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Pediatrics > L5: Development of Gait > Flashcards

L5: Development of Gait Flashcards

1
Q

Normal and fluid gait pattern

Need:

A
  • Normal ROM
  • Adequate motor control
  • Adequate strength
  • Normal sensation
  • Normal align/structure
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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***

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3
Q

CPGs

How is info received?

A

Received from descending and peripheral inputs to activate CPGs

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4
Q

CPGs from birth

A

Auto. reflex present from birth→ WHY typ dev. children do NOT need to be taught to walk

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5
Q

CPGs

Post-natal period

A

Accelerated growth in brain/maturation of CNS bw 3-10mos plays a major role

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6
Q

_______environment sets stage for dev. of typ. gait; constraints placed on the _____ and _______

A

Uterine environment

bones and joints

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7
Q

Typ developing full term newborn is born w/ _______

A

Physio. Flexion

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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
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9
Q

Describe Physio Flexion

@ hips

A

“Pseudocontractures” @ hips

Excessive lateral hip rotation ~70*

ABDuction @ hips

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10
Q

Describe Physio Flexion

@ Knees/tibias

A

Knee flexion + genu varum

Medial tibial torsion

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11
Q

Describe Physio Flexion

@ Ankles

A

Ankle DF

Everted heels

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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

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13
Q

Setting the stage and building blocks of typical gait

Developing a stable base

A

Core stability

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14
Q

Setting the stage and building blocks of typical gait

What does Wt shifting do?

A
  • Wt Shifting
    • Elongation on the WB side
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15
Q

Setting stage for Upright Mobility

0-2mos:

A

Dec’ing physio flexion

  • Gravity assists elongation of flexors and strengthening of EXTs
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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
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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
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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

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19
Q

Wt Shifting importance..

Discuss…

A
  • Stance stability reqs mature wt. shift
    • children practice 1000s/day
  • Occurs early as 8mos****
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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
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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

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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
Q

Gait: 4-5yrs

A
  • Characterized by a period of DISequilibrium
    • balance + postural control out of sync
    • “Awkward” stage of gait dev.
    • MAY be related to growth spurts
26
Q
  • Characterized by a period of DISequilibrium
    • balance + postural control out of sync
    • “Awkward” stage of gait dev.
    • MAY be related to growth spurts
A

Gait @ 4-5yrs old

27
Q

Gait: 6-7yrs

A
  • 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
Q

Take Home Messages

Gen Gait Changes over Time

SLS

A

Duration SLS incs w/ age

Most rapid inc bw 1.5 and 3.5 yrs

29
Q

Take Home Messages

Gen Gait Changes over Time

Emergence of SLS ability

A

Bw 1.5-3.5yrs

30
Q

Take Home Messages

Gen Gait Changes over Time

Step length ___ w/ age

A

INCs!!!

31
Q

Take Home Messages

Gen Gait Changes over Time

Walking velocity INCs from ___ to ____

A

1yr to 7

32
Q

Take Home Messages

Gen Gait Changes over Time

Cadence ____ w/ age

A

DECs!!!

33
Q

Take Home Messages

Gen Gait Changes over Time

Ratio pelvic span:ankle spread

A

Narrows== Decd BOS

34
Q

Take Home Messages

Gen Gait Changes over Time

Alignment of lower limbs change according to?

A

Childs age

35
Q

Gait for Knee Alignment

As in… how does knee alignment change as child ages?

Starting from birth

A
  • Birth→ Varum
  • 2→ Neutral
  • 3→ ValGum
  • 6-7→ Back to Neutral
36
Q

Gait for Knee Alignment

As in… how does knee alignment change as child ages?

Birth

A

VaRum

37
Q

Gait for Knee Alignment

As in… how does knee alignment change as child ages?

2→

A

Neutral

38
Q

Gait for Knee Alignment

As in… how does knee alignment change as child ages?

3→

A

ValGum

39
Q

Gait for Knee Alignment

As in… how does knee alignment change as child ages?

6-7

A

Back to Neutral

40
Q

Wait until _____yrs old to give inserts in shoes

A

6yrs of age

41
Q

Gait impairments in Peds can be due to:

General list

A
  • Bony deformity
  • Abnorm mm tone
  • Decd ROM & Spasticity
  • Weakness
42
Q

3 Bone Deformities impairing Gait in Pediatrics

A
  1. Increased femoral medial torsion
  2. Tibial torsion
  3. Pes ValGus (pronation)
43
Q

Bone deformities impairing Gait:

Incd Femoral Medial Torsion

A
  • From DECd hip loading
  • Inapprop mm forces placed during dev.
  • May have in-toeing gait
44
Q

Bone deformities impairing Gait:

Tibial Torsion

A
  • 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
Q

Bone deformities impairing Gait:

Pes Valgus (Pronation*)

A
  • COMMON in children w/ neuromotor deficits
  • Heel→ everted; NO neutral alignment
  • Impacts alignment “up the chain”
46
Q

Three Biomechanical Components of Pronation

YOU WILL NEED TO KNOW THIS ANYWAY!!!

A
  1. Calcaneal valgus
  2. Midfoot eversion/collapse
  3. Forefoot ABDuction combined w/ varus and DF
    1. “Too many toes” sign
47
Q

Other Gait Impairments in Peds

Decd ROM & Spasticity

Limtd ankle DF

A

Limtd ankle DF; Incd hip flexion, circumduction, toe walking

48
Q

Other Gait Impairments in Peds

Spasticity → Impacts ROM (velocity dependent)

HS Spasticity

A

HS Spasticity

  • NO elongation @ IC and limtd Hip EXT @ TSt
    • @ TSt→ would flex knee instead of keeping it extended
49
Q

Other Gait Impairments in Peds

Weakness

A

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
Q

Other gait impairs in Peds

  • ***Hip ABD Weakness is a BIG ONE!!!
A

uncontrolled pelvic dropping on the swing side and lateral trunk shift over the stance side

== ADDuction moment @ all jts

51
Q

Other Gait Impairs in Peds

Weakness

Gastroc/Soleus Weakness ANOTHER BIG ONE!!!

A
  • 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
Q

Gastroc/Soleus weakness

Will impact 2 phases

A

MSt & TSt

*MSt→ DECd control of forward progression of tibia==> Excessive DF

53
Q

Weakness

2 things to note**

A
  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

Pediatrics (27 decks)

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