The phenomenon of toe-walking,
A small percentage of S.L.D. children habitually walk on their toes.
They are able to walk normally but walking on the toes seems to be the
preferred and most comfortable manner of walking. Constant injunctions
to 'walk properly' by care staff over the years results in nothing more
than a compliance with each request for a few minutes, and then the toe
walking resumes. Such interventions are a complete waste of time, and
indicates the erroneous belief that the child chooses deliberately, for
some obscure reason, perhaps perversely, to walk in an unnatural fashion.
It is well known that:-
the more severe the degree of mental handicap of the child the more likely it
is that the child will show symptoms of organic impairment.
We will naturally look for such features in our S. L. D. children.
Now anyone with the slightest grasp of neurology will be able to see a
similarity between toe walking and the features of gross damage to the upper
motor neuron, (U.M.N.) Patients with this condition showed two striking
a. hyperextension at the joints of the lower limb, ( legs)
b. hyperflexion at the joints of the upper limb, (arms)
It is not hard to see, in our toe-walker, a sufferer from a minor or residual
U.M.N dysfunction. While the extension has disappeared from most joints of
the legs, that at the extremities, the ankles has not, with the result that
the child walks on her toes. This remnant or vestigial form is associated
with the extremity of the limb, the foot, because, as in the development of
neural control in the infant, the pattern of recovery proceeds from the
center to the periphery or extremities of the body.
Normal babies, when first learning to walk, often do so on their toes. The
child's nervous system is immature, it learns to control proximate parts
first and distal parts, e.g. limb extremities, only later. As time goes on
primitive response patterns are replaced by more mature ones.
C.N.S damage will delay development of control of high centres over low ones
and the replacement of primitive response patterns by more organised and
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