Pediatric Gait

Question 1

What are the 5 attributes of “normal” walking?

Answer 1

●stability in stance
●sufficient foot clearance in swing
●appropriate pre-positioning of the foot for initial contact
●adequate step length
●energy conservation

Question 2

What are some early neurological factors that influence gait?

Answer 2

●CPG’s (in either SC or brainstem) probably define the gross movement pattern (reflexive vs. volitional movement)

●Descending and peripheral input modify the output to match the regulatory conditions of the environment

Question 3

Characteristics of standing posture of a baby birth- 9 months

Answer 3

●Rapid weight gain, high ratio of body fat
●flexion contractures present at hips
●increased ER of hips
●genu varum
●internal torsion of tibia
●calcaneal eversion

Question 4

Characteristics of standing/ walking posture of a baby 9-15 months

Answer 4

●genu varum decreasing
●slight decrease in internal torsion of tibia
●Wide BOS standing and walking
●high guard position
●increased hip and knee flexion
●lack of df during swing
●no heel strike
●significant co-contraction at ankle/knee

●Rate limiting factor is thought to be strength

Question 5

At what age are knees straight?

Answer 5

20 months

Question 6

What are the characteristics in standing/walking of a baby 18-24 months ?

Answer 6

●About 20 months knees are straight
●BOS decreasing, but still wide
●heel strike usually consistent by 24 mth
●decreasing co-contraction of lower extremity musculature

Question 7

What are some characteristics of a 3-3.5 year old’s walking/ standing pattern?

Answer 7

●Genu valgum
●decreasing calcaneal eversion
●EMG pattern is mature

Question 8

What are some characteristics of a 4-6 y.o.’s standing/walking pattern?

Answer 8

●Continued increase in duration of single limb stance
●growth spurt, disequilibrium
●normal knee alignment
●neutral calcaneus
●Normal vertical excursion 4.5 cm

Question 9

Dorsiflexion at HS has what purposes in gait?

Answer 9

Attenuation of forces

Question 10

Foot flat at HS would cause?

Answer 10

The baby gets larger, but would have less attenuation of forces, decreasing efficiency because they do not have a heel rocker

Question 11

What would you expect to see with a hip flexion contracture gait pattern?

Answer 11

Flexed knee during gait

Decreased heel strike…

Question 12

What would you expect to see during gait with a knee flexion contracture?

Answer 12

Hip flexed to stabilize

Possibly flexion of contralateral side to even out legs

Question 13

What would you expect to see in a gait with plantarflexion contracture?

Answer 13

Decreased/ loss of heel strike
Early heel off
Trouble clearing foot in swing
Restriction of tibia from moving forward
Knee hyperextension

Question 14

What are the benefits of using a Hinged AFO vs a regular AFO?

Answer 14

Both: increase stride length,
Decrease abnormal ankle plantar flexion during initial contact, midstance and terminal stance
Increase ankle plantar flexor moments closer to normal during terminal stance.

Both: could be used to reduce the excessive ankle plantar flexion without affecting the knee position
during stance.

Hinged AFOs: increase ankle dorsiflexion at terminal stance
Increase ankle power generation during preswing (vs AFO)
Increase ankle dorsiflexion at loading (vs no AFO).

The hinged AFO: recommended to produce more normal dorsiflexion during terminal stance
increased ankle power generation during preswing in children with spastic diplegic CP.