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Tag: toe walking

Serial Casting

Serial Casting- Casting That’s Not for Broken Bones

Dynamic serial casting is a conservative treatment method in which skilled physical therapists apply and remove a series of lightweight casts to a patient’s leg(s) in order to improve foot alignment and increase range of motion. The goal of serial casting is to improve range of motion in order to prevent chronic skeletal issues, reduce falls, improve function and efficiency, improve the child’s walking pattern, decrease current pain or prevent future pain, and improve alignment for future orthotic use. Serial casting can help to delay or prevent the need for surgical intervention. 

The casting process is performed by skilled physical or occupational therapists. A soft, semi-flexible casting material is applied over stockinette that is padded to protect bony prominences (natural bony points such as the ankle bones) and wrapped in a layer of cotton wrap. The joint is carefully positioned in a neutral position to maximize alignment and gently stretch the soft tissue, with the position maintained throughout the casting process. The child wears and walks (and squats, walks up and down stairs, and stands) on the cast for several days (typically 4 days on and 3 days off), with increased movement and weight bearing allowing for increased gains throughout the casting process. This process is repeated every week for 6-12 weeks until the desired range of motion gains have been made. Notable and measurable gains can be noted in just a few casts, too! 

Conditions that can be addressed with serial casting:

*This is not an exclusive list, as serial casting can benefit a wide variety of patients. Patients who are younger typically make quicker gains throughout the serial casting process; however, patients of any age can participate (and have participated) in serial casting. 

  • Cerebral Palsy
  • Idiopathic Toe Walking
  • Club Foot
  • Charcot-Marie-Tooth
  • Traumatic Brain Injury
  • Duchenne Muscular Dystrophy
  • Spasticity (abnormal muscle tone)
  • Contractures

This noninvasive process is designed to make gains while having limited impact on the child’s typical daily activities. Children can play, stand, and walk within their home, school, and community and participate in after school activities and sports (with the exception of swimming and water play). It is typically not a stand alone treatment method. Casting typically coincides with or is followed by ongoing physical or occupational therapy, and a referral for a pediatric orthotic evaluation to continue to maximize the gains made throughout the serial casting process.  

Check out BDI’s Serial Casting page or ask your child’s BDI physical therapist for more information.

Cassidy Bannon, PT, DPT

 

feet forward

Put Your Best Foot Forward!

When to see a pediatric physical therapist for your child’s feet?

How do you know if your child’s little feet are functioning at their very best? Here are 10 clear signs that you should have a pediatric physical therapist screen your child’s feet so they can put their best foot forward!

Pain 

If walking causes pain in your child’s feet this is a concern that should be addressed immediately. There are a number of reasons for pain in the feet and a pediatric PT can assess and address painful walking.  

Asymmetry

Any difference in one foot compared to the other foot should be seen by a pediatric PT. Feet should look and move the same at the other foot. Seek advice if you notice a difference in foot size, a heel lifted on one side, turning in or out of one foot or any other noticeable differences. 

Toe Walking

Toe walking is an abnormal gait or walk at any age at any time! We often see children raise up on their toes when they are very excited, nervous or cold but only for a few steps and then come down to their heels to walk or run. The earlier a child is seen for toe walking, the faster the treatment and the better the outcome. Don’t Wait!

In or Out Toeing (Pigeon or Duck footed)

Toe inning or outing is a common foot alignment deficit. When the feet are not aligned, the knees are not aligned which can lead to pain and inflammation. Often it can be a sign of leg, hip or trunk weakness or all three! It could also be a misalignment of bones within the joints. Seeing a pediatric PTl will determine the root cause and help get those duck feet in a row!

Flat Feet / Pronation

Flat feet is when almost the whole foot makes contact with the floor while standing. Pronation is when the ankle collapses inward when standing. Both flat feet and pronation can cause similar problems. Postural deficits are usually present as well as over use and under used muscle groups. This imbalance causes poor body mechanics which can lead to premature breakdown of joints. Flat feet and pronation cause the body to move inefficiently. It will take more energy to walk, run and jump!  

Tripping

Children are still developing their sensory systems and body awareness which can look a bit messy. It’s common to miss a crack in the sidewalk or move too fast for their feet causing them to trip and fall. Tripping becomes a problem when they are doing it so much they are hurting themselves. Tripping on the same thing over and over, on stairs or ramps, carpets or even nothing at all can be concerning.  A pediatric PT will be able to assess why they are tripping so often and help keep them on their feet!

