Archive | April 2012

Barefoot is best

[Creative Commons Licensed Photo by Flickr user hlkljgk]

One of the most frequent questions parents ask me is, “What type of shoes do you recommend for my baby?” They are often surprised by my answer.

The truth is, the best shoes for emerging and new walkers are actually no shoes at all. That’s right – barefoot is best. When babies are crawling, pulling to stand, cruising around the coffee table, and even starting to take those first few steps; they need to be able to flex their forefeet and toes. They also need as much sensory input as they can get in order to feel the floor underneath their feet and know where there feet are in relation to their body. A hard-sole shoe just doesn’t allow for that (try putting on your stiffest shoes or boots and crawling around on the floor – you’ll see what I mean).

For toddlers and young children who are already walking, parents are often concerned about what appears to be “flat feet” and wonder if a special arch support or orthotic is needed. They are relieved when I tell them this is unnecessary. Flat feet are actually quite normal until age 6 or 7. Research shows that almost all typically-developing toddlers have flat feet (no visible arch in standing). At 3 years old, the majority of children continue to have flat feet. As children grow and develop strength in their feet and ankles, their arches develop. Although parents (and sometimes therapists) are tempted to place the child in a supportive shoe or order a custom or off-the-shelf arch support, there is no evidence this is helpful. In fact, it may even be harmful. Research shows that, in cultures where children under the age of 6 rarely wear shoes, there is a lower incidence of flat foot than in (Western) cultures where children typically wear shoes at young ages. So even for preschoolers, it seems that barefoot is best.

If a parent or caregiver has to put shoes on a young child who is an emerging or new walker (perhaps the childcare center requires it or the family is attending an occasion where going barefoot may not be appropriate), I tell them to simply think of shoes as foot covers. They really serve no other purpose, and they don’t need to. For crawlers and new walkers, I typically recommend a soft-soled shoe like this:

Image from robeez.com

This is a water-resistant leather or fabric shoe (foot cover) with elastic around the ankle. The sole of the shoe is also fabric, but slightly thicker and textured to prevent falls. This type of shoe allows for almost complete freedom of movement of the foot and toes, and allows quite a bit of sensation through the foot. Name brand styles of this shoe are widely available at Department stores, baby boutiques, and on the internet; but there are several off brands you can purchase for less than half the price at discount stores.

Once children are bona fide toddlers – walking exclusively and exploring by walking over many types of surfaces, including outdoors – I recommend something like one of these:

Image from robeez.com

Image from squeakers.com

The shoe at the top is similar to the infant shoe I recommend, but it does have a slightly thicker sole to protect the foot from things like puddles and sharp rocks. The shoe at the bottom is a more traditional shoe, but still has a soft sole. When I grasp this shoe, I can easily bend the sole in half. Again, these styles of shoes are available at multiple price points – and I have had success finding them at second-hand stores as well.

So the take-home message when it comes to infant and toddler shoes is this:

1. Barefoot is best. The best shoes for young children are no shoes at all, and hard-sole shoes should be avoided.
2. Flat feet is normal for toddlers and children up to age 6. Children need time – not expensive shoes or orthotics – to develop good arches.
3. Think of infant/toddler shoes simply as foot covers. Purchase the flimsiest, thinnest-soled shoe that will fit your needs.  There is no need to purchase an expensive “supportive” shoe, shoe insert, or orthotic for a child.

Of course, if you have concerns your child isn’t developing typically or if you notice her flat foot is so significant that her ankles are turning in, you should visit your doctor or physical therapist.  Otherwise, have fun [not] shoe shopping!

Kids these days, part 3

I recently attended a meeting for rehabilitation managers in my community titled, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  This is Part 3 in a series of posts on the themes of that discussion about the Millennial generation.  You may also want to read Part 1 and Part 2.

Yesterday, the New York Times ran a story about a kindergarten class that tweets 3 days a week.  After reading the story and viewing the accompanying video (see below), I couldn’t stop smiling.  With her class project, kindergarten teacher Jennifer Aaron is addressing the “technology gap” using a brilliant strategy, one I think we should model in our professional health care education classrooms as well as our clinics.   She has become familiar with the technology, has learned how to use it, and is teaching her students (and probably their parents) how to use it, too.

One of the themes that arose – and involved much discussion – during the area rehabilitation managers meeting I attended last week were concerns about students’ and new grads’ use of technology:

“Students and new grads are always texting, playing Words with Friends, and checking Facebook. They don’t have good professional boundaries when it comes to checking and using their mobile devices.  They know how to Facebook and text, but they struggle with “real-life” communication and relationships.”

These concerns are valid and often true.  We have some of these same frustrations with “kids these days” in professional education.  And why wouldn’t we?

