Taking steps and walking is one of the most common physical therapy goals for families I hear. This is not at all surprising! Walking is a big gross motor milestone, and it gives your child greater independence within their environment. As a physical therapist, being able to analyze the phases of gait (as well as other motor tasks that support the foundational skills for walking) is crucial to identifying the impairments that are affecting this skill. Range of motion/posture, strength, balance, endurance, and coordination all affect gait, and often more than one of these contribute to gait deviations. These gait therapy exercises benefit children with CP (Cerebral Palsy) among other disabilities.
Here are some common physical therapy exercises for gait and balance:
This position eliminates the use of two joints (knees and ankles) but focuses on and activating important pelvic stabilizers (GLUTES!!) that are needed for balance when walking, while eliminating compensatory strategies (eg extensor tone, hyperextension of knees, and others). Start with support for your child to lean on such as a table/couch. Is leaning on a table too easy, but hands free is too hard? Have them facing a wall or play with magnets on a fridge so they can still use their hands without leaning over a horizontal surface. Adding reaching with any of these supports will help with balance for weight shifting.
Knee walking can help your child to begin to have more independent mobility, and work on the same movement and postural muscles needed for walking and balance required for weight shifting. It is important your child is in the best upright alignment to avoid overuse of their quads. You can support them to perform this with hands on help, or using a push toy, and then hands free. Don’t forget about side stepping too, either at a table/couch or along the wall!
Among other gait training physical therapy techniques, NAPA Center incorporates treadmill training into both its intensive therapy program as well as its traditional treatments using the SpiderCage, a body weight support system.
This simply means one foot is placed in front of the other; this will work on balance when both feet are not next to each other, which is how our feet are positioned when both are on the ground during gait. Start with a wider stance for more stability, and then work on narrowing stance. To make this more challenging, you can work on reaching for your child to weight shift forward and back, left to right onto each foot, and also have them catch/throw toys to work on holding their balance as their body responds to subtle movements. This will help with control and stability when stopping and starting to step.
As your foot swings to take a step, your standing leg needs to be stable and supportive throughout this movement. Your child can start by placing one foot on a raised surface (such as a step/box) so they have some stability from both feet, but the majority of their weight is on one leg (the one on the floor). Increasing the height of the raised surface makes it more challenging, as well as making it more dynamic, like having them stand with their foot on top of a soccer ball. Making shapes or letters with their raised foot on a ball, or freely in the air adds to the level of difficulty.
These are just a few of MANY gait therapy exercises that work on balance for standing and gait. Keep in mind safety is #1; make sure your child is supported as much as they need (but not too much!), and use of a gait belt is always a good idea. Happy balancing!
Lindsey is the lead trainer and physical therapist at NAPA Center Boston. She is certified in NDT and CME and is also trained in kinesiotaping. Outside of her position at NAPA she practices yoga and is a certified yoga instructor.