Fatigues Quickly with Walking

Carry me! Is a phrase often used by a child who fatigues quickly when walking. A child who has good endurance, body mechanics, postural control and strength will want to walk vs being pushed in a stroller or carried. A child who struggles with one or more of these deficits will fatigue quickly when walking and ask to be carried more often. Ask a professional if your child seems to fatigue quickly when walking vs other children their age. 

Aversion to changing shoes

New shoes or any new clothing item can be stressful to a developing sensory system. Our children who are more sensitive to change will often break down their favorite pair of shoes to a thin sole, or wear shoes that lack proper support such as slip-on type shoes. A professional can help get children into good quality shoes that support the foot properly, helping them to move with better posture and efficiency. Let’s make shopping for new shoes fun! 

Sprained or twisted ankles

This painful injury literally stops you in your tracks. It’s common once in a while but abnormal if it happens over and over again, especially when doing everyday activities. Ankle weakness, misalignment or even vision could be the cause of ankle sprains. A PT can assess and address the reason for this very painful problem. 

Abnormal gait / walk

Any abnormality of a child’s gait should be addressed as soon as possible. Sometimes it’s hard to put your finger on it because the smallest thing could be affecting their gait or it comes and goes. Listen for your child’s steps on a hard surface. It should be an even beat most of the time. Rubbing the top of their foot while walking can be a sensory movement that is affecting their gait. Running instead of walking. Gait abnormalities can easily be addressed in PT. 

High Arches

High arches do not always need to be addressed but if your child has any other deficits such as any problems above, then high arches may need extra support. A PT can assess their gait and determine if treatment is necessary. 

Pediatric Physical Therapists assess the cause of these symptoms and use conservative interventions to improve their everyday function on their feet! They will also refer you to the appropriate healthcare professionals when extra attention is required for the best care of those little feet! 

Set up a free screening with a pediatric PT to ensure your child is putting their best foot forward!

Written By: Dana Bukala, PTA

 

Reflex

Primitive Reflexes

Primative Reflexes- The Good, The Bad, The Better!

Have you ever tripped and simultaneously reached out your hands to stop the fall? That is your primitive reflexes at work! They are essential as the first line of defense to protect ourselves but they can also be detrimental to our development.

What are primitive reflexes? 

Primitive reflexes are involuntary motor responses present at infancy that facilitate survival. Pediatricians check these reflexes at wellness visits to ensure the nervous system is working properly. It is important that these reflexes are present but it is just as important that these reflexes mature or integrate in early childhood. 

The Good: 

REFLEX

GOOD

Moro Reflex

The startle reflex

A fear response to sudden movements or noise
Hands PullingHead control reflex and the ability to contract our muscles to sit up
Hands SupportingOur falling reflex. Ability to reach out and catch yourself.
Tonic Labyrinthine (TLR)Develops balance and spatial awareness
STNRHead, limbs and balance system connection
Asymmetrical Tonic Neck Reflex (ATNR):  Differentiates our left and right side.
Spinal GalantConnects the trunk and lower body
AmphibianActivates nerves between both hemispheres of the brain
Babinski:Supports mature walking and balance
BabkinTongue and mouth coordination for eating and speaking
PlantarProtective response to provide stability
PalmarAdvances fine motor movements of fingers.
Landau Promotes ability to control head in tummy time

Why do reflexes need to integrate?

We unconsciously use these reflexes everyday, but what happens when we are unable to consciously control them? That’s what happens when reflexes don’t integrate. It’s like being in a self driving car and not being able to take control of the wheel, which can be very scary. Sometimes our reflexes do not mature because of abnormal movement patterns in utero or infancy, neurological deficits, or just unknown reasons. These primitive neuro connections are powerful and can inhibit our ability to voluntarily control our body and mind if they are retained.

How do reflexes affect development?

A retained reflex can present in strange ways causing possible behavioral, emotional, sensory and physical deficts. Not all reflexes present the same way in every person but they do have common patterns. The infant’s movements work together in sequence during development. If one reflex does not integrate it can cause others to also be retained. It is not uncommon to see two, three, or almost all the reflexes present during a primitive reflex evaluation. The following are common traits you might see if reflexes are retained.   

