Talk to me about physical therapy please

[fancynewbeesly]

We got a referral for Reese for physical therapy. She will be 4 at the end of the May. 

I plan on calling tomorrow to set up an evaluation. 

A little background for the people that don't know about Reese. Reese was completely healthy, developing toddler. Last year in January she got diagnosed with acute lymphoblastic leukemia. After the induction phase, which I would NEVER EVER want to repeat in my life--29 days of hell. She was in the hospital for about 18 days. Part of the induction phase is a bunch of chemotherapy I don't remember, and vincristine and twenty nine days of steroids (twice a day). Well she had every side effect from the steroids. By the end of induction phase, she wasn't walking/running/moving at all. We weren't sure the reason or if the reason is threefold. 1. The steroids side effect is dizziness, and muscle weakness/mobility problems. 2. Vincristine's side effect is neuropathy, and she did complain of numbness. 3. Being in the hospital and just not moving and feeling crummy and just atrophy. 

We suspect her mobility was a steroid side effect issue, because once she was off the steroids, slowly but surely she started moving/running/climbing/jumping. It took a lot of patience to get her confidence back that she could do it. She was scared of steps, slides, anything steep or with heights. Her confidence is back and except for some times of anxiety of being scared of heights; she doesn't have mobility issues per say.

Yesterday she had her oncologist appointment and they were very focused on her gait and that she is indeed becoming a toe-walker; they believe THIS time it is from the vincristine--because she has been on it for over a year, and has a lot of long term side effects. But we have never experienced physical therapy--what should I expect? 

The referral is just for physical therapy; not occupational therapy.

[toastie]

Lots of stretching, balance work, squats, twisting. My boys do a lot of stair climbing, stretching, working on yoga balls.

It is very play based and will look a lot like a game.

And toe walking could be shortened heel cords from not walking enough. My boys do it because of short heel cords, not sensory reasons.

Or she could have neuropathy and doesn't receive enough input while walking to feel stable.

[fancynewbeesly]

toastie

We definitely are leaning to neuropathy because she has complained about the numbness in her hands at least. (like she can't feel her fingers, etc). Since her diagnosis last year, her regular walking resumed by about two months later after diagnosis--so she has been walking/running for nearly a year--so I doubt that it is due to lack of walking. I could be wrong though.

[speedymarie]

My LO is 19 months and has been in PT since 12 months. For her, PT is play that gets her to move in certain ways, and teaching me how to play with her at home the same way (ie how to place toys on a certain side so she leans cross-body). The older toddlers and preschoolers I see do play and games like walking on balance beams or fake feet or riding special bikes, stretches, climbing walls, trampolines, etc.

[mrsbuttinski]

Generally speaking toe walking comes from two kinds of antecedents.

The first would be a neurological difference of some kind. And the second is generally sensory- toe walking creates a large joint compression that provides a kind of pleasurable sensation for the individual.

I wonder if what you're seeing is a combination of the two. Maybe the toe walking is a way to get some sense of where her feet are if she's got numbness caused by neuropathy. The joint compression could be providing some input in terms of prescioperative feedback (i.e. knowing where her body is in space).

PT for toe-walking should focus on stretching/lengthening her achilles tendon using exercises and sometimes nighttime splints/orthotics. For milder cases, sometimes stretches and "squeaker" shoes to prompt the child walk heel to toe.

weesqueak.com/