What is the impact of delayed gross motor development, including abnormal gait and inability to run or jump, on physical activity and participation in a 2-year-old boy, and what role can a physiotherapist play in promoting development and participation?

From the Guidelines

Physical activity and participation for Orlando are likely to be significantly impacted both now and in the future due to his delayed gross motor development. Currently, Orlando is unable to run or jump and only crawls on stairs, which limits his ability to engage fully with peers during play activities. These limitations may lead to decreased confidence, social isolation, and potentially impact his overall physical fitness as he grows. As a physiotherapist, I would recommend a comprehensive intervention program focusing on developing Orlando's fundamental movement skills. This should include twice-weekly physiotherapy sessions for 8-12 weeks, with daily home exercises performed with parental guidance. The program would target core strength, balance, coordination, and lower limb strength through playful activities appropriate for a 2-year-old. Specific exercises would include assisted jumping activities, stair climbing with hand support, balance games on various surfaces, and activities that encourage running in short bursts. I would also recommend incorporating obstacle courses that combine multiple skills and gradually increase in difficulty as Orlando progresses. The physiotherapist's role extends beyond direct intervention to include parent education and support. Teaching Brooke and Ferdinand how to incorporate therapeutic activities into daily routines will maximize Orlando's development. Additionally, providing reassurance and acknowledging their concerns is crucial given their feelings of guilt and inadequacy. Orlando's developmental timeline shows significant delays (commando crawling at 10 months, walking at 17 months) that warrant thorough assessment. I would conduct standardized developmental testing to quantify his delays and potentially recommend further neurological or developmental assessment if indicated, as suggested by 1. Regular reassessment every 4 weeks will allow for program modification based on Orlando's progress. The goal is to help Orlando achieve age-appropriate motor skills, enabling full participation in physical activities with peers and establishing a foundation for lifelong physical activity engagement. Key elements of motor history, as outlined in 1, will be considered, including delayed acquisition of skills, involuntary movements or coordination impairments, regression of skills, and strength, coordination, and endurance issues. A comprehensive approach, as recommended by 1 and 1, will be taken to address Orlando's developmental delays, including referrals to early childhood services, speech and language evaluation, physical therapy, occupational therapy, and behavioral therapy as needed.

From the Research

Physical Activity and Participation

• The case study of Orlando Patel, a 2-year-old boy, presents concerns regarding his gross motor development, including an abnormal gait and difficulty with running, jumping, and navigating stairs 2.
• Research suggests that children with developmental coordination disorder (DCD) may experience persistent motor difficulties without intervention, highlighting the importance of physiotherapy in promoting development and participation 2.
• Physiotherapy interventions, such as gross motor training, have been shown to improve motor function and activities of daily living in children with DCD, with significant improvements in balance, ball skills, and overall gross motor function 2.

Role of the Physiotherapist

• The physiotherapist plays a crucial role in assessing and addressing Orlando's gross motor development concerns, working in collaboration with the family and other healthcare professionals to promote optimal development and participation 3, 4.
• Physiotherapy interventions, such as task-specific training and virtual reality-based therapy, have been shown to be effective in improving gross motor outcomes in children with acquired brain injuries and intellectual disabilities 3, 4.
• The physiotherapist must consider the individual needs and circumstances of the child and family, taking into account factors such as stressors and financial pressures, to provide tailored support and guidance 5.

Exercise and Development

• Exercise and physical activity are essential for promoting gross motor development and participation in children, with research highlighting the importance of task-specific training and progressive balance training 2, 6.
• Physiotherapy interventions, such as the Stay Balanced program, have been shown to be effective in improving balance, gait speed, and leg muscle strength in older adults, demonstrating the potential for similar interventions to be adapted for children 6.
• The physiotherapist must work with the family to develop a personalized exercise program that addresses Orlando's specific needs and promotes optimal development and participation 2, 3, 4.