Gait And Balance Flashcards
How do mechanics/structure connect to form locomotion in a pediatric population?
Wolff’s law - the epiphyseal plate not being finished developing.
Babies are born in physiological flexion and will acquire less Hip ER and arches as they develop.
They will need strength to function, but principally balance.
What neuro factors come into play for a pediatric population with respect to locomotion?
These pathways are still forming (dendritic arborization), especially in the 3-10 month phase of development and myelination.
How does cognition play a role in creation of locomotion in a pediatric population?
Understanding (they have to see it to move it)
Motivation (they have to be motivated to look)
Moving gives rise to more cognition.
How does perception play a role in a development of locomotion in a pediatric population?
Interaction with environment (if a baby can’t be mobile, give them mobility so that they can learn).
Pattern Generation, Articular Differentiation, Postural Control, Visual Flow Sensitivity, Tonus Control and Extensor Strength, Body Constraints, and Motivation are all part of…
The Dynamic Systems Theory of why humans can’t walk at birth.
What are some physiological aspects of birth-9mth olds relevant to development of gait?
Greater fat than muscle. Stuck in hip flexion kinda. Hip ER is still greater than IR. Femoral anteversion (in-toeing) - remember, normal is 15-20 degrees. Genu varum (bow legs) Slight internal tibial torsion
At 9 months to 15 months what should we expect as far as physical aspects of standing and gait go?
Standing: the COM is higher than in older child (they still have big heads), hip flexion/ER/ABD, Internal Tibial Torsion + knee virus - these are all still there. + they have an everted heel when they stand.
Gait: pressing everywhere (co-activation on EMG), net extensor moment (they can finally press up against gravity), full foot contact, an increase in muscle, but still a lot of fat.
What are some characteristics of early walking?
decreased stride length Decreased gait speed Increased time in double support Increased base of support Toe clenching Decrease degrees of freedom with high guard Less coordination Increased co-activation (EMG)
@ 18-24 months what changes do we see in alignment and gait?
Varus @ knee is gone
Improved hip ex ROM
Hip abduction is now normal
They have a more p -> a loading in stance *but a true heel strike is not present til the very end of this phase.
Walking experience plays a role
Decrease in co-activation
What is typical for 3-3 1/2 year olds for alignment and gait?
A little valgus is normal.
FA continues to decrease but is still more than an adult.
The COM is lower.
Joint angles are like an adults
Mature EMG pattern
Balance is better!
Velocity is now normalized to height.
What is normal for alignment and gait in a 6-7 year old?
Valgus is gone
FA mostly resolved
COM is still a little high compared to an adult.
They have a neutral heel now (less eversion).
At 7, patterns are mature for gait.
What is ideal gait speed for a 1 year old vs. an adult?
.38m/s vs. 1.2 m/s
What are the 3 requirements for balance?
ROM, postural Control
motivation, intention, cognition
What are some ways we can observe balance?
Sway, rxn to be thrown off balance, falls counted, peers?, shoes on/shoes off.
What are some ways balance is assessed in pediatrics?
TUG
Timed up stairs
SLStance
Tandem
