The Inclined Floor: The Ideal Environment To Become Independently Mobile
By Douglas Doman
After 45 years of working with parents of special needs children with severe mobility problems, I have learned that the greatest challenge is getting a child to reach absolutely independent and self-motivated transportation from a state of complete immobility or paralysis.
My father, Glenn Doman, solved this great barrier to wellness for thousands of children more than seventy years ago. He did it by creating two programs to develop the brain and create mobility. He teaches the how’s and why’s of both programs in his groundbreaking book, What To Do About Your Brain-Injured Child.
The first program is the Patterning Program. The human brain functions much like the way a computer functions - you cannot get any information out unless the information has already been put in. There are five principal ways to get information into the brain. They are through the visual, auditory, tactile, olfactory, and gustatory pathways. These are sensory pathways and are one-way streets into the brain. Patterning is a tactile program. We are providing information to the brain saying, “This is how it feels to crawl, this is how it feels to crawl on your tummy.” Once this information is stored in the brain, we have to give the child unlimited opportunity to use it and move.
It was shortly after the Second World War that my father and the great genius, Dr Temple Fay, his mentor, envisioned patterning. Fay had understood that first, information had to be supplied to the Central Nervous System. My father came up with a practical way of teaching the parents of children with special needs. Now tens of thousands of special needs children and adults around the world have been patterned to create or improve mobility.
From the child’s standpoint, it requires no effort. All the work is done by adults patterning the child. Typically it is done spread throughout the day for five minutes each time. It requires three people for each session. For bigger kids or adults, it may be necessary to have four to five people. Patterning has proven to be almost “miraculous” in some cases. Children who have been immobile for two or three years of their lives will begin to crawl on their tummies like soldiers within a few days of being patterned. For some profound brain-injuries, it can take months or even years. The first part of the puzzle is patterning and providing the information to the brain.
The second part of the puzzle and the main focus of this article is how to create the ideal environment in which an immobile human being can learn to move. This involves using an Inclined Floor. The great Child Developmentalist, Arnold Gesell, said, “The floor is the athletic field of the child.” This is true for babies who have to have floor time to learn to crawl on their tummies and then push up on to their hands and knees and creep. It is ten times more important for special needs children. Sadly, children with special needs get even less floor time than well babies. When, in fact, they may need forty times more floor time than their well peers.
Children with special needs may be put in wheelchairs or carried around and never be given the opportunity to be on the floor. I have seen in my decades of experience, dozens of children who are put on the floor for the first time in their lives at the age of two, four, eighth, or sixteen years, who independently crawled a short distance in seconds. Such children can learn to crawl well all around the house, sometimes in a matter of weeks or months. This is miraculous and shows how much potential children with special needs actually have.
Immobilizing human beings is a very bad thing to do. This is true for all children, especially for immobile children with special needs. It is true for seventy-five-year-old grandmother and grandfather. It is true for you and me. NASA has done studies with very fit twenty-year-olds. In space, there is no gravity. Gravity is what makes moving on earth difficult. Astronauts move very easily without gravity and they lose muscle mass very quickly. The studies done with twenty-year-olds involves keeping them in bed twenty-four hours a day for weeks. They can lose twenty percent of their entire muscle mass within weeks. As a result, all astronauts in space have a required exercise routine to maintain their strength and mobility. Otherwise, when they return to earth they will be immobile and in very poor cardiological shape.
Imagine a three-year-old immobile child lying face down on the floor being given the opportunity to move. The child may be able to move her or his arms or legs, perhaps poorly. The child moves her arms or legs but her body does not move forward. Why? Gravity is sucking her body down to the core of the earth. Her injured brain is not capable of defying the force of gravity. It is not that she is wasting her time. It is much worse. She moves her arms and legs, her body stays in the same place. That information is stored in her brain. I move my arms and legs and I stay in the same place. This is a dangerous sensory lie.
You and I know that movement of arms and legs has everything to do with mobility. We need to give this child the ideal environment in which she can move successfully. My father understood that we need to take the enemy of gravity and make the enemy into a friend. He did this in a simple and ingenious and inexpensive way. The Doman Method™ Program is a home program. Parents are empowered to be the best therapists for their children with special needs. Since the family is working with the child at home, any equipment needed has to be inexpensive so the family can afford it.
This is exactly the opposite of how the world operates for human beings with mobility problems. They create motorized wheelchairs costing thousands of dollars. Now, companies are spending hundreds of thousands of dollars in developing exoskeletal systems to help people to walk. If these systems come to fruition they will cost tens of thousands of dollars. The Inclined Floor can be made by Dad, grandfather, aunt or uncle for just a few hundred dollars of wood. Or if you are like me and are not very handy, we have a partner company, Mobithem, that makes all of our physical equipment with extraordinary precision and care.
As you can see in the photo above, the floor is inclined and the child is headed downhill. The floor surface must be smooth and hard. The child must have bare hands, elbows, knees, and feet. The smooth surface permits the child to move easily and successfully. If it was soft, gravity would pull the child into the floor and make it harder to move. The principal power points of crawling are hands, elbows, knees, and feet. We reach out with our hands and arms and we pull ourselves forward with our hands and elbows. We move our knees forward and push with our knees and feet. They are bare to get the best traction.
