L5: Development of Gait Flashcards
(53 cards)
1
Q
Normal and fluid gait pattern
Need:
A
- Normal ROM
- Adequate motor control
- Adequate strength
- Normal sensation
- Normal align/structure
2
Q
CPGs
What are they?
A
Located in BS and SC→ basis for execution of locomotion
Bio. neural networks that produce rhythmic patterned outputs w/out sensory feedback***
3
Q
CPGs
How is info received?
A
Received from descending and peripheral inputs to activate CPGs
4
Q
CPGs from birth
A
Auto. reflex present from birth→ WHY typ dev. children do NOT need to be taught to walk
5
Q
CPGs
Post-natal period
A
Accelerated growth in brain/maturation of CNS bw 3-10mos plays a major role
6
Q
_______environment sets stage for dev. of typ. gait; constraints placed on the _____ and _______
A
Uterine environment
bones and joints
7
Q
Typ developing full term newborn is born w/ _______
A
Physio. Flexion
8
Q
Describe Physiological Flexion
A
- Flexion “pseudocontractures” @ hips
- Excessive lateral hip rotation (ER) ~70* (know this)
- ABDuction @ hips
- Knee flex + genu vaRum; Medial (IR) tibial torsion
- Ankle DF and everted heels
9
Q
Describe Physio Flexion
@ hips
A
“Pseudocontractures” @ hips
Excessive lateral hip rotation ~70*
ABDuction @ hips
10
Q
Describe Physio Flexion
@ Knees/tibias
A
Knee flexion + genu varum
Medial tibial torsion
11
Q
Describe Physio Flexion
@ Ankles
A
Ankle DF
Everted heels
12
Q
Setting the stage and building blocks of typical gait
Based on theory of what?
A
Elongation and strengthening of structures
Balancing flexors/Exts
13
Q
Setting the stage and building blocks of typical gait
Developing a stable base
A
Core stability
14
Q
Setting the stage and building blocks of typical gait
What does Wt shifting do?
A
-
Wt Shifting
- Elongation on the WB side
15
Q
Setting stage for Upright Mobility
0-2mos:
A
Dec’ing physio flexion
- Gravity assists elongation of flexors and strengthening of EXTs
16
Q
Gait:
Birth→ 6mos
A
- MAY still have early stepping reflex
-
First 6 post-natal months: % of bf rises 12-25%
- Fat>muscle mass; weak
-
Cranium: adds to body mass
- Work hard to achieve head control against gravity in variety of pos’s
17
Q
Gait: 6-8mos
Supported walking characterized by:
A
- Wide BOS
- Hip lat. rotation + flexion
- Bowed legs
- Tibias still appear medially rotated until ~2yrs
- Everted heels
18
Q
Gait: 6-8mos
By 8 months….Sensory system starts to what?
A
Sensory system starts to join visual, proprio, vestib. inputs to work together for balance
***Supported ambulation by 8mos
19
Q
Wt Shifting importance..
Discuss…
A
-
Stance stability reqs mature wt. shift
- children practice 1000s/day
- Occurs early as 8mos****
20
Q
More on Wt Shifting importance
A
- Need mature wt. shift
- This begins from early age→ shifting most important during Cruising
- Wt SHOULD BE transferred to lateral border of outside foot on the side child is moving towards
21
Q
Wt shifting importance
______ at the Hip is one of the most crucial components of gait development; why?
A
Lateral stability
W/out it, gait will be unsteady
22
Q
Gait: 9-15mos
A
- Pronation w/ foot flat IC
- Swing:
- incd hip/knee flexion
- ABD + ER hips
- Foot drop**
- High guard pos. UEs**
- Wide BOS (wider than hips); short strides and incd cadence; stiff LE w/ some knee hyperEXT t/o stance; robotic gait; pelvic immobility (waddling)
- Stance:Swing= 70:30
- COM @ lower thoracic lvl
- gravity incs demands on abs, hip flexors, quads, ankle DFs→ “Walk by Falling”
23
Q
Gait: 18-24mos
A
- Heel strike: inconsist @ 18mos, fairly consist @ 24mos
- incd hip EXT
- Decd hip abd==dec’ing BOS
- Arm swing MAY emerge w/ incd gait speed
- overall maturation and decd fat content==improved strength, control, balance
- By 18mos→ knee varum resolves- neutral knee alignment BUT heels continue to be everted
- Knee swing emerges
- Efficiency improving→ improved mechanics and lower COM (upper lumbar region now)
- → LEs growing @ faster rate vs trunk
- → moves COM downward toward prox. legs
24
Q
Gait: 3-3.5yrs
A
- Structural changes:
- Dec femoral torsion
- Dec heel eversion (only slight)
- Knees now have MAX valGum
- COM lower
- Balance mechs refining
- Velocity compared to ht is that of adults
25
Gait: **4-5yrs**
* Characterized by a period of **DISequilibrium**
* balance + postural control out of sync
* “Awkward” stage of gait dev.
* MAY be related to growth spurts
26
* Characterized by a period of **DISequilibrium**
* balance + postural control out of sync
* “Awkward” stage of gait dev.
