Forced Use is Not Forceful

Before I made the move to pediatric PT 17 years ago, I worked with adults with neurological injuries for 14 years. (Now don't put your math skills to work. Those numbers add up to way too many years.) I don't want to throw out a lot of technical terms and anatomy. And I don't do that when I talk to patients and parents. When your patient has had a brain injury like a stroke, telling them to activate their gluts or eccentrically contract their quads and find midline orientation gets a blank stare. In that same vein, a 15 months old does not understand those terms either. And if you want to get a little more in depth with why that won't work... It takes understanding the words, sending the signal from the brain to the muscles and then making the muscles react. That takes a lot of time when you're trying to walk and not fall down.

Before I get to the trick of trade I want to talk about why kiddos sometimes demonstrate different crawling or walking styles. When I see a child who only belly crawls or uses a 3 - legged crawl I immediately know that somewhere there is a weak muscle or muscle group. This causes a child to take a "different route". Here's an example - if you stub your toe, no one has to teach you how to limp to avoid using the hurt toe. When you have sore muscles after a hard workout, you instinctively know how to side step down the stairs to avoid the pain. Babies also know how to compensate when they have a weakness. They know when they aren't ready to walk without holding on. They know if they aren't strong enough to crawl on all 4s.

So how do I get a child to do what I want?? Forced Use! As I say in the title forced use is not done with any force. Forced use means putting your body in a position that automatically causes muscles to fire. As a PT, I determine what muscle groups are weak. Then I reach into my bag of tricks and find a position that will take that compensation out of play. Sometimes I use unstable surfaces. Sometimes I use unlevel surfaces to force more weight onto the weak side. Sometimes I use weights to encourage more effort. Sometimes I use an annoying stimulus to get a baby to move in a certain direction (Ex: Placing a blanket over the eyes for peek-a-boo will encourage your baby to reach up to the face to grab the blanket.) I even use little nudges to make a child resist me and not let me push them over.

If your child is demonstrating an alternate crawl, a walking pattern that looks different, and inability to sit or hold their head up, please consider a PT evaluation. Having a weak muscle group will snowball and prevent your child from achieving higher level gross motor skills. Having one side of the body be stronger than the other can cause orthopedic issues later like scoliosis or joint pain. It never hurts to check it out early and get a plan. And remember, PT does not have to be forceful just because we use forced use.