The most important aspect of the Inclined Floor is the angle of the incline. If the Inclined Floor is too low, it will be too slow and difficult for the child. He is still at the effect of gravity. If the Inclined Floor is too high, the child will simply slide down and learn nothing. The height or angle must be perfectly determined for each individual child. The best height is the highest height so gravity is helping the child to move easily and successfully. The slightest movement of an arm or a leg must cause the child to go forward a little bit. Every time the child moves a limb, the child must go forward a little bit. This information is being stored in the child’s brain. Every time I move an arm and leg, my body goes forward a little bit. The more this information is stored in the brain, the more easily and successfully the child will move.
For example, if a child is one meter (39 inches) in length and the Inclined Floor is three meters (9 feet 9 inches) long, then the child will crawl two meters to the bottom. This may take two minutes or more. We never want the child to be on the Inclined Floor for more than two minutes because we want movement to be fast and successful. If your child needs more than two minutes, you simply start the child at the half waypoint. Meaning, you start the child’s head at the distance of one and a half meters from the bottom of the Inclined Floor. Then the child only has a meter and half to get to the bottom.
If you pattern the child several times a day and place the child on the Inclined Floor several times a day, your child will crawl down faster and faster. She will go from two minutes to one minute, then thirty seconds or less. At this point, some parents have made the mistake of lowering the Inclined Floor. Don’t do it. From the child’s standpoint, the child is thinking, I am getting better and better at this and it is getting easier and easier. Now, dad lowers my Inclined Floor, and it becomes more difficult for me and slower. We want it to be easier and easier and faster and faster. If the child crawls down in ten seconds, great. This means you can do more Inclined floors because they are so fast. Such a child is probably ready to start to crawl on the flat floor.
What do we do when the child can easily and quickly crawl down the entire two meters? We let the child start to crawl off the Inclined Floor onto the flat floor. It’s important that the Inclined Floor goes directly on to the flat floor. It’s important at the bottom of the Inclined Floor that there is not a two-inch drop onto the flat floor. This drop can hurt a child’s head or body and discourage a child from crawling off. When the Inclined Floor is made, it needs to be made so it ends on the flat floor, and the transition from one to the other is easy.
We let the child crawl down the Inclined Floor until the child’s head comes completely off the Inclined Floor and is on a flat floor surface. If the child is three, we would typically recommend the child gradually builds up to thirty trips a day. Now, the child crawls down each trip until his head is on the flat floor and does that thirty trips a day. As he improves, he crawls off the Inclined Floor up to his waist, again in thirty trips. Then, he crawls off till his knees are off, thirty trips. Finally, he crawls off and his toes are five centimeters (2 inches) away from the bottom of the Inclined Floor. Now, the child has crawled on the flat floor two inches and we build back up to thirty times. This equals one hundred and fifty centimeters a day or sixty inches of crawling on the flat floor. Spectacular.
Typically, the Inclined Floor is made of masonite. This is a man-made wood product. It comes in different grades and we use tempered masonite because it is the smoothest and fastest for the child to crawl on. We have tried dozens of surfaces and for the great majority of children, masonite is best. The flat floor that the child crawls onto, should also be masonite. It will be easier for him to crawl on a flat surface of masonite than something else.
Let’s discuss motivation. For all of us, success means more success. We are motivated by our success to do better. The opposite is also true. Failure creates more failure. Children with special needs under conventional circumstances or in school have lots of opportunities to fail. The world has stacked the cards against them. The Doman Method™ is the exact opposite. At home, we can create successful and winning environments. This motivates the child to get better and better. The children learn about winning, winning, winning. We do our best. Our parents do their best to arrange for the children to win and not lose.
The Inclined Floor’s entire purpose is to create independent crawling on a flat floor. In the beginning, it can be very difficult for children. If the children are patterned, the chances of success are ten times greater. Although, there are many children who learn to crawl on the Inclined Floor who didn’t have the benefits of patterning. Providing the height, width, and length of the Inclined Floor is correct for the child, and providing the child has bare hands, elbows, knees, and feet, the child has the best chance of winning.
We do not help the child by moving their arms or legs for them. That is why we have patterning. They need to learn for themselves how to use their arms and legs to pull and push. The child is placed on top of the Inclined Floor so the toes are at the top end. Then mom or dad sits at the bottom of the Inclined Floor encouraging the child to come down. They compliment the child on his movements and success. When the child’s head arrives at the bottom of the Inclined Floor, you sweep the child into your arms and cover her or him with kisses. You may decide to dance around the room and sing a song at the same time.
The child is thinking, “Wow! What did I do? Well, I am going to do it again the next time she puts me on that thing. I’ll show her how good I am and I bet she will do this great dance and song that is so much fun.” Arrange for your child to be a winner and he or she will get better and better and better.
At this point, the child is ready to graduate from the Inclined Floor. Instead of thirty trips a day of crawling totally off the Inclined Floor and crawling a couple of inches on the flat floor, we do twenty-nine trips and give the child a two-minute opportunity to crawl on the flat floor. Gradually we ween the child off the Inclined Floor and increase crawling sessions on the flat floor. Once, the child is crawling thirty times on the flat floor several feet at a time, the child no longer needs the Inclined Floor. The rule of thumb is that when the child crawls on the flat surface twenty-two and a half meters (70 feet) a day they are complete graduates of the Inclined Floor.
Now we teach the child to crawl for transportation. We do this with short easy, fast sessions of two to five minutes. The goal is for the child to crawl around the entire house for meals, to be patterned, to play with mom or dad or brothers or sisters etcetera. Usually, when a child achieves one hundred meters (325 feet) consistently, the child is able to get wherever they want at any time of the day. The child is now an independently mobile human being. It is now time to prepare the child for creeping on their hands and knees.
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