Date Presented 03/26/20
This study examines sensory functions in children with ITW and establishes a framework to detect sensory differences underlying ITW. Our results showed that ITW is related to sensory-processing differences, particularly in the area of vestibular processing. A small number of participants also showed differences in tactile and proprioceptive processing. Identifying sensory functions that underpin toe walking will contribute to targeted treatments for ITW.
Primary Author and Speaker: Virginia Chu
Contributing Authors: Laura Anderson
PURPOSE: This research aims is to quantify sensory differences in children with idiopathic toe walking (ITW), and to examine the support for the use of sensory-based interventions for children with ITW. Clinicians have long suggested links between ITW and sensory processing dysfunction, but to date, there is limited research examining this relationship.
DESIGN: We use a two-group descriptive study design. Individuals with ITW 4 years and older and age-matched typically walking participants are recruited from the VCU Health Systems, local clinics, and the community. Exclusion criteria include inability to follow instructions, had muscle lengthening surgery, neuromuscular or orthopedic diagnosis.
METHOD: 9 children and 1 adult with ITW were assessed with a set of activities to differentiate profiles of sensory dysfunction related to toe walking. Balance-related proprioceptive, vestibular and visual processing is assessed with the Sensory Organization Test (SOT) and perturbation tests using the Neurocom SMART Balance Master. Proprioceptive processing is assessed by testing ankle position sense (without vision) and force perception (matching forces without visual feedback). Tactile sensitivity was measured using monofilaments (light touch) and biothesiometer (vibration). Range of motion (ROM) at the ankle was measured for all participants. Children also completed the Test of Gross Motor Development (TGMD-2). Parents of the children participants completed the Sensory Processing Measure (SPM) and the 5 to 15 Questionnaire (5-15). Data was analyzed in MATLAB and Excel.
RESULTS: 6 out of the 8 ITW participants who completed SOT scored below the norm (<5th percentile), demonstrating challenges with using vestibular and visual information for balance, particularly when the platform is moving. More falls were also observed in the ITW group in the perturbation tests (ITW mean = 3.44, TD mean =0.28, p = 0.018). For the proprioception and tactile tests, most of the individuals in the ITW group performed within the normal range (< 2SD of control mean). Nonetheless, 1 ITW participant had significantly higher errors in ankle position sense, 4 ITW participants had significantly higher errors in the force perception task, and 5 ITW participants had significantly higher detection (light touch and vibration) thresholds on the soles of their feet compared to the control group (> 2 SD from control mean). 7 out of 10 ITW participants had restricted ankle ROM (negative dorsiflexion range in 1 or both feet). 3 out of the 9 children in the ITW group had significant gross motor challenges (> 2 SD from control mean in TGMD). 7 out of 9 children in the ITW group had significant challenges in every day functioning (> 2 SD from control mean in 5-15). 8 out of 9 children in the ITW group had sensory challenges (some or definite dysfunction in 1 or more domains on SPM).
CONCLUSION: Our results showed that children with ITW had significant challenges with sensory processing and daily functioning based on parent reports. We showed that as a group, individuals with ITW had challenges with vestibular processing and balance and show signs of restricted ankle range of motion. Some individuals with ITW also had challenges with proprioception and tactile processing. Currently, there is no comprehensive evidence-based framework for understanding the underlying causes of ITW. This research will provide a standardized framework to detect and analyze the underlying sensory differences in children who toe walk. Our research strives to better understand the causes of ITW, so that we can develop more effective treatment strategies to guide earlier intervention to prevent long-term consequences of persistent toe walking.
References
Ganley, K. J., & Behnke, C. (2016). Distal Vibration Perception Threshold in Children Who Toe Walk. Pediatric Physical Therapy, 28(2), 187–91. doi: 10.1097/PEP.0000000000000241
Wick, J. Y., & Zanni, G. R. (2010). Tiptoeing around gait disorders: multiple presentations, many causes. The Consultant Pharmacist, 25(11), 724–37. doi: 10.4140/TCP.n.2010.724
Williams, C. M., Tinley, P., & Curtin, M. (2010). Idiopathic toe walking and sensory processing dysfunction. Journal of Foot and Ankle Research, 3, 16. doi: 10.1186/1757-1146-3-16.
Williams, C. M., Tinley, P., Curtin, M., Wakefield, S., & Nielsen, S. (2014). Is idiopathic toe walking really idiopathic? The motor skills and sensory processing abilities associated with idiopathic toe walking gait. Journal of Child Neurology, 29(1), 71–8. doi: 10.1177/0883073812470001
