“How should I apply this information?” This valuable systematic review reminds therapists of subtle, but distinct differences between idiopathic toe walking and cerebral palsy. The authors report these differences observed through the application of a number of assessment methods. Standard assessments described by this review include joint range of motion, muscle length and flexibility, and classification of any spasticity (Modified Ashworth Scale). If these are not standard practices, therapists should consider these as assessments which are easily learned and perfected in any practice setting. Nonstandard clinical methods included the use of electromyography or 3-D gait analysis. These improved the clinical picture enabling greater differentiation between the conditions. However, these assessments may be less accessible to therapists, potentially costly, and setting dependent. “What should I be mindful about when applying this information?” Although there is limited discussion of validity or reliability of the assessments, this should not dissuade therapists from applying these measures in practice where possible. This review did not consider of birth complications or developmental history of the child. These additional factors from the history could influence a therapist’s referral for nonstandard assessments. These additional nonstandard assessments may place additional cost or time pressure on families, and the results may or may not change treatment course. This review highlights the lack of consensus of measures for differentiating between conditions. It highlights the poorly defined diagnostic criteria for idiopathic toe walking. These differences may impact communication about these conditions between health care providers. It may also impact health care providers to communicate either diagnosis or long-term treatment plan. These inconsistencies may create challenges for parents, particularly if they observe their child being assessed in different ways by each of their health care providers. This warrants consideration for the development of standardized assessment practice for toe-walking gait.
Williams, C., Caserta, A., & Chee, M. (2020). Commentary on "Differentiating Between Idiopathic Toe Walking and Cerebral Palsy: A Systematic Review". Pediatric Physical Therapy, 32(1), 11-11. https://doi.org/10.1097/PEP.0000000000000674