* MAY be related to growth spurts
Gait @ 4-5yrs old
27
Gait: **6-7yrs**
* Stands of mvmt mature, not much diff from adult pattern
* **Arm swing present (4mph)**
* Knee align returns to neutral (**valgum resolves)**
* Talotibial inclination no longer present= **neutral heel align.**
* COM mid-lumbar vs adult @ pelvis
* Femoral anteversion decs→ **helps to contribute to nrml knee align. in stance**
28
Take Home Messages
## Footnote
**Gen Gait Changes over Time**
**SLS**
Duration SLS incs w/ age
## Footnote
**Most rapid inc bw 1.5 and 3.5 yrs**
29
Take Home Messages
## Footnote
**Gen Gait Changes over Time**
**Emergence of SLS ability**
Bw 1.5-3.5yrs
30
Take Home Messages
## Footnote
**Gen Gait Changes over Time**
**Step length ___ w/ age**
INCs!!!
31
Take Home Messages
## Footnote
**Gen Gait Changes over Time**
**Walking velocity INCs from ___ to \_\_\_\_**
1yr to 7
32
Take Home Messages
## Footnote
**Gen Gait Changes over Time**
**Cadence ____ w/ age**
DECs!!!
33
Take Home Messages
**Gen Gait Changes over Time**
Ratio **pelvic span:ankle spread**
Narrows== Decd BOS
34
Take Home Messages
## Footnote
**Gen Gait Changes over Time**
**Alignment of lower limbs change according to?**
Childs age
35
Gait for **Knee Alignment**
## Footnote
**As in… how does knee alignment change as child ages?**
**Starting from birth**
* Birth→ Varum
* 2→ Neutral
* 3→ ValGum
* 6-7→ Back to Neutral
36
Gait for **Knee Alignment**
## Footnote
**As in… how does knee alignment change as child ages?**
**Birth**
VaRum
37
Gait for **Knee Alignment**
## Footnote
**As in… how does knee alignment change as child ages?**
**2→**
Neutral
38
Gait for **Knee Alignment**
## Footnote
**As in… how does knee alignment change as child ages?**
**3→**
ValGum
39
Gait for **Knee Alignment**
## Footnote
**As in… how does knee alignment change as child ages?**
**6-7**
Back to Neutral
40
Wait until \_\_\_\_\_yrs old to give **inserts in shoes**
6yrs of age
41
Gait impairments in Peds can be due to:
## Footnote
**General list**
* Bony deformity
* Abnorm mm tone
* Decd ROM & Spasticity
* Weakness
42
3 **Bone Deformities** impairing Gait in Pediatrics
1. Increased **femoral medial torsion**
2. **Tibial torsion**
3. **Pes ValGus (pronation)**
43
Bone deformities impairing Gait:
## Footnote
**Incd Femoral Medial Torsion**
* From **DECd hip loading**
* Inapprop mm forces placed during dev.
* **May have in-toeing gait**
44
Bone deformities impairing Gait:
## Footnote
**Tibial Torsion**
* **OUTward twist in Tibia**
* In **isolation** OR **compensation for Femoral torsion**
* Presents as **out-toeing posture** during ambulation in **External/Lateral Torsion**
* Presents as **in-toeing** in **Internal/Medial Torsion**
45
Bone deformities impairing Gait:
## Footnote
**Pes Valgus (Pronation\*)**
* COMMON in children w/ **neuromotor deficits**
* Heel→ **everted;** NO neutral alignment
* Impacts alignment “**up the chain”**
46
Three Biomechanical Components of **Pronation**
## Footnote
**YOU WILL NEED TO KNOW THIS ANYWAY!!!**
1. Calcaneal valgus
2. Midfoot eversion/collapse
3. Forefoot ABDuction **combined w/** varus and DF
1. “Too many toes” sign
47
Other Gait Impairments in Peds
## Footnote
**Decd ROM & Spasticity**
**Limtd ankle DF**
Limtd ankle DF; Incd hip flexion, circumduction, toe walking
48
Other Gait Impairments in Peds
**Spasticity →** Impacts ROM **(velocity dependent)**
**HS Spasticity**
HS Spasticity
* NO elongation @ IC and limtd Hip EXT @ TSt
* @ TSt→ would flex knee instead of keeping it extended
49
Other Gait Impairments in Peds
## Footnote
**Weakness**
Weakness== **Compensations + Decd efficiency**
* **\*\*\*Hip ABD Weakness:** uncontrolled **pelvic dropping on the _swing side_ and lateral trunk shift over the _stance side_**
* **== ADDuction moment @ all jts**
50
Other gait impairs in Peds
* **\*\*\*Hip ABD Weakness is a BIG ONE!!!**
uncontrolled **pelvic dropping on the _swing side_ and lateral trunk shift over the _stance side_**
## Footnote
**== ADDuction moment @ all jts**
51
Other Gait Impairs in Peds
## Footnote
**Weakness**
**Gastroc/Soleus Weakness ANOTHER BIG ONE!!!**
* **PF weakness will impact Mst and Tst\*\*\***
* MSt→ **decd control of forward progression of tibia== excessive DF**
* Push off inadeq. and delayed
* Hip flexors reqd to gen. incd force to assist in clearance
* ==decd efficiency
52
Gastroc/Soleus weakness
## Footnote
**Will impact 2 phases**
MSt & TSt
\***MSt→** DECd control of **forward progression of tibia==\> Excessive DF**
53
Weakness
## Footnote
**2 things to note\*\***
1. Hip ABD weakness
1. pelvic drop on Sw side, lateral trunk shift over St side
1. == ADD moment all jts
2. Gastroc/Soleus weakness
1. PF weakness impacts MSt & TSt
1. decd control of forward progression of tibia over fixed foot=== Excessive DF
