The benefits of long-term stander use for children who do not walk or walk minimally are well known based on extensive research. What about short term use of standing programs as an adjunct to therapy for children who are expected to walk, but are delayed by hypotonia or orthopedic issues?
As Zoe approached her first birthday, her mother became increasingly concerned about the progression of her gross motor development. She had never learned to crawl. Zoe’s style of scooting on her bottom while propelling herself with her right leg and left arm was efficient enough for her. While she would stand briefly, she would not pull herself from the floor to standing or attempt to take steps. External tibial torsion, or twisting of the lower leg bone to make Zoe’s feet turn outward, was present bilaterally. This was accompanied by significant flexibility of the ankles, which had allowed the tops of Zoe’s feet to touch her shins, likely because of in-utero positioning. As her social, language, and fine motor skills progressed age-appropriately, Zoe’s gross motor skills seemed to plateau.
At 14 months, the family saw an orthotist because of concerns regarding Zoe’s lower leg and foot alignment. The orthotist noted good intrinsic strength and active movement in the feet and ankles. The recommendation was to provide Zoe with shoes with a good arch support, a solid heel cup, and ankle stability. Her mom tracked down the perfect purple patent leather hiking boots and tried to increase Zoe’s standing playtime.
Stander use for a motor delay paid off by increasing strength and mobility.
At 15 months, Zoe’s parents took her to her well baby appointment and were not able to report any significant improvements in her gross motor skills. The doctor noted asymmetry in Zoe’s muscle mass and referred the family to an orthopedic surgeon. After examining her x-rays and observing Zoe’s movement, the orthopedic surgeon stated he felt Zoe’s joints were stable and aligned within a normal range. The family doctor and orthopedic surgeon both said something along the lines of, “If she’s still not walking at 18 months, then we might have to pursue further intervention.”
What would that intervention consist of? Would it include referral to a pediatric physical therapist? Zoe spent most of her waking hours with a pediatric physical therapist who studied her every move – her mother. A standing program was initiated at home. Zoe stood for 45-60 minutes three to five times per week. After two weeks, Zoe was able to pull from the floor to standing at a stable object. Walking was still an area in which she showed no interest.
At age 16 months, after four weeks of stander use, Zoe started cruising furniture and walking with both hands held. She would crawl a few cycles for a round of applause, but still preferred to scoot to most destinations in her hurdling position. Once she began spending at least 45 minutes per day standing independently with support, stander use was discontinued.
Now, at 17 months, Zoe takes one to two steps with one hand held and stands unsupported for up to five seconds. She has made about six months worth of gross motor gains in two months, and the standing program was essential to getting her progress started.
Have you utilized standing therapy for a child with milder motor delays? Please share your experiences in the comments below.
Thanks Stephenie for sharing this experience. It is really neat to hear of this use of a stander, beyond what we usually think a stander should be used for! I am glad that Zoe made such great progress with standing therapy!
Yaaaaaaay, Zoe! Yaaaaaay, Zoe’s mommy!
I am a pediatric PT also. I prefer to help children with mild delays begin to stand at a sofa or soft chair to play. At first I give them all the support they need to be successful, often holding both knees in extension and having my body behind theirs so their hips stay aligned over their feet. Once i have them interested in standing, I have them sit on my ankles ( I am sitting in the criss cross style) and I bring their feet back towards me and flex the ankles deeply (past 90 degrees into consdierable dorsiflexion) and get knees forward of the feet. Do not allow the knees to go out to the side (frog leg), keep the knees aligned with hips. To easily figure this out, seat yourself on a couch. As you prepare to stand, notice that you draw your feet back and knees go forward, then you stand. Often, once I get the kids in this position and weight is on the front of their foot (ankles flexed past 90 degrees) many children will push into stand. Most of the children I have evaluated, that are non weight bearing and families say they can’t get them to bear weight, will learn quickly using this technique. Those that don’t just need more help to extend their knees and hold them in extension while they play at the sofa. While there have been a handful of kids in 27 years that were more difficult to teach, the vast majority responded easily with this method. Give it a try. If you get the movements confused, just go back to a sofa and observe your own motions of getting to stand.