Published on in Trisomy 21 Update
Walking up and down stairs is a skill we do multiple times throughout a day. It becomes an automatic skill that we do not think about performing once we achieve the motor plan of stair negotiation. We see stairs in front of us and are able to easily walk up and down without much thought, with good balance and with one foot on each step.
Most children begin walking up and down the stairs around 2 years old, after they have refined their independent walking skills. Children with trisomy 21 can also begin walking up and down the stairs shortly after they learn to walk — with appropriate modifications and support for the task.
When a child is able to four-point crawl but is not yet walking independently, the child can creep up stairs and creep down the stairs backward on his belly. Many children are interested in creeping up the stairs, but may be resistant to coming down backward. Activities such as coming down off the couch and bed backward and sliding down a slide backward serve as practice for coming down the stairs backward. Some children are fearful of moving backward because they cannot see where they are going. Start a few stairs from the bottom at first if the child is fearful. Always be close to the child for supervision to prevent him from falling down the stairs. Use appropriate gates at the top and bottom of all stairs to block stair access when you are not able to assist your child.
Once your child is walking and ready to learn how to navigate the stairs, these are some helpful tips to help with success and efficiency and to help prevent injury.
Walking up stairs
Progressions I like to use when first teaching children how to walk up stairs are:
- Practice walking up first with two feet on each step and holding a railing. You should be behind your child on the stairs. Your child may want to push back against you for support, which will result in her straightening her leg and extending the knee instead of bending at the knee and ankle to shift weight forward on the leg that is on the higher step. Provide her with support and use of the rail and encourage her to bring one foot up to the next step, then bring the second foot up to meet it. Make sure you alternate feet when practicing to avoid only one leg achieving the skill or becoming stronger than the other leg.
- In the school setting, start by side stepping up the stairs if your child needs to keep up with his classmates. This will give him more support and speed.
- Once your child can walk up the stairs with two feet on each step, but alternating which foot leads, with use of a railing, practice placing only one foot on each step using a foot-overfoot pattern. Ask her to walk “like a big kid.”
- The next progression is to practice the stairs without a railing, which may require going back to putting two feet on each step when first learning this skill.
Walking down stairs
Progressions I use when teaching children how to walk down stairs are:
- First practice squats on the floor to pick up small toys and make sure they are comfortable bending their knees slowly with good mid-range control in standing. Children with Trisomy 21 often have a hard time controlling how fast they bend their knees. They will often stand and “lock” their knees into extension or they will bend their legs and squat all the way down to the ground without being able to hold the middle positions. In other words, they do not use their quadriceps muscles eccentrically to control how fast they bend down to pick up a toy. This skill is needed to walk down the stairs successfully.
- Have your child practice holding a railing and bringing one leg down at a time and then alternating their feet. You should be in front of him. He may need you to help him alternate his feet. Children will often want to advance their weaker leg first, while the stronger leg does the work of lowering, and may need help to advance the stronger leg. When stepping down, the leg on which you are standing is the weight-bearing leg and is the one doing all the work.
- If your child is nervous about stepping down, try side stepping with two hands on the railing or start at the bottom few stairs and then increase the number of stairs to practice as performance improves.
- Practice placing the foot on the stair and keeping the knee just a little bent. Your child should avoid coming down on a “locked knee” as this can lead to knee injury over time.
- Once your child can step down alternating feet with two feet on each step, practice taking “big kid” steps and placing only one foot on each step.
Helpful strategies to help children alternate their feet include:
- Place a different sticker (such as a Sesame Street character) on each foot and then say: “Give Elmo a turn, then give Cookie Monster a turn.” This is a helpful visual cue.
- Tape cut-out feet of different colors to the stairs, such as a red foot for the left foot and a blue foot for the right foot. Ask your child to step on the red foot then the blue foot.
- Place a strip of brightly colored duct tape along the edge of the steps if your child has any visual impairments or visual perceptual issues. This helps her identify the edges of a stair.
At school, stairways tend to be busy, loud areas. Walking without a railing, with a backpack and with noise are all challenges faced at school. Ask the school physical therapist to make sure your child is safe and successful navigating stairs. Stair skills can be practiced with the therapist in a controlled, quiet environment and followed through at home to gain the necessary practice before transferring the skill to the busy school day. Timing your child while on the stairs and comparing it to the time it takes for the rest of the class to do the stairs is important information when evaluating stairs. A child may be successful at home and in therapy but have a hard time at school.
Children will encounter stairs when they go out to the playground at recess. Walking up stairs to a slide, stepping over a small curb or railroad tie, and stepping down off a small step without a railing are common obstacles on a playground. Practicing these skills at home and in therapy may help them improve on the playground.
Your child’s footwear can also be a factor on the playground and stairs. Children with trisomy 21 often have pronated feet (when feet roll inward), low muscle tone, decreased strength and ligamentous laxity. Make sure your child has appropriate footwear, preferably a supportive tie sneaker and orthotics, if prescribed. Your child’s backpack should also be considered. Make sure the bag is the correct size, the straps are adjusted correctly and your child is not carrying too many items, making the backpack too heavy.
Stair climbing is an important skill that can be improved with practice at home, during school and in therapy. Consult with your child’s physical therapist to inquire how well your child walks up and down the stairs during the school day. Practice, proper footwear and an appropriate backpack will have an impact on your child’s success keeping up with classmates during the school day.
Contributed by: Helen Milligan, PT, MPT
Categories: Trisomy 21