How to use behavioural methods to teach a child to walk with correct gait? Moondog or others, any ideas?

[HairyMaclary]

I've just come back from an orthotics appt with DS1 and it's become very clear to me that I need to use a different method to get dS1 to walk properly.

For those who don't know DS1 has cerebral palsy, is nearly 9 and almost two years ago had the SDR operation that released a lot of his spasticity. Since then he has made great strides, literally, with his walking. Prior to SDR he had very poor balance and gait pattern with small steps, always on his toes etc because he couldn't walk any other way. Now he can, he has the ability to walk in a near normal gait pattern, long strides, with good heel strike,(heel hitting the floor first) and good balance. However he doesn't or rather, he only does it for a few steps at a time when asked, bribed or shouted at ! We have a treadmill in our tiny sitting room that he goes in most days and can sometimes get longer periods of good walking but it's rare. In order to improve further and have a gait pattern that means he won't needs further orthopaedic operations in the future he needs to 'buy in' to walking in a better, heel - toe, pattern all the time. It's tricky because it involves changing the neural pathways and repatterning. It's easier for him to walk in the old way and it's functional for him so he doesn't see why he needs to out the effort in to learning to walk another, initially harder, way.

I think he would do well with a behavioural method of teaching this but I really don't know enough about it or where to start looking for info as it's a bit different to all the EIBI stuff but I think the principles would work well. I'm thinking about starting with instant rewards or reinforcers for every heel strike and the looking to gradually fade the reinforcers out over time. Is this the right idea? I seem to remember something called ' clicker training' would this work in a situation like this? How can I rewarded every heel strike without breaking the rhythm of his walking?

If anyone has any ideas around this area I'd be really grateful!

You want Tagteach
Theresa is here training in Birmingham 29th May.
Strongly encourage you to go.
She is brilliant.

how can they change the kids' neural pathways with behaviour intervention? I am curious

Moondog- thank you!that is exactly wht I need! I don't think I can wait until the end of May to start though. Do you know of anyone who could start me off sooner? I know I could look at the trainer section of their website but personal recommendation is always better! I also think it would be better me or DH actually doing it rather than having to involve another teacher/ therapist in our lives atm. Think I'd need to rope in our physio though so that I knew exactly where the tag point is.

On looking at the website further, should I do the online course? Starlight - is it you doing this with your two? Did you do the online course?

DS has the OT from Skybound (ABA team) coming out to see him in the next month (storms allowing!) & this is one of my queries, as he's old enough that more and more people are picking up on it. I'm worried that in years to come it'll make him stand out like my Dad's did. Do pm me if I forget to respond to this post won't you?

Ooooh Tagteach is amazing.

salondon, much of what we do is not 'nature' but a learned response. For instance, when DD1 had her broken ankle, for a good while afterwards she kicked her leg out to the side as she walked. It was because she'd had a cast on for several weeks.

Tagteach breaks a task down into teeny tiny mini-tasks, so that you can master the mini-task, then build towards using it all together.

So instead of teaching someone to write an 'M', tagteach would teach | then |, then |/ then |/|. So the person gets each stage to success and the whole is just a culmination of the parts.

High jump

It's using a clicker to mark a learner's success, Poltergoose. So you can use backward chaining, but the point of tagteaching is that the learner knows what the 'success criteria' is.

So in the high jump video, the first tag point is 'arched back'. As long as her back is arched, it doesn't matter what else she does at that point. She'll get her 'tag' click.

Then it moves on so that the 'tag point' is 'throw the arms up', etc.

Lougle- did you tag teach the correct gait after your DD1's broken leg?

It sounds perfect and I'm wondering if I can go to the pet shop tomorrow to get a clicker and just start or if there are some subtleties I should know about before I go charging in!

No, I didn't, but I should have done!!

Hairy, you sound pretty sussed about behavioural methods. I needed and appreciated the guidance of TAGteach but you may be confident enough to try yourself. Can't recommend Theresa and her training highly enough though and it isn't just throwing in random old clicks. You have to work hard at it.
Star recommended these gorgeous clickers to me which I bought straight away. I emailed Theresa and told her about them and she bought them too!
Skinner's daughter, Julie Vargas is very involved in TAGteach as are Precision Teaching demi gods like Carl Binder

Book section on site is superb, all highly recommended, in particular Julie Vargas' book which has a great section on TAG in it.