The Bad- Unintegrated Primative Reflexes

REFLEX

GOOD

BAD

Moro Reflex

The startle reflex

A fear response to sudden movements or noise
  • Anxiety
  • Difficulty sleeping
  • Insecure
  • Sensitive to light
  • Sound and/or touch
  • Emotional
  • Common in toe walkers 
Hands PullingHead control reflex and the ability to contract our muscles to sit up
  • Poor muscle tone
  • Poor hand, eye, and mouth coordination
  • Delayed gross and fine motor movements 
Hands SupportingOur falling reflex. Ability to reach out and catch yourself.
  • Clumsy
  • Poor personal boundaries
  • Aggressive
  • Avoids interactions
  • Difficulty processing information
Tonic Labyrinthine (TLR)Develops balance and spatial awareness
  • Motion sickness
  • Poor sense of time and organizational skills
  • Coordination difficulty
  • Spatial and balance problem
STNRHead, limbs and balance system connection
  • Crawling difficulty
  • Low muscle tone
  • Slumps while seated
  • Difficulty copying tasks
  • Poor attention
  • W sits 
Asymmetrical Tonic Neck Reflex (ATNR):  Differentiates our left and right side.
  • Challenged with crossing midline
  • Difficulty catching
  • Focus and memory difficulty
  • Auditory challenges
  • Dyslexia
Spinal GalantConnects the trunk and lower body
  • Postural deficits
  • Hip rotation effecting gait
  • Hyperactive
  • Fatigues with cognitive functions
  • Bed wetting
AmphibianActivates nerves between both hemispheres of the brain
  • Rigid movements
  • Limited stride length
  • Poor coordination
  • No rotational movement
  • No hand dominance
Babinski:Supports mature walking and balance
  • Tripping
  • Stabilizes with tongue
  • Oral motor and articulation deficits
  • Flat feet
  • Walks on toes or sides of feet 
BabkinTongue and mouth coordination for eating and speaking
  • Open mouth posture
  • Poor mouth coordination
  • Lacks facial expression
  • Speech delay
  • Sensory chewer 
PlantarProtective response to provide stability
  • Grasping hands
  • Poor running/jumping
  • One sided crawl
  • Standing delay
  • Fight/flight response to loss of balance.
PalmarAdvances fine motor movements of fingers. 
Landau Promotes ability to control head in tummy time
  • Poor posture
  • Clumsy
  • High tone in legs
  • Visual challenges
  • Depression and fears
  • Poor focus and balance

 

The Better: 

It is extremely common to have one or more reflexes present and you might even identify some of these traits in yourself. That does not mean it needs to be treated unless the reflex is so dominant that it interferes with the ability to learn, be safe and thrive. Reflex therapy helps to identify and create an individualized reflex exercise program to promote integration. The brain responds by taking the wheel and improves control over it’s own mind and body. Now that’s better!

 

If you think your child may have primitive reflexes present we can help! Free primitive reflex screenings are available via Zoom or in person at our Orland Park or Naperville/Aurora locations. 

Reflex Integration

Reflex Integration

What are reflexes?

Reflexes are automatic responses that occur out of someone’s control in response to an external stimulus or facilitated movement.  Reflexes are necessary automatic movements that are essential for survival as a baby and are what helps a baby develop movement. 

Each reflex is present and integrated at different parts of development.  An example is the rooting reflex, when the baby’s cheek is stroked the baby will turn their head in the direction of the stimulus and open their mouth automatically. This reflex allows the baby to find their mother’s breast and is essential for feeding.  This reflex will usually integrate around 4 months of age once the infant starts to develop volitional control and has learned how to respond IND when they smell, feel and see mother’s breast.  

Unintegrated Reflexes

Reflexes can become problematic when they are delayed or unintegrated. In the case of the rooting reflex, if it is not present at birth it can impact IND feeding response or if present after feeding can impact speech, eating, and response to facial touching.  Common things you might see in your child if this reflex is not integrated include trouble pronouncing words, difficult breaking thumb sucking, messy eatering, or has poor tolerance to kissing or touching their face. 

Unintegrated Reflex Red Flags

There are many reflexes and each has a vital role and can have a huge impact on development if delayed or not integrated at the right time.  Some of the red flags to look for include

  • difficulty or delayed gross motor skills
  • difficulty or delayed fine motor skills
  • emotional lability
  • poor tolerance to new situations
  • difficulty with learning/writing
  • poor vision
  • poor attention
  • bed wetting
  • difficulty with potty training
  • abnormal muscle tone
  • poor tolerance to certain movements.

