Tuesday, February 23, 2016

Why are we so hung up on walking?

By Louise Kinross

Why is a skateboard cool, but a walker not so much?

Why is walking at the top of those child development charts, and crawling at the bottom? And why is the option of wheeling in a chair entirely absent?

Holland Bloorview scientist Barbara Gibson just gave a fascinating talk on how we may limit the way children move because of the social value we place on walking. Her book Rehabilitation: A Post-critical Approach was just released.

“Rehab and other health professions focus on ‘normal,’” Barbara said. “They think about normal function, normal bodies, and, in children’s rehabilitation, normal development. Our interventions encourage uniformity in body structure and how bodies move,” she said, which may unintentionally reinforce cultural values about walking as the preferred way of getting around.

Barbara talked about a number of factors that influence attitudes about mobility.

Walking is seen as an endpoint in child development. Crawling is tolerated in infants, but is disparaged in the older child who “has not grown up.” Even human evolution depicts our ascension from crawling on the ground to being upright. Young children are taught that there are specific times and places where they must be still or move in certain ways. Literature and other forms of media and culture associate a person’s moral character with standing upright. Someone who is stooped is often viewed as “suspicious, dishonest and unreliable,” Barbara noted.

Children internalize these social meanings about the 'right' and 'wrong' way to move. As a result, kids who can’t get around in typical ways are often teased or isolated. 

Disabled kids who prefer to crawl because it's more efficient may feel they need to walk as a way of fitting in. “The child who crawls has to navigate the social rules by which normalcy is judged,” Barbara said.

Being able to walk conveys “membership with other walkers,” Barbara said. “There are issues of identity.” For example, “I’m a walker” a young girl with a disability told Barbara.

Barbara suggested that it would be helpful for rehab professionals to view “difference as the default human condition.” Then we could drop our culture’s baggage about movement and creatively assess all options when a child has a disability.

Should we broaden advocacy for different ways of moving in the world? For example, “Should public spaces be designed for crawlers?” Barbara asked.

Barbara suggested we need to consider whether rehab reinforces cultural norms about movement or transforms them.

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Walking is a great milestone to achieve due to health benefits of being in that extra postion. When elderly go to the wheelchair, the chances of bed sores and other issues rise. Also there are accessibility issues and care issues of the wheelchair, not just in public places but in small quarters at home. It makes things a lot easier all around when someone can walk a bit, rise, and/or transfer.

I was the caretaker for both grandmothers before they passed away. The one who was able to walk was a lot easier in terms of care, physical exertion, time, etc than the other. Never even came close to a bed sore or rash on the bottom, with even the little amount of rising, walking that she did. It does make a difference.

That said, if the trauma of trying to walk, rise, transfer is worse than the consequences of not doing so, and emotional health is taken into account in the equation, it should not be made as a goal in therapy. There is always that balancing act. I barely pushed for the grandmom who found the efforts to walk to be onerous. Not worth it in her case, though purely on a physical basis she could have done more. But there was truly a cost to the loss of that option as there often is when an option disappears.

Although kids with special needs may categorize themselves as "walkers", they remain just as isolated as any wheelchair user. And, in the case of those with moderate CP, there needs to be a balance between walking and using one's wheelchair to maintain health.

I'm sorry, but I remain unconvinced.

Matt Kamaratakis