Isaac is an 8-year-old boy with developmental delay. He has been diagnosed as being on the Autism spectrum. He is not talking and started walking independently without a walking aid only 1 month ago.
Isaac was born at 32 weeks after an uncomplicated pregnancy. In his gross motor development, Isaac has been a slow starter. He just appeared to be not interested in moving and seemed quite happy to just observe the world from a position lying on his back.
When I first met Isaac, he was 3 years old. He was not able to sit by himself at that stage but managed to commando crawl through the house and was still quite happy to be lying on his back. He was able to hold toys in his hands but didn’t always understand what he needed to do with these toys. I focused on sitting as a treatment goal, as being able to sit independently goes a long way in school, home and community settings. I started with supported sitting on the floor while playing with toys in front of him to challenge his sitting balance a bit while still supported, and then decreased my support to just be there if he was close to losing balance. It took six months of regular physio sessions and some home exercises to get Isaac to sit independently on the floor. Once he could sit, there was no lying down any more.
I think this first step greatly improved his view of the world, and made a big change in how he was able to play with his toys. It also changed the way he was using his voice – he was able to show a greater variety of sounds, although he was still not speaking.
I started to focus on getting him from sitting to standing; first we started with supported standing at a sofa or any other surface that supported him at hip level. Initially, he collapsed forward on the surface. With lots of exciting toys and encouragement, he managed to be able to stand upright for longer and longer. Getting from sitting to standing was tricky because Isaac wasn’t very strong in his legs, and didn’t quite seem to get the concept of how to do this. We practised lots and lots of standing up from a chair and getting onto his knees when sitting on the floor (and then continue to get up to standing).
One day, when no-one was looking, he stood at the sofa on his own. To his mother’s delight, she turned around to find him standing there! Once he had discovered this, he wanted to stand up and start to practise furniture walking. As he was already five years old by that time and about to attend school, I decided to give him a special paediatric walking frame to help him walk and for him to be able to meet his new friends eye to eye when going to school. This walker allowed him to walk right up to a table, and to kick a soccer ball during play times. Isaac continued to be stronger and stronger and walked longer distances with this walker.
We started to do some hydrotherapy to use the water to take some of the pull of gravity away and to do exercises in a fun way. Slowly, Isaac started to take some independent steps in the water; now the big challenge was to transfer this to ‘land based’ as well. Isaac found it a big challenge to rely on his own body and strength to walk, and took a while to build enough confidence to let go of the walker. We practised standing with minimal support at very wobbly surfaces to try and decrease the amount of support required. We had a lot of fun trying to do some balance exercises on the balance foam and wobble-board.
4 weeks ago, Isaac decided it was time to let go of the walker and walk like it was something he had done all his life. Everyone was so excited about this and he just had this look of “what’s all the fuss about? I’m just walking” on his face. He now refuses to use the walking frame and is increasing the distance he can walk every day. His gait pattern is very good but still needs some fine tuning, so we are currently working on walking with a narrower base of support, doing obstacle courses in the Physio sessions, continuing with balance exercises and strengthening both in the pool and in the clinic.
This is a nice example of how physiotherapy can help children with significant developmental delay reach their milestones at a later age. If your child has a developmental delay, even if it’s just mild, an appointment to see a Paediatric Physiotherapist can make the world of difference in their (and your) life.
