Gait Development in Children

Question 1

What are the foundational components of gait development

Answer 1

• MSK system: bony structure, muscle, ligament, tendon, & fascia
• Neurological system: muscle tone, somatosensory (tactile, proprioception)
• Effects of practice, variability, & use history
• Postural control, weight lines, & temporal/spatial organization

Question 2

When are the foot structures ossified in children

Answer 2

• Ossification starts in utero & completes in late teens/early 20s
• Foot ossified b/w ages 4-7 yrs

Question 3

What is Wolff’s Law

Answer 3

• Bone will adapt to loads (muscle and gradational pull)

Question 4

When do the arches of the foot develop

Answer 4

• Develop b/w 4-7 yrs
• Navicular bone is the last to ossify & is the keystone of the arch
• Sustenculum tali of calcareous should be horizontal to support the talus
• Obese children ages 4-7 yrs should be closely monitored for arch development

Question 5

Gait Pathologies are more likely a result of

Answer 5

• Weakness
• Malalignment
• Compromised vestibular & somatosensory input
• Contracture of muscles & connective tissue
• Dysfunctional corticospinal influences on reciprocal inhibition & selective motor control
• Not due to spasticity

Question 6

_____________ must remain inside base of support to maintain balance.

Answer 6

• Center of gravity

Question 7

Describe the 4 levels of postural control

Answer 7

• Early: “en bloc” pattern (non-articulated movement) 0-6 mo
• Second: ability to select adjustment from experience & adapt to postural activity ~6mo, independent sitting
• Third: more adaptive with ability to transition in & out of quadruped & sitting around 7-10mo
• Fourth: anticipatory postural adjustments using feed-forward control at ~13-14mo, with 6 wks of walking experience

Question 8

At 7-11 years, integration of ________ and _________ modes of postural control, coordinated timing of muscle recruitment improves, better integration of ______ and __________ info, and adult-like balance control strategies (headstabilization) are used

Answer 8

• Reactive and predictive
• Visual and vestibular

Question 9

Characteristics of toddler (~12-24 mo) gait

Answer 9

• First 2 yrs of life infant body weight x4, height x2, and head circumference increases by 1/3
• Use wide BOS and high guard due to proportionally large head & feet to keep body stable in frontal plane
• Decreased stride length, low velocity, increased cadence, lacks propulsion, & takes more energy
• Flexed hips & knees, hips ER, heels everted, flat foot contact, & no reciprocal arm swing

Question 10

Between 3-8 yrs of age, ______ _________, _____ development , and full _____ ______ lead to a more mature gait
pattern.

Answer 10

• Bone ossification
• Arch development
• Full hip extension

Question 11

Treatment to develop better gait mechanics

Answer 11

• Maintain posterior center of mass & work on posterior balance reactions
• Improve lateral weight shifts to unload swing limb
• Work on aligned posterior standing posture
• Control early & excessive tibial inclination in standing & wlaking