Passive Range of Motion
- Gastrocnemius(Ankle dorsiflexion/plantarflexion): With the child supine on back or seated, hold his/her foot in your hand apply light pressure flexing foot up towards his/her head. Once you feel resistance, hold for 20-30 seconds, alternate feet and repeat stretch.
- Hamstring(Knee extension/flexion): With the child supine on his/her back, opposite knee bent or flat on floor, lift leg with knee straight until you feel resistance. Hold for 20-30 seconds, alternate legs and repeat stretch.
Active Range of Motion
- Have the child stand supported/unsupported without shoes on dynamic surface (foam, air cushion, dynadisc, tilt board), as he/she shifts his/her body weight to maintain balance he/she will experience an active stretch of the affected musculature.
- Have the child walk on dynamic surface without shoes (step down/up), similarly this will serve as an active stretch as well as a method to encourage intrinsic plantar muscle activation, as he/she will be recruiting these smaller muscles to assist with balance.
- Intrinsic plantar muscles-negotiating uneven surfaces/dynamic support surfaces, picking objects up with toes
- Anterior compartment musculature-seated scooter board in forward direction, stair climbing, stepping over obstacles(hurdles, cones, etc)
- Abdominal musculature-activities which challenge core strength include seated/standing balance on dynadisc/tilt board, seated on therapy ball shifting weight posterior or laterally to activate abdominals/obliques
- Joint compressions
- Vibratory input
- Heavier shoes/high tops with ankle cup to control calcaneus
- Use of Tactile surfaces(rice and beans/textured discs)
Other ideas: baby flippers, roller skates, rain boots (all to encourage downward input)
Air Cushion http://www.southpawenterprises.com/Air-Cushion-P1063.aspx
Tactile Balance Beam http://www.southpawenterprises.com/Balance-Beam-Tactile-Straight-Path-P469.aspx
Tactile Discs http://www.especialneeds.com/tactile-discs.html
Balance Board http://www.physicalenterprise.com/exdb20.html