hold, with the caregiver and child both holding onto a toy. The reduced support helps the child gain stability with standing and walking. Once a child is able to walk independently on flat surfaces, further challenges can be added to mimic their home environment. Practicing navigation of obstacles, small changes in surface heights, or compliant surfaces, like a change from a wood floor to carpet, can further challenge the child’s balance and independence with navigating their environment.
6. Using toys as motivation: play based treatment and exercises help encourage a child’s motivation to participate in exercises. Using a child’s preferred toys or activities and moving them around the play space can help to encourage the exercises discussed.