Salondon, behavioural practitioners don't look at changing neural pathways but rather, changing behaviour. To get formal for a minute:

Applied Behaviour Analysis (ABA) is a discipline which uses specific, comprehensive, principles of learning to develop understanding and modification of human behaviour. In this context, ‘behaviour’ refers to anything observable and measurable, including speech and language (Skinner, 1957).

ABA is a well-developed discipline with a mature body of scientific knowledge and established standards for evidence-based practice. Currently, there are 135 Board Certified Behaviour Analysts (BCBA) in the U.K.

ABA is defined by precise terminology, a breakdown of target behaviours into their component parts, and meticulous date collection. Focus areas are addressed using scientific principles of reinforcement, shaping, prompting, prompt fading, and generalisation of acquired skills across different settings (Cooper, Heron & Howard, 2007).

If a child cannot physically jump, is that a 'behaviour' problem? Can ABA work here?

I'm no expert, salondon, but I think the jump would be broken down into its component stages and then you'd look at whether the child has the component skills, or the foundation skills that would lead to the component skills, before deciding that it's an appropriate goal.

DD1 couldn't jump until quite recently. Now she can jump downwards from something, but can't jump with two feet into the air. She doesn't have the calf muscle strength or the coordination. TAG couldn't increase her calf muscle strength, but it could help her coordinate her movement, if the tag was 'feet together'

Salondon, a behavioural practitioner cannot get a child in a wheelchair to suddenly start breakdancing (although it would be nice!).
It involves looking at small behaviours that can be shaped and/or chained.

It does not deny the part that neurology plays, or genetic factors (the great ontogenic versus phylogenic issue) but does not see that ABA is best suited to this focus.

It does not focus on labels that often end up as an end in themselves and serve ultimately as a form of circular logic which gets one nowhere.
What is 'dyspraxia'? An issue that involves problems with physical co-ordination.
'Dyslexia'? Problems with reading
And so on and so forth.

The problem is that a label often (not always) becomes a dead end. It prevents people focussing on looking for ,if you like, the small embers, that can be fanned into a flame.

I spent 15 years working as a generic 'helping professional' and subscribed to this view of labels and 'neural pathways' and vague ill focussed therapy.
Then I discovered ABA and suddenly, like Dorothy in the Wizard of Oz, the world went from black and white to colour. It blew me away and still does, every day

Sorry to gate crash but does this work with smaller children? My ds is quite similar to hairy's at a much younger age (nearly 4)

Sorry - I think I may have confused things with the terminology I used. I'm not expecting TAG teach or any other behavioural method change DS's neural pathways per se. What I am hoping for is that by finding some way of helping DS walk repeatedly in the correct way, this correct way will become the most used, the strongest and therefore the default pathway. I'm not too clear on the whether this neural pathway idea actually has a bassi in scientific evidence, I'm pretty sure it does, but I'm using it with a lay persons understanding.

Salondon DS can't jump either and I don't know if he ever will but I could teach aspects of it, ie feet together, knees bent, push through feet as separate tag points so he can see how to jump. I don't know if he could put them together at all but if jumping is broken down into it's different parts me might get it.

Everysilverlining - as your DC is younger the wrong patterns are less ingrained so it should be easier to change the behaviour (I think!) . Certainly 4 is not too young IMO.

I realize this thread is a year old, but I just came across it and I though you might like to know about some new resources related to TAGteach that may be helpful.

Firstly: this published study on TAGteach for use to diminish toe-walking:

Persicke, A., Jackson, M. and Adams, A.N. (2014) Brief Report: An Evaluation of TAGteach Components to Decrease Toe-Walking in a 4-Year-Old Child with Autism. J Autism Dev Disord 44:965-968.
link.springer.com/article/10.1007%2Fs10803-013-1934-4

Secondly a FREE online course that explains the basics of TAGteach and how to get started using behavior science with your child: tagteachblog.com/free-course-3-things-landing/

Thirdly: a blog from a UK Dad who is using TAGteach to help his young daughter learn to walk, talk and interact socially despite a devastating diagnosis: tinkstagteam.com/

I hope this helps!

Joan (from TAGteach)

Maybe use a timer, for example "do your exercise for 5 mn "and then reward if go through the 5 mn. We use a standard kitchen timer.

With timer, probably best to build up gradually over several days from a few seconds to minutes......

Ooh, this is my thread, thank you Joan. Still have the same issue over a year later. He has no interest in walking well, especially when with his friends as he wants to run with them (with bad gait!).

The clicker worked v well for about one week, he loved it, now however he can't be bothered!

I may revisit this though, will read the links too.

Thanks