Physiotherapy for children

Crawling is an essential milestone in motor development — it helps build core strength, bilateral coordination, balance, and cross-pattern movement, which are often delayed or impaired in children with cerebral palsy (CP). Physiotherapists use specific crawling techniques and adaptations based on the child’s tone (spastic, athetoid, ataxic) and motor control level. Here’s a structured overview 👇 ⸻ 🧠 1. Purpose of Crawling Training in CP • Promotes reciprocal limb movement (coordination between left & right sides). • Strengthens shoulders, hips, and trunk. • Enhances weight shifting and balance reactions. • Improves visual-motor integration (eye-hand coordination). • Aids in postural control and spatial orientation. ⸻ 🧩 2. Preparatory Activities Before direct crawling training, physiotherapists work on: • Tummy time – to improve head, neck, and shoulder control. • Quadruped (on hands and knees) position with support under chest or hips. • Weight shifting exercises in quadruped: gently rock side-to-side and forward-backward. • Trunk rotation activities using therapy ball or wedge. ⸻ 🦋 3. Crawling Techniques (Step-by-Step Progression) A. Supported Crawling (Initial Stage) • Place the child on all fours with therapist support at the pelvis or chest. • Use rolled towel or wedge under chest to maintain quadruped. • Encourage small forward arm movements while maintaining balance. • Assist leg movement alternately (therapist moves opposite leg and arm gently). • Duration: 1–2 minutes, gradually increasing. B. Quadruped Crawling • Encourage opposite hand–knee movement (right hand–left knee). • Place toys in front to motivate reaching. • Use visual cue or colored mat to mark hand-knee placement. • For spastic CP, focus on slow controlled movement to prevent stiffness. • For hypotonic CP, use vibration or gentle tapping for muscle activation. C. Army Crawling (Commando Crawl) • Useful when full quadruped is difficult. • Child lies on tummy and pulls forward using elbows and forearms. • Strengthens upper body and trunk control. • Can be done on smooth surface or mat for easier glide. D. Obstacle or Sensory Crawling • Crawl over soft pillows, tunnels, foam blocks, or mats. • Provides sensory feedback and enhances motor planning. • Add visual targets or sounds to improve motivation and attention.