Although there are many well-documented characteristics (stereotypes?) associated with the Millenial generation, what really sets them apart is their use of technology.  They are curious and fearless when it comes to technology.  They are constantly connected to their friends, family, and world in a way no other generation has before.  They enjoy mobility (smart phones) and real-time interaction (Twitter and texting).  They don’t want to be tethered to a PC (or even a laptop) or wait for email.  This technology has been around as long as they can remember, and they often identify as “digital natives.”  They are accustomed to using technology in every aspect of their lives – except education and practice.  The “head-in-the-sand, if-we-ignore-this-maybe-it-will-go-away” approach we’ve taken to technology (and – in particular – social media) in education and health care has not served our students well.  Suddenly, they enter professional education or a clinical internship (or even a first job) and they’re told they’re supposed to put their mobile device away.  But they don’t wear a watch, so how will they tell time?  And what about the anatomy app on their phone they use for quick reference?  They should hide their social media profiles (or at least make them private).  But what if they want to “like” the America Physical Therapy Association on Facebook?  Tweet a link for a new Physical Therapy Journal article they just read? Or start a blog and a Facebook page where they can (gasp!) friend their patients so they can share good, reputable health care information?

The truth is, many Millennials don’t know how to use technology and social media in a professional, appropriate way because no one is teaching them.  No one is modeling it for them.  They are figuring it out on their own, and when they make mistakes, us old folks wag our giant fingers at them and say, “I told you that texting/tweeting/Facebooking/smartphone app using wasn’t a good idea.  We should just ban it all.”  How’s that working for us?

We all need to take a cue from Ms. Aaron and her kindergarten class.  Part of the professional PT education curriculum should be about appropriate, professional use of technology and social media.  Instead of telling our students to “turn off and put away” their mobile devices, we should be using them during class as an opportunity to engage students in education and the profession, all the while teaching them to be better digital citizens.  Schools and health care facilities should re-think broad policies banning mobile devices and social media.  It is time that we recognize that social media is part of “real life,” and that the next generation of health care providers will be expected to have technology and social media skills.  Their patients (and the public) will demand that they engage with them using social media.  They will walk into a clinic with no Facebook page, no Twitter feed, and no blog; see a physical therapist walk up to them with a paper chart and a medical reference book and wonder, “Is she practicing physical therapy like it’s 1995, too?”

It is time to stop approaching technology and social media in health care and education from a risk management perspective and start approaching it as an opportunity to educate, learn, engage.  An opportunity to elevate our practice and the profession.

If Ms. Aaron and her kindergartners can do it, we can, too.

Kids these days, part 2

I recently attended a meeting for rehabilitation managers in my community titled, “New Graduates and Generation Y: Training for Emotional Intelligence and Face-To-Face Communications Skills.”  This is Part 2 in a series of posts on the themes of that discussion about the Millennial generation.  Part 1 can be accessed here.

“Students and new grads [Millennials] don’t seem to have the listening skills they once had.  And they don’t have the self-awareness to reflect and correct, and they often get defensive or emotional when criticized.”  This was one of the central themes of the rehabilitation manager meeting I attended last week.  Kids these days don’t listen, they won’t learn, and they get upset when someone with  little more experience tries to tell them how to do it better.  In other words, Millenials are immature and they don’t respect authority.

This is a common criticism of Millennials and one that – as an educator – I certainly understand.  But I think that, when we examine the characteristics of Millennials, it it clear that the problem isn’t that Millennials don’t respect authority.  It’s just that Millennials view authority differently than the generations before them.

It is true that Millennials are confident, and sometimes that confidence can seem arrogant.  It can appear that they aren’t listening or reflecting when they continue to do things “their way.”  Millennials are social and informal.  They get along well with their parents.  Similarly, they want to like their instructors and bosses and have casual, friendly relationships with them.  The boundaries between “work” and “play” are blurry, and Millennials may have difficulty hearing professional criticism from a colleague and not taking it as a personal attack from a friend.  Millennials like teamwork and value open communication.  They believe that others on the team want to hear their thoughts and ideas, and they share them freely.  When they are frustrated about a work situation or don’t agree with criticism, they aren’t afraid to express their feelings.  To a Baby Boomer or Gen Xer, this way of relating to coworkers can seem immature, unprofessional, and just plain uncomfortable.

Here are a few of my suggestions for improving the “authority gap” between Millenials and Baby Boomers or Gen Xers:

  1. Build time into the day for communication.  Allow time after a treatment session for a patient or family to provide feedback about home exercise program instruction.  Schedule time at the end of the day to communicate with a colleague or clinical instructor about an intervention technique.  These will give the student or new grad opportunities to practice receiving (and giving) constructive professional criticism.
  2. Millennials love technology  – use it!  Get permission first, then grab a video camera or smart phone and record a student or new grad conducting a patient interview or education session.  Allow him to view the video and reflect on his performance and communication skills.  Discuss what he did well, and what he should do differently next time.  Again, this gives practices with communication and provides an objective way to self-reflect.
  3. Position yourself not strictly as an authority figure, but also as a mentor and advocate.  Millennials value relationships and are fiercely loyal.  This can be a tricky one – you want to be a guide, not a friend – but once you’ve established a relationship of mutual respect, you may find the student or new grad listening a little more and accepting criticism without defensiveness or emotion.
Have you experienced the “authority gap” in your classroom or practice?  What strategies have you used  to close the gap?
[Creative Commons-licensed image by Flickr user xflickrx]
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