To the Editor:
I am writing in response to the article titled "On the Move: Should PTs teach children with disabilities to crawl?" (June 9, 2003 print edition).
In the article, author Ginny Paleg presents convincing evidence from the literature that crawling is an important developmental milestone that aids in the development of effective and appropriate neuronal pathways, visual-perceptual skills, and upper extremity function. Paleg also dispels false assumptions regarding crawling, identifying no correlation between creeping skills and upright locomotion with no generalization of motor learning between these two distinct skills. Finally, Paleg appropriately presents concerns about patterning approaches, such as Doman-Delacato, to facilitate crawling in young children.
While the information presented in the article is sound and informative, the idea that creeping should not be a focus of a physical therapy treatment plan for a child with developmental disabilities is the subject of my disagreement. In my opinion, the underlying theme of the article may be more accurately reflected in a subtitle reading: "Should PTs treat upper extremity deficits?" Paleg asserts, "toning shoulders, arms and hands. is best addressed through occupational therapy."
While occupational therapists are skilled in facilitating effective upper extremity function, we should not limit our scope of practice to lower extremity function exclusively. In the course of my physical therapy training, I learned anatomy, physiology, and biomechanics of the whole body as a functioning unit. We are doing our patients a disservice if we do not treat our patients as such.
Many children with physical disabilities have proximal weaknesses that are effectively addressed by practice in a quadruped position, requiring upper and lower extremity weight bearing as well as co-contractions of abdominal and spinal extensor musculature.
Clearly, crawling is no pre-requisite to walking and is not essential for functional ambulation. However, should we, as physical therapists, count creeping out as a useful, appropriate and efficacious skill to address the needs of developing children? Should we limit our practice to only little legs and feet or should we treat the whole child?
--Candace Chaney, PT