L5: Development of Gait Flashcards
Normal and fluid gait pattern
Need:
- Normal ROM
- Adequate motor control
- Adequate strength
- Normal sensation
- Normal align/structure
CPGs
What are they?
Located in BS and SC→ basis for execution of locomotion
Bio. neural networks that produce rhythmic patterned outputs w/out sensory feedback***
CPGs
How is info received?
Received from descending and peripheral inputs to activate CPGs
CPGs from birth
Auto. reflex present from birth→ WHY typ dev. children do NOT need to be taught to walk
CPGs
Post-natal period
Accelerated growth in brain/maturation of CNS bw 3-10mos plays a major role
_______environment sets stage for dev. of typ. gait; constraints placed on the _____ and _______
Uterine environment
bones and joints
Typ developing full term newborn is born w/ _______
Physio. Flexion
Describe Physiological Flexion
- 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
Describe Physio Flexion
@ hips
“Pseudocontractures” @ hips
Excessive lateral hip rotation ~70*
ABDuction @ hips
Describe Physio Flexion
@ Knees/tibias
Knee flexion + genu varum
Medial tibial torsion
Describe Physio Flexion
@ Ankles
Ankle DF
Everted heels
Setting the stage and building blocks of typical gait
Based on theory of what?
Elongation and strengthening of structures
Balancing flexors/Exts
Setting the stage and building blocks of typical gait
Developing a stable base
Core stability
Setting the stage and building blocks of typical gait
What does Wt shifting do?
-
Wt Shifting
- Elongation on the WB side
Setting stage for Upright Mobility
0-2mos:
Dec’ing physio flexion
- Gravity assists elongation of flexors and strengthening of EXTs
Gait:
Birth→ 6mos
- 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
Gait: 6-8mos
Supported walking characterized by:
- Wide BOS
- Hip lat. rotation + flexion
- Bowed legs
- Tibias still appear medially rotated until ~2yrs
- Everted heels
Gait: 6-8mos
By 8 months….Sensory system starts to what?
Sensory system starts to join visual, proprio, vestib. inputs to work together for balance
***Supported ambulation by 8mos
Wt Shifting importance..
Discuss…
-
Stance stability reqs mature wt. shift
- children practice 1000s/day
- Occurs early as 8mos****
More on Wt Shifting importance
- 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
Wt shifting importance
______ at the Hip is one of the most crucial components of gait development; why?
Lateral stability
W/out it, gait will be unsteady
Gait: 9-15mos
- 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”
Gait: 18-24mos
- 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
Gait: 3-3.5yrs
- 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
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
- 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
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
Take Home Messages
Gen Gait Changes over Time
SLS
Duration SLS incs w/ age
Most rapid inc bw 1.5 and 3.5 yrs
Take Home Messages
Gen Gait Changes over Time
Emergence of SLS ability
Bw 1.5-3.5yrs
Take Home Messages
Gen Gait Changes over Time
Step length ___ w/ age
INCs!!!
Take Home Messages
Gen Gait Changes over Time
Walking velocity INCs from ___ to ____
1yr to 7
Take Home Messages
Gen Gait Changes over Time
Cadence ____ w/ age
DECs!!!
Take Home Messages
Gen Gait Changes over Time
Ratio pelvic span:ankle spread
Narrows== Decd BOS
Take Home Messages
Gen Gait Changes over Time
Alignment of lower limbs change according to?
Childs age
Gait for Knee Alignment
As in… how does knee alignment change as child ages?
Starting from birth
- Birth→ Varum
- 2→ Neutral
- 3→ ValGum
- 6-7→ Back to Neutral
Gait for Knee Alignment
As in… how does knee alignment change as child ages?
Birth
VaRum
Gait for Knee Alignment
As in… how does knee alignment change as child ages?
2→
Neutral
Gait for Knee Alignment
As in… how does knee alignment change as child ages?
3→
ValGum
Gait for Knee Alignment
As in… how does knee alignment change as child ages?
6-7
Back to Neutral
Wait until _____yrs old to give inserts in shoes
6yrs of age
Gait impairments in Peds can be due to:
General list
- Bony deformity
- Abnorm mm tone
- Decd ROM & Spasticity
- Weakness
3 Bone Deformities impairing Gait in Pediatrics
- Increased femoral medial torsion
- Tibial torsion
- Pes ValGus (pronation)
Bone deformities impairing Gait:
Incd Femoral Medial Torsion
- From DECd hip loading
- Inapprop mm forces placed during dev.
- May have in-toeing gait
Bone deformities impairing Gait:
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
Bone deformities impairing Gait:
Pes Valgus (Pronation*)
- COMMON in children w/ neuromotor deficits
- Heel→ everted; NO neutral alignment
- Impacts alignment “up the chain”
Three Biomechanical Components of Pronation
YOU WILL NEED TO KNOW THIS ANYWAY!!!
- Calcaneal valgus
- Midfoot eversion/collapse
- Forefoot ABDuction combined w/ varus and DF
- “Too many toes” sign
Other Gait Impairments in Peds
Decd ROM & Spasticity
Limtd ankle DF
Limtd ankle DF; Incd hip flexion, circumduction, toe walking
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
Other Gait Impairments in Peds
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
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
== ADDuction moment @ all jts
Other Gait Impairs in Peds
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
Gastroc/Soleus weakness
Will impact 2 phases
MSt & TSt
*MSt→ DECd control of forward progression of tibia==> Excessive DF
Weakness
2 things to note**
- Hip ABD weakness
- pelvic drop on Sw side, lateral trunk shift over St side
- == ADD moment all jts
- pelvic drop on Sw side, lateral trunk shift over St side
- Gastroc/Soleus weakness
- PF weakness impacts MSt & TSt
- decd control of forward progression of tibia over fixed foot=== Excessive DF
- PF weakness impacts MSt & TSt