Next Steps

If you have any of these concerns you should try physical and/or occupational therapy to perform movements that are designed to help with reflex integration.  In addition, your therapist will be able to work on the functional or emotional skills your child is having difficulty with to improve their IND and participation.

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Gait Clinic

BDI Gait Clinic

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  • Feet

  • Gait Clinic 5

  • Foot

Have any questions about gait clinic?

Give us a call anytime at (708)478-1820 or sign up below!

Attend a Gait Clinic Session

What is Gait Clinic?

BDI Playhouse Children’s Therapy is excited to offer a monthly gait clinic using a team based approach to optimize a child’s gait.

  • Designed for parents, therapists, and orthopedic specialists to discuss and determine appropriate orthotics based on each child’s needs.
  • Includes on site modification, video analysis and clinical assessment to aid in appropriate orthotic and/or shoe recommendations.
  • Follow up visits will occur based on orthotist and physical therapist guidance to monitor progress and adapt as needed.

Orthoses and/or shoe modifications can optimize gait mechanics by:

  • Equalizing leg lengths Improving foot arch support
  • Dynamically stretching tight muscles
  • Activating appropriate muscles
  • Enhancing energy conservation
  • Increasing mobility and range of motion

Who is Gait Clinic for?

  • Parents looking for input on your child’s orthotic intervention?
  • Therapists looking to confirm or collaborate with your orthoses recommendations?

Who runs gait clinic?

Physical Therapists and Orthotists at the Gait Clinic:

  • Offer experience in gait analysis and orthotic prescription
  • Have extensive education in proper pediatric gait mechanics, gait analysis, orthotic recommendations, and shoe modifications
  • Utilize the most current research based techniques

What do I need to bring to Gait Clinic?

  • Athletic shorts and a T-shirt
  • Shoes your child wears frequently
  • Current orthotics and/or shoe modifications
  • Insurance card
  • Your questions and ideas!

Interested in Our Monthly Gait Clinic?

Give us a call anytime at (708)478-1820 or sign up for a gait clinic session below.

Attend a Gait Clinic Session

Download a Gait Clinic Flyer for Families here

Download Information for Professionals referring to Gait Clinic Here

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Aqua Therapy

Pediatric Aqua Therapy

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  • Aqua 2

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  • aqua 4

  • aqua 5

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Aqua Therapy Questions?

Give us a call anytime at (708)478-1820 or schedule a free screening or consultation below.

Schedule a screening

What is Aqua Therapy?

Aqua Therapy is a fun way to develop your child’s motor skills! The unique properties of water enhance therapeutic activities. The use of water in therapy can:

  • Provide a reduced gravity environment to help children explore and practice movements
  • Develop skills they are not yet able to perform on land
  • Provide resistance to active movement through all planes of motion
  • Facilitate gains in strength for all major muscle groups.
  • Increase tactile, vestibular, and proprioceptive input that enhances body awareness and motor learning

Benefits of Aqua Therapy?

  • Increase in mobility and range of motion
  • Balance and coordination
  • Increase in trunk stability and postural alignment
  • Perceptual and spatial awareness
  • Muscular strength and endurance
  • Joint mobility
  • Muscle flexibility
  • Head & trunk control
  • Blood supply to muscles
  • Attention span & sensory motor integration
  • Respiratory rate
  • Circulation
  • Symmetry, strength and endurance
  • Decrease in pain
  • Decrease in muscle spasms
  • Decrease in abnormal tone and rigid muscles
  • Decrease in joint compression
  • Stress and tension release
  • The psychological benefits include improved self esteem, confidence, and motivation!

Your Aqua Therapists

BDI Playhouse Children’s Therapy’s aqua therapists are licensed physical and occupational therapists with experience in aquatic pediatric therapy. They have attended aquatic therapy courses, and have received certificates in Water Safety and CPR. They utilize aquatic and landbased techniques, including myofascial release, neuro-developmental treatment, sensory motor integration and functional motor skills in their treatment sessions with children who have orthopedic, neurologic and/or sensory motor challenges.

Aqua Therapy Locations and Materials

What do I need to bring to my child’s Aqua Therapy session?

