Tall Kneeling

In January this year, I emailed Matthew's physical therapist (PT) at school to ask how he was doing during his PT sessions. One of the things she said was that in the group he had difficulty staying in a tall kneeling (on knees, not sitting on buttocks) and half kneeling ( one knee up the other down on floor and balancing in this position).

When googling for information on tall kneeling, I came across Adaptivemall.com. We didn't need the equipment but it was very interesting to see that adaptive equipment to help with tall kneeling actually existed. Also to quote from the site:

Tall kneeling is achieved when someone is kneeling and the buttocks are not resting back on the feet. Tall kneeling can assist with the development of balance and leg strength. Note: This position can be difficult for people who have limited ankle bend (plantar flexion) or who wear ankle foot orthotics (AFO).

Matthew doesn't wear orthotics but he does have insole wedges in his shoes for ankle support since he has pronated ankles(but I don't think that matters). The gluteal/buttock muscles are needed to maintain the tall kneeling position. I imagine his gluteal muscles didn't inherently have the tone to easily get into a tall kneel and maintain it. He always preferred to sit on the backs of his feet to stabilize himself.

And of course, I wanted him to develop better balance and leg strength because that will make more physical play activities easier for him. So what do we do? We work on it at home!

How to Position?
His PT and NACD evaluator gave me a few suggestions:
- try kneeling at support surface.
- work on him imitating you go from sitting on heels to tall kneeling position, or in front of a mirror.
- (if he were still in diapers) try bridges, like when his diaper was being changed, ask him to raise his bottom up with knees bent and feet flat on the floor. Hold the position for 5-10 seconds....move a train, ball under his hips to keep hips up.
- have him get on hands and knees and cross creep (crawl on hands and knees). Then while facing him, model getting up into a tall kneel and ask him to do it. From there play something or sing something while maintaining that position.
- practice kneewalking around the room to get things off of the sofa or low tables.

Which strategy worked for him? Asking him to cross creep and then get into a tall kneel to kneewalk and then pause in the tall kneel position helped him understand the concept of tall kneeling. So we played around with kneewalking a lot. He liked jumping and running on giant bubble wrap so I used that as our kneewalking activity motivator.



Within days, his kneewalking improved. More importantly, he was developing the balance and strength to maintain the tall kneeling position for longer periods of time. He'd still sometimes take 3-second breaks to sit on the backs of his feet but he could now easily return to the tall kneeling position without falling over.

Just yesterday, Matthew, Elizabeth, and I had lots of fun playing a fast-paced game of rolling the beach ball back and forth to each other in the tall kneeling position.

At age 2, Elizabeth had no trouble with tall kneeling at all. Seeing her easily play in tall kneeling was one of the many reminders of how much more work Matthew had to put in just to achieve what Elizabeth could do so naturally and effortlessly (relatively). It's at moments like that when one simply appreciates each child's development as it is and admires and learns from Matthew's determination and can-do attitude.