Pediatric Gait/Orthotic Prescription Flashcards
what problems can occur in the sagittal plane
- anterior displacement of center of mass
- forward head
- protraction/retraction
- kyphosis
- lordosis
- hip flexion
- knee flexion/hyperextension
- ankle DF/PF
what problems can occur in frontal plane
- head tilt
- pelvic obliquity
- hip abd/add (scissoring)
- trendelenburg
- genu varum/valgum
- pronation
what problems can occur in transverse plane
- shoulder or pelvic retraction/rotation
- antetorsion/retrotorsion
- tibial torsion internal or external
- metatarsus adductus
- toeing in or out
- windblown
both feet turn in the same direction
windblown
how does frontal plane balance develop
- lateral stability first (walking side to side - cruising to prepare for gait)
- sagittal mobility next
body weight distribution/COM ____ throughout the age continuum
changes
_____ falls through a load bearing joint in typical gait
body weight
proximity of loaded joints to the weight line _____ efficiency of gait
improves
what are the 4 stance phase rockers
- rocker 1: loading response
- rocker 2: midstance
- rocker 3: terminal stance to propulsion
- rocker 4: toe rocker
when do rockers typically develop
between 2.5 and 3.5 y/o
as rockers develop, the foot becomes more ___
propulsive (it becomes more stable)
_____ continues to develop until 10 y/o
power generation
when does rocker 1 typically occur
seen within first 6 months of independent walking
requires control of mass acceleration
rocker 1
what is the size of the step taken prior to rocker 1 proportional to
strength of the stance hip
single leg stance where the tibia advances over the foot
midstance
when the tibia is vertical during midstance, the femur is
reclines
when the femur is vertical during midstance, the tibia is
inclined
stance phase stability
- femur vertical
- weight line is between heel and metatarsal heads
- body weight is aligned over a stable base
how much DF is needed for rocker 3
> or equal to 10deg
quick elongation of posterior compartment leads to enhanced PF power
rocker 3 terminal stance
PF propulsion accounts for up to how much of the acceleration energy in typical gait
45%
strong U/L LE muscles will free up the pelvis to rotate and allow what
for the swing leg to extend
a stable loaded foot converts from a shock absorber _______ to a rigid lever ______
- rocker 1
- rocker 3
dominant muscles are
not counterbalanced, shortened and weak
overpowered muscles are
lengthened end weak
how to address PF contractures
- bring the floor up to the heel
- post weight shift/posterior weight line training
- strengthen ant tib/EHL
diagnosis of exclusion with no cause from neurological conditions or family/genetic components
idiopathic toe walking (ITW)
until what age is intermittent toe walking part of typical development
age 3
what part of the foot makes contact during initial contact in ITW and what rockers are lost
- toe touch/forefoot
- rocker 1 and 2
by what age should you have all 3 rockers
6 yrs
interventions for ITW
PROM, strengthening, night bracing, orthotics, serial casting, address sensory needs, botox injections, surgical lengthening
what do you need to the orthotic device to do
hold
stop
resist
assist
- arch support
- mild medial/lateral instability
shoe inserts
- hind foot instability
- medial-lateral instability
- not assistance for DF
- no blocking of PF spasticity
- foot plate: full or behind met heads
supramalleolar orthoses (SMO)
what does a behind met head foot plate allow for
aids in rockers 3 and 4
- set at 90deg or 2-3deg DF to put tibia in inclined position
- controls hindfoot
- does not allow PF
- assists with heelstrike and passively replaced DF
molded ankle foot orthosis (MAFO)/solid ankle AFO
- anti-crouch AFO
- helps at the knee and ankle
ground reaction AFO
- permits ankle DF
- need 10-15 deg of DF to use (need good ROM)
- ankle joint can be free or with DF assist
- watch for crouching
- can utilize a check strap to control DF
articulating AFO
- similar height to AFO
- assist in heel strike
- DF assist in the type of material used
- limited hindfoot stability provided
- cut behind met heads to help promote rockers 3 and 4
posterior leaf spring (PLS)
- DF assist AFO
- load the material in the brace to dive DF assist
- need consistent heelstrike to utilize brace to its finest
carbon fiber AFO
