Tiptoe Walking and Autism
Persistent toe walking in autism
"The incidence of persistent toe walking (20.1%) and tight heel cords (12.0%) were found to be higher in 324 children with an autistic spectrum disorder but lower (10.0%/3.0%) in 30 children with Asperger syndrome."
Source: Barrow WJ, Jaworski M, Accardo PJ. (2011) Persistent toe walking in autism. Journal of Child Neurology. May;26(5):619-21.
Although tiptoe walking is not uncommon in children with autism, not all children with autism display this symptom. Also, not all tiptoe walkers have autism.
Sensory Integration and a Dysfunctional Vestibular System
Tip toe walking may be related to sensory issues and a dysfunctional vestibular system. Let me simplify this complex system with a brief lesson in sensory integration.
- Sensory integration is the communication of sensory stimulation from the environment to the brain.
- Sensory integration primarily focuses on three sensory systems - tactile, vestibular, and proprioceptive
With sensory integration in mind, consider the sensory issues that are common in children with autism. Here are a few examples -
- It is not uncommon for them to be sensitive to flickering or fluorescent lights (sight)
- To cover their ears due to a loud noise or sudden sound (hearing)
- To be sensitive to certain clothing or textures (touch)
- To smell food prior to tasting or eating (smell)
- To resist unfamiliar foods (taste)
Let's look at the three primary systems of sensory integration: tactile, vestibular, and proprioceptive.
- Tactile - through nerves under the skin one feels touch, pain, temperature, and pressure
- Vestibular - refers to structures within the inner ear. These structures detect movement and changes in the position of the upper body - primarily the head.
- Proprioceptive - refers to the combination of muscles, joints, and tendons that provide a person with a subconscious awareness of body position. This system helps you identify where to step on a ladder, where to sit on a chair or reach for a glass when not looking. Basically it is a spatial awareness of your body within its surroundings.
"A dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking. The vestibular system provides the brain with feedback regarding body motion and position. It may be possible to reduce or eliminate toe walking by providing the person with therapeutic vestibular stimulation (e.g., being swung on a glider swing)." - Stephen M. Edelson, Ph.D.
As a researcher and a parent of a child in the spectrum I find Edelson's interpretation intriguing. Although my son did not display persistent tip toe walking he has displayed several other sensory issues. One of his favorite forms of play as a toddler was for me to rock him back and forth. We would both lie on the bed and he would lie on top of me. He would have me hug him tightly and quickly rock him from side to side. I noticed this activity greatly calmed him and seemed to reduce the more negative symptoms of autism. Interestingly, this motion of swinging or gliding was considered therapeutic by Edelson.
Understanding sensory integration does lead to a greater comprehension of the sensory reactions and physical outcomes our children display. It also supports symptoms such as tip toe walking are potential responses to an impaired vestibular system. Continued research is needed for effective therapies as well as for a potential cure for these impairments.
Interventions for reducing tip toe walking
These interventions may not be considered conventional by some, but have been found to be beneficial by others. Use your own due diligence when choosing alternative methods of therapy. Consider discussing the following therapies with your physician and therapist.
- Improve flexibility through stretching - The tendon is usually tight in those that tip toe walk. Flexibility exercises may help lengthen this area making it easier for walking from the heel to toe. Stretching the calf may also help alleviate tightness from toe walking.
- Swinging and rocking - Edelson suggests this activity helps improve vestibular functions.
- Vision Therapy and prism lenses - Prism lenses displace the person’s field of vision up, down, left or right. It has been reported that this has induced immediate heel walking while wearing the lenses.
The first two interventions can be easily practiced through exercise and play. Vision therapy would require a visit with an optometrist. Be sure to find an optometrist that practices vision therapy. Discuss experience with using prism lenses as a therapy for reducing tip toe walking. Consider the visual strain and long term effects this may cause. Prism in a lens basically moves the true optical center of the lens away from the view of the natural eye. Due diligence is strongly suggested.
- Sensory Integration Cindy Hatch-Rasmussen, M.A. legacy.autism.com
- Toe Walking - Dysfunctional Vestibular System Written by Stephen M. Edelson, Ph.D. legacy.autism.com
To learn more about my journey with my autistic son, you may read my article: Autism in Children: Raising an Autistic Child
Questions & Answers
© 2012 Marisa Hammond Olivares