Development of Posture and Gait

Question 1

Describe the general trend of how antigravity movements develop in babies?

Answer 1

Extension, then some flexion, the start in coronal plane and end with transverse plane (rotation)

Question 2

What are some bio-mechanical constraints that affect the development of postural control?

Answer 2

1. relative length/mass of body parts: big head- High COM, short limbs
2. early walkers: short distance between floor and COM -> causes relatively high frequencies of postural sway with large arcs of motion, sway amplitude more variable in young children
3. spontaneous sway reaches adult values around 9-12 with eyes open, 12-15 with eyes closed

Question 3

T/F, sway amplitude tends to become more variable the older the child gets

Answer 3

false, greater in young children and decreases with age

Question 4

T/F, newborns can cross midline with vision or grasping

Answer 4

false, can only come to midline

Question 5

true or false, it takes 3 months to develop equilibrium reactions and function

Answer 5

true, takes about 3 months of practicing equilibrium righting reactions

Question 6

True or false, looming visual stimulus moving anterior and posterior will evoke postural responses more than lateral moving stimulus

Answer 6

true, want vision to be straight and more of our BOS is found in the sagittal plane so we react more in forwards and backwards rather than side to side

Question 7

What is the normal adult response to LVS moving toward subject, away?

Answer 7

towards- lean back
moving away-lean forward

Question 8

What can you expect from a 2 month child when presented with an optical flow pattern?

Answer 8

infant in supported sit shows directionally appropriate neck muscle activity to LVS

Question 9

What can you expect a 5 month old child in response to optical flow patterns?

Answer 9

in SUPPORTED STANCE, has postural responses to LVS

Question 10

At what age can you expect to see ant/post sway responses to LVS in unsupported sitting

Answer 10

11-16 months

Question 11

Describe what a 13-17 month old child with 0.5-6.5 months of walking experience would respond to LVS?

Answer 11

sitting: excessive sway and loss of balance
standing: excessive sway and fall

Question 12

At what age do children in standing switch from visual dependence to reliance to SS input?

Answer 12

6-7 years

Question 13

true or false, young children rely more on vision than vestibular or SS systems

Answer 13

true

Question 14

true or false, infants of around 4 months make appropriate postural responses when tilted with vision occluded

Answer 14

true, labyrinthine righting response

Question 15

true or false, infants from 7-10 months demonstrate inconsistent directionally appropriate leg muscle responses in response to induced sway (standing)

Answer 15

true

Question 16

true or false, infants 14-15 months old never regain posture independently in response to induced sway, with possible directionally appropriate responses

Answer 16

false, they may regain posture independently and have directionally appropriate responses

Question 17

true or false, a 3-4 year old can stay upright in all conditions of SOT while a 4-6 year old will fall

Answer 17

true, have a growth spurt at this time that can contribute to this

Question 18

By what age do you start noticing the emergence of head control consistently?

Answer 18

3 months

Question 19

Describe the emergence of independent sitting (trunk control)

Answer 19

6-8 months sit unsupported
-organized response to perturbations develops simultaneously

• 2 months- no consistent appropriate response
• 4-5 months- half the time show directionally appropriate neck responses
• 5 months- coordinated trunk response about 40% of the time
• 8 months- coordinated patterns to manage A/P sway and perturbations

Question 20

Describe the transition to independent stance- development of muscle synergies

Answer 20

1. 2-6 months (before pull to stand): do NOT show coordinated synergistic responses to perturbations
2. 7-9 months: (early pull to stand): BEGIN to show directionally appropriate responses in LOWER legs when standing with assistance
3. as pull to stand IMPROVES, mms in thigh segment become ACTIVE, with emergence of DISTAL TO PROXIMAL sequencing→ ankle strategy improves when pull to stand improves**
4. 9-11 months (standing and walking): COMPLETE synergy with trunk muscle activation

Question 21

At what age do adult values in postural sway occur in children?

Answer 21

12-15 years

Question 22

At what age do appropriate trunk muscle activation occur in hip strategy?

Answer 22

7-10 years

Question 23

Describe the development of hip strategy in children

Answer 23

after 3-6 months after learning to walk, appropriate use of HIP MUSCLES during HIP STRATEGY occur WITHOUT TRUNK MUSCLE ACTIVATION

Question 24

Describe the development of anticipatory strategies in kids

Answer 24

1. feedforward control evolves SEPARATELY from feedback control
   
   1. infants 9 months: activate trunk muscles PRIOR TO REACH
   2. 12-15 months: postural muscles activated BEFORE reach
   3. 4-6 years: well developed postural adjustments
      
      1. require cognitive processing to determine what they need to do physically to do postural control (feedforward and feedback control)

Question 25

What impact do developmental disabilities have on children in terms of postural control?

Answer 25

they over rely on vision

Question 26

What are some feed-forward control issues with children with Down’s syndrome?

Answer 26

they have appropriate but delayed COM shifts with UE activity in sitting. COP shifts are larger than TD

Question 27

What is a common thing children with CP do when trying to choose strategies for feed-forward control?

Answer 27

tend to co-contract

Question 28

What are things that are determinants of mature walking?

Answer 28

1. Single stance time→ tends to increase with age and increase stability and control
2. velocity
3. cadence→ decreases throughout childhood
4. stride length→ increases due to increase in height and leg length
5. pelvic span/ankle spread
6. least discriminating→ heel strike**don’t focus on this for gait

Question 29

What is the age range for negotiating steps and what are some key landmarks?

Answer 29

9 months to 4-4.5 years, creeps up at 9, 24-27 months (around 2 yrs old) can walk up AND down non-reciprocal WITH RAIL, 4 walks up and down steps reciprocal without rail

Question 30

How is running categorized in children?

Answer 30

Categorized by how the UE and LE interact → not based on age