Standing and Walking
Not all children with significant disabilities will achieve the ability to stand and walk independently. Certain issues like paralysis, hip displacement, spinal injury or cerebral palsy can all affect a child’s ability to stand or walk. Still we can help the learner to experience being in an upright position where arms and legs are free to move through a variety of activities.
Standing requires leg strength and balance. Walking requires leg strength, balance, the ability to shift your weight while in motion, manage changes in surfaces and inclines, move up and down stairs, and so much more. Work with your Orientation and Mobility Specialist and Physical Therapist to determine priority skills for your child. They can help guide you in creating learning environments and activities that are most appropriate for your child.
You may also want to visit Pulling to Stand, Cruising and Crawling for more strategies.
The HOPSA Dress is designed to give learners who are unable to stand independently, the opportunity to actively move their legs while in a standing position. Over time, individuals with special needs can improve arm and leg movements, head control, trunk control, muscle strengthening, practice weight bearing, improve circulation, improve balance and achieve the skills necessary for standing and walking. The Velcro belt secures the child, and has a snap quick release. The HOPSA Dress can be attached to a single point such as an eye hook on a swing set, to a track system to allow the learner to move in a straight line over a specific distance, or to a floating H-track system to allow for free movement in any direction. It is manufactured in three sizes to fit children and adults. The HOPSA Dress is attached to a crossbar for support, which is then secured using a pulley or lift system. Learn more about the track systems.
Below is a video clip of a young boy using a HOPSA Dress on the track system at Penrickton Center for Blind Children in Taylor, Michigan.
Jack using a HOPSA Dress
Original webcast date: 09/01/2016
Description: Jack uses a HOPSA dress and explores, both, beads and spoons attached to the dress and crinkle paper, plastic pegs and rice in containers under his feet.
See more examples of children using a HOPSA Dress.
Weight-Bearing in Standing
In order to be able to stand, your legs and torso muscles need to be able to support your weight while maintaining control of your head and arms. This is also when a child typically experiments with flexing his legs as if jumping and shifting weight from one foot to the other. There are a variety of activities using an Essef Board that will help to develop both the strength and flexibility needed to be able to stand and bear weight. These are done by pushing against the Essef Board or other resistant surfaces in prone, supine, and sitting positions. When the child has developed the ability to bear his own weight, he needs practice pulling to standing for a short period of time then learning how to return to a sitting or lying position. Your Physical Therapist can help assess the child’s leg strength and suggest strategies for helping the child move from lying to sitting to standing.
The HOPSA Dress allows for gradually letting the child bear more and more of his or her weight while in standing. As the child develops leg strength and the ability to move his or her legs, the pulley system allows you to lower the child to a point where he is bearing most of his or her weight. This is probably the best way to work on weight bearing.
If you don’t have access to a HOPSA Dress, there are other activities to provide opportunities for your child to practice weight-bearing while in standing. When the child is seated in a chair that allows his feet to be on the ground, place his hands on a bar or Wall Ladder and encourage him to pull up and stand for a brief time to reach a motivating object. While seated on a small therapy ball, practice bouncing then coming to stand. In a swimming pool where the child is deep enough in the water so it will support some of his weight, let your child grasp your hand, a bar or hold on to the side of the pool for brief times while supporting his or her weight while in standing. Place interesting objects on a fixed shelf that the child can use to bring himself to stand for a few minutes to retrieve or explore the object.
Working on Balance while Standing
Along with a HOPSA dress which does allow the child to work on shifting weight and balancing, an Essef Board and Wall Ladder are other pieces of equipment to consider using with a child. The child must be able to grasp and hold the rails of the ladder before they can safely use this equipment. They also need to be able to pull to standing and have practice maintaining their balance while in unsupported sitting. Initially you may want to use the Wall Ladder without the Essef Board and allow the child to explore objects while supporting himself in standing. Watch a video of a child using an Essef Board and Wall Ladder.
Walking with Support
Children who can Stand and support their own weight, typically will begin to cruise while holding on to furniture or rails. While the HOPSA Dress is ideal for letting a child practice walking with support, especially if hung on an H-Track, there are other ways to help the child practice walking. A child might use a walker or gait trainer to practice walking.
Provide opportunities for the child to walk on various surfaces. You may want to create pathways of various textures such as tile, carpet of vairous textures, wood, cardboard, concrete, asphalt, or rubber for the child to move along. You can also adhere various textures to the rubber floor mats tiles to create a path, like Teacher of the Visually Impaired, Liz Eagan, created. (Visit this page on Paths to Literacy to learn more about this idea.) This not only helps the child walk on different surfaces, it can also help the child work on orienting to a path to get to a desired location or object. Try placing interesting objects or treats along the way for the child to discover and to help motivate continued movement.
Of course, taking a walk outside provides a great opportunity to practice walking with support. Talk to your Orientation and Mobility Specialist about appropriate ways to provide sighted guide for individuals who need more support to walk. Begin with short walks on harder, smoother surfaces and expand to longer walks on more challenging surfaces, such as dirt, short grass, or bumpy gravel. If possible, allow the child opportunities to walk barefoot on dray and wet surfaces, cool and warm or mildly hot surfaces, grassy or sandy surfaces. Give the child opportunities to experience going up and down inclines.
Have the child walk while holding onto a child’s push toy, such as a toy grocery cart. Add weight to the cart so it doesn’t topple over and also to build leg strength. Use other scooter toys that allow the child to move his or her legs and feet in a walking movement, but allow him to frequently take sit-down breaks.
When a child who is visually impaired is able to walk independently, they need intensive services from an Orientation and Mobility Specialist. This person can help them learn how to use travel devices such as pre-canes and travel canes. They can teach them important skills to help them orient and become independent in using routes to get to familiar places. They also help teach appropriate sighted guide techniques to the child and the adults working with the child.
At the same time, there are many activities that support practice in walking independently that you can build into the child’s day. Walking for the sake of just moving is enough for some children. Other children need a purpose to get up and walk. As much as possible have different locations around the house or classroom for specific activities, and have the expectation that the child will walk to that location for the activity. Let the child help collect materials from specific locations to complete a cooking or art activity. Place a radio or other music source in one part of the room and ask the child to walk to it to change the music or to turn the music off. Continue to provide opportunities for the child to walk on a variety of surfaces, and add additional challenges of various inclines.
You might borrow this idea from TVI Liz Eagan for making textured paths using interlocking rubber mats. These can be connected in various configurations to create interesting pathways for the child to explore.
Make obstacle courses in the living room or gym that the child can complete using various gross motor skills. Place pillows, ottomans, ropes, and other furniture and items along a path that require the child to climb over or walk around. Use cardboard boxes open on both ends to or low table that invite crawling through and under things. Encourage play on playscapes and other motivating outdoor environments.
Sonya Using a HOPSA Dress
Sonya has hip dysplasia, but her orthopedist approved her using a HOPSA Dress to be able to walk around her play area at Penrickton. Even though she may never walk independently, she benefits from the experience of being able to move herself around her environment.