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Baader-Meinhof

Has this ever happened to you? You learn something new.  It could be a new word, phrase, place, or concept.  Then all the sudden, you see it or hear mention of it all over the place! The feeling of, “That’s funny, I just heard about that yesterday!” Well, it turns out there’s a name for that: the Baader-Meinhof Phenomenon aka frequency illusion.  This is most definitely what I experienced once I learned of the “vertical tibia”.  Once I saw it, I couldn’t unsee it.  I never really noticed it before, but now it leaps out at me when I work with my toddlers.  Even more importantly, I take note of when I DON’T see it!  So what on earth is the “vertical tibia”?

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The tibia is the technical term for your shin bone.  Unlike grown-ups and kids who have been walking for quite awhile, new walkers keep their tibias vertical during gait and especially when squatting down to the floor.  Their shin doesn’t drift forward over their foot like mine does.  They keep everything locked in….spine and pelvis become one unit, and tibias remain vertical over a foot that is facing forward and has all its weight in the heel.  Why is this a big deal? You can feel it for yourself that if you do a squat with a straight back and your weight in your heels that your abs, gluteals, and quads turn on big time.  These are all the muscles that make up the “core” that provide us with postural control.  They keep us stable as we move through space.  So what happens with new walkers? They fall.  A LOT.  In fact, new walkers average around 17 falls PER HOUR.   And what happens when they fall? They get back up through a beautiful vertical tibia squat that helps them get stronger with each of those 17 falls.

Now when I see a toddler squat with a vertical tibia, I get excited and think “there it is!!!” because I know he has good postural control or at least he’s working on it.  If I don’t see it, I will instead typically see a deeeeeeep squat with a tibia drifting so far forward that the ankle and shin are coming really close together.  In this case, I make the vertical tibia happen by giving the toddler something with some weight to pick up. This could be picking up a ball for a catch back and forth with mom or helping to clean up by lifting bigger toys up from the floor with both hands.  They will have to counterbalance the weight by shifting back into their heels and then YAY! that tibia goes vertical, just the way I like it!

I should say that as children grow and change in proportion, around 2 years old, we see the vertical tibia in a squat less and less.  There is a small window of time to catch it in action.  Don’t worry, though.  Now that I’ve mentioned it, I’m sure you’ll see it thanks to Baader-Meinhof!

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Myths!

I’ve gotten the chance to work with so many amazing families over the years! I’ve had great conversations with moms, dads, grandparents, nannies, and foster parents about progress their little ones make every day and what skills to expect next as kids keep learning and growing. Likewise, we talk about when development looks atypical, and why kids might choose some movement patterns over others based on muscle tone, weakness, and alignment. Families know their children better than anyone else, but when it comes to motor development, there are some things I hear all the time from families that are really just not true. I’m here to dispel the myths! Here are my top 3:

1.  “I think he’s just lazy”. This is a big one! I hear this all the time and it’s 100% not true. There is no such thing as a lazy baby!! There is such a thing as low muscle tone, skeletal malalignment, weak muscles, an immature or impaired neurological system and over or underwhelmed sensory processing. There are so many systems trying to work together to pull off the magical feat of holding your body up and moving through space! So if your little one hasn’t started crawling or walking yet, or your toddler is struggling with a new skill, it’s not because he is “lazy”. It’s for a reason, and your PT can help you figure it out and give you strategies to work on it.

2. “I think she’ll grow out of it”. Again, no! You can’t grow out of atypical movement patterns, stark asymmetries in alignment, significant weakness or the extreme highs and lows of muscle tone. Using the wrong muscles the wrong way to compensate for these is very inefficient! If you wait for kids to “grow out of it” the wrong muscles will only get stronger, further reinforcing this inefficiency. Did you know that typically developing new walkers take an average of 2,368 steps per hour?!? If you have atypical movement patterns, that’s an awful lot of practice walking incorrectly!

Toe walking is the perfect example. When taking those first steps, leading with the toe is to be expected. But what starts out as normal definitely becomes a problem if it lingers. About 6 months after a baby starts walking (roughly 18 months), there should be consistency in the heel hitting the floor first.  Torticollis is another example. You definitely do not grow out of  torticollis!! I could go on and on about this one but you get the gist!

3. “I think he’ll skip crawling and go straight to walking”. Ok so this one is a wild card, since it definitely does happen (or so I’ve heard). BUT, significant neurological impairments aside, if you’re working with me as your PT, it is very highly likely that you will crawl before you walk. And if you don’t, be assured that we will go back and work on it even after you’re walking. It’s that important! Basically, there’s no getting around crawling. It needs to be a part of your repertoire for strength, coordination, and motor planning.

I’ve been around long enough to know I haven’t heard the last of these pesky long held myths about development. It’s ok….I’ll keep setting the record straight. Now you can too!

Babies in “Buckets”

I recently went shopping with my sister for a baby shower gift. Her friend is having a baby boy at the end of the month. I work with babies everyday, but to say I was out of my element in this big bright baby store is a bit of an understatement. So much……stuff. And stuff babies don’t need! In particular, “buckets”.

I’m talking about vibrating seats, swings, jumpers, bouncers, walkers. All of which are contributing to gross motor delays in infants. Because we are very busy people these days, our babies tend to go from the car seat, right into the stroller, then they get home and lay in the swing, and then to the bouncer. Before you know it, the day has gone by with no opportunity to experience a position that isn’t fully supported and reclined.  That means no chance to try to hold your head up against gravity and build strength in the neck and trunk. It also means decreased tummy time that translates to core weakness and delayed gross motor skills. If always in a supported reclined position, the baby’s weak neck muscles will seek stability by hyperextending and tilting to one side (torticollis anyone?). And reclined equipment isn’t the only culprit. It happens very often where a parent will put their baby in an infant walker and proudly tell me, “Look! She’s walking!”  At this point I always think to myself “Oh boy, we have to talk”, because studies have shown that gait abnormalities are likely to arise after as little as 30 minutes per day in an infant walker.

Infant equipment was no doubt born out of convenience and yes, they are super convenient for busy parents.  But they also contribute to gross motor delays when used consistently and they take up so much space! My advice….of course you need to put your baby down throughout the day, just put them on a safe space on the floor.  And if you feel like you must use equipment because you got it at your shower from a well meaning friend, limit the time spent to no more than 30 minutes for the day.  Instead of moving our babies from “bucket” to “bucket”, let’s try to give them some opportunities to experience other positions so they can build strength and stability for continued development of motor skills.

My Approach

My mission is to promote safe and efficient mobility so that children can fully participate in their most important job…PLAY! With proper alignment as the framework, I focus on central stability (core strength) through everyday play activities and transitions.  Children develop and grow stronger simply by exploring and being active.  Typically developing 6 month olds put their feet in their mouth while playing on their backs.  Besides being absolutely adorable, this serves a function…..to strengthen the abdominals and lengthen their hip muscles to prepare them for crawling and walking.  For those with neurological impairments, less than ideal alignment, or compromised postural strength, they might miss out on this opportunity, setting them up for challenges as they grow. My treatment approach is all about facilitating typical development and educating parents. Helping the baby bring his feet to his mouth and showing his family how to do it too, in a way that is natural and is incorporated into regular playtime – not “exercise”.  The same goes for little ones learning to walk, or older children perfecting a new skill.  I thrive on the success of my children and their families and am so proud of their achievements big and small!!