1-5: Development of Gait in the Young Child

Question 1

Attributes of successful gait

Answer 1

• Stability in stance
• Foot clearance in swing
• Appropriate prepositioning of the foot for initial contact
• Adequate step length
• Energy conservation

Question 2

Prerequisites for attributes of successful gait

Answer 2

• Adequate motor control and CNS maturation
• Adequate ROM, strength, bone structure, and sensation/proprioception
• Rudimentary anticipatory postural adjustments
• Muscle activation patterns for pelvic stabilization

Question 3

Neurologic mechanism for generating gait

Answer 3

Central pattern generator

Question 4

Neurologic factors for generating gait

Answer 4

• Organize activation and firing sequence of muscles during gait
• Accelerated brain growth in 3-10 months
• Increased myelination –> increased neural organization

Question 5

Biomechanical factors for generating gait

Answer 5

• ROM
• Strength
• Body structure
• Ability to manage gravity and inertia
• Muscle activity, joint kinematics/kinetics
• Have to physically grow into the body dimensions

Question 6

Determinants of Walking (immature walking)

Answer 6

<2.5 y/o

Question 7

Determinants of Walking (mature walking elements)

Answer 7

3-4 y/o

Question 8

Determinants of Walking (mature walking)

Answer 8

Full maturity by age 7

Question 9

Obstacles to walking 0-9 months

Answer 9

• High fat content in proportion to overall body mass
• Relative muscle weakness
• High rate of growth in extremities for first few months

Question 10

Characteristics of supported walking posture

Answer 10

• Hip flexion
• Hip abduction, ER
• Genu varum
• Everted heel in weight bearing

Question 11

What helps 0-9 month kids walk?

Answer 11

• Practice frequency
• Hip extensor muscle strengthening (prone activities, creeping, kneeling, transition to stand)
• Hip abductor strengthening w/ cruising

Question 12

Typical gait 9-15 months

Answer 12

• Wide BOS, hip/knee flexion, abduction, ER
• Genu varus and eversion of calcaneus
• COM at upper thoracic level
• Lumbar lordosis
• Head still proportionally large

Question 13

Rate limiting factors for gait 9-15 months

Answer 13

• Sufficient extensor muscle strength for single limb support
• Dynamic balance
• Postural control (anticipatory and adjustments)
• Must control the head w/in BOS

Question 14

Characteristics of gait 18-24 months

Answer 14

• Limb is straight
• Decreased BOS
• More A-P movement
• Heel remains everted
• Heel strike emerges as early as 24 months
• Knee extension in midstance
• COM lowers
• Single limb stance more stable
• Stance time increases
• Decreased co-contraction

Question 15

Characteristics of gait 3-3.5 years

Answer 15

• Joint angles in gait mature to adult pattern
• Joint torques and propulsion sill immature
• Genu valgus
• COM closer to LE
• Heel eversion decreasing
• Immature vestibular and visual systems

Question 16

Characteristics of gait 6-7 years

Answer 16

• Gait patterns are fully mature by age 7
• Maturity of visual, vestibular and proprioceptive
systems may not be until 10-12 years old
• Heel position is neutral by age 7
• Center of mass still slightly higher than an adult
• Younger children consume more energy during
gait than teenagers and adults