  • Towels
  • Lock for locker (optional)
  • Bottle of water
  • Water diapers or rubber pants (for incontinence)
  • Non-skid slippers or water shoes

Locations:

Getting Started With Aquatic Therapy

Find answers here

Still not sure? Schedule a free consultation here

Download or print this page

Great Feedback from Great Families

Our son received physical therapy both in the office and in the pool for his torticollis. While we were incredibly happy to have our son ‘graduate,’ we were also so sad to say goodbye to our amazing physical therapist. She was dedicated, thorough, and caring; we are so grateful for this positive experience!”

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Physical Therapy

Pediatric Physical Therapy

  • Serial Casting

Questions about Physical Therapy? 

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708-478-1820

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Schedule a screening

BDI Pediatric Physical Therapy

Pediatric physical therapy is for more than just injury rehab or treatment of a diagnosed motor condition. Many children need short term Physical Therapy to address minor challenges or concerns noted by parents. A diagnosis is not required or necessary.

Casting for Pediatric Orthotics

Physical Therapy can help with

  • Infant head shape: flat spots or other differences
  • Bladder and Bowel Training
  • Gross motor development
  • Milestones related to walking, sitting, crawling
  • Sports Performance
  • Scoliosis Intervention
  • Bike Riding
  • Difficulties in Gym and Physical Education Class
  • Muscle strengthening
  • Posture / postural control
  • Pre-gait and gait training
  • Neuromuscular function
  • Environmental adaptations / seating and positioning
  • Splinting / bracing / orthotics
  • Improving endurance
  • Coordination of movements
  • Balance training
  • Family education

If your child does have a diagnosed condition

If your child does have a diagnosed condition, you can feel confident in our collaborative team approach that brings multiple specialties together to address the whole picture and make sure nothing falls through the cracks.  Our therapists have a high commitment to continuing education and stay in tune with the latest research-proven methods for the treatment of:

  • Cerebral Palsy
  • Spina Bifida
  • Down Syndrome
  • Sports injuries
  • Scoliosis
  • Juvenile Rheumatoid Arthritis
  • Torticollis
  • Brachial Plexus injuries
  • Traumatic brain injuries
  • Spinal cord injuries
  • Decreased coordination
  • Incontinence
  • Various other motor conditions

Reflex

Physical therapists assist children in reaching their fullest potential in functional independence and fitness.

Innovative programs are aimed at:

  • Enhancing strength, coordination and balance
  • Physical fitness
  • Wellness for optimal quality of life

If you have questions or concerns, a free 30 minute screening with a Pediatric PT is a GREAT place to start. Our therapists work with children with or without a diagnosis.

Schedule a screening

A-Z of our PT Services

A

Adaptive Sports

Aquatic Therapy

B

Balance

Ball Skills

Bike Riding

Bilateral Coordination

Biofeedback

Bowel and Bladder Dysfunction

C

Coordination 

D

Developmental Screening

Dynamic Serial Casting

E

Early Intervention

Environmental Adaptations

F

Family Education

G

Gait Training

Gross Motor Skills

H

Health Promotion

Head Shape

Home Exercise Program

I

Incontinence Training

Infant Massage

Intensive therapy

K

Kinesiology Taping

M

Motor Learning

Myofascial Release

N

Neurodevelopmental Therapy (NDT)

O

Orthotic Assessment and Training

P

Pelvic Floor Education

Positioning to assist with feeding

Postural Awareness and Training

Prosthetic Training

R

Reflex Integration

S

Scoliosis

Schroth Therapy

Serial Casting

Sports Injury Recovery

Strengthening

T

Toe Walking

Total Motion Release (TMR)

Torticollis

V

Visual Motor

W

Wheelchair Assessments

We are proud to collaborate with


Great Feedback from Great Families

My son Jayden is 11 and has been coming to BDI for the past 4 years. BDI has become family in the way they treat my son. I truly feel deep in my heart if it wasn’t for his PT my son wouldn’t be walking the way he is today. BDI hires only the BEST. Every child here is treated with respect and love and each parent is respected and appreciated for their role in their child’s treatment plan.”

Getting Started With Physical Therapy

Find answers here

Still not sure? Learn more about whether your child needs therapy here


https://totalmotionrelease.com/tmrhome
https://www.bedwettingandaccidents.com/find-a-provider


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