Paediatric Development of Gait

OutlineCentre of gravity and gaitDevelopment of gait Video: Normal gait development in the child

ReferencesTax, HR (1980) Podopaediatrics, Williams & WilkinsBundoora AV: Normal gait development in the child AVV 612.76 NOR:T U-Matic

Centre of Gravity & Gaitadults = anterior to S2 vertebra (55% of height)at birth = above umbilicusbasic principle: to guard against and neutralize major displacements of the centre of gravity

Human locomotion:“It is like teetering on the brink of catastrophe because only the rhythmic forward movement of one leg and then the other keeps man from falling on his face” (Napier, cited in Tax, 1980)

Locomotionmade difficult in humans as only two contact pointsvery difficult to construct a machine to simulate two-legged gaithow to maintain balance? running even harder than walking

Basic movements affecting COG during gait:pelvis rotationpelvis tiltingknee flexion (@ heel strike and heel lift especially)foot and ankle motion in stancecancelling of ankle rise by knee flexionlateral pelvic displacement as weight is shiftedexaggerations in these movements affect other factorsmotion of foot, ankle and knee smooth out the path of the COG in the plane of progression(Saunders et al., 1953)

Gait in childrenReaching out to play on hands and kneesCrawling/creeping...

‘Bear-stand’... on hands and feet.elongates hamstrings, triceps surae, toe flexors, intrinsic foot muscles & plantar fascia

Kneel-stand to half kneelactivates hip stabilizing muscleselongates hip flexors

Initial pull to stand

weight distributed over both feet

‘Cruising’begins on the frontal plane then progresses to rotary motion

Development of gait: 1 yearstaccato in rhythm (jerky movements)arms flexed at shoulder, lack of arm swinglateral sway of torso (external femoral & knee position)exaggerated flexion of hips and knees (lowers COG)often ‘catching up’ with their COG

ankle rotation (plantarflexion esp. prior to foot load. Anterior & posterior musculature are active to assist stabilisationfull foot strikewide base of support (abducted feet & increased angle of gait)low duration of single limb stance (hip instability)

high cadence (steps/min) ≈ 176 (short bursts & limited control of velocity)limited control over velocitylow walking velocity, short step length (stride length ≈ 43 cm)

Gait at 2 yearsarms by their side although lacks co-ordinationfoot flat, fails to resupinatehips still externally rotateddecrease in cadence: 156 steps/minstride length: 54.9 cms

Gait at 3 yearsreciprocal arm swinglordosis with anterior pelvic tiltpossible knee hyperextensionpossible negative angle of gait (internal femoral position - internal hip position)hip extension

appearance of knee flexion wavegenu valgum may peak heel strike - early as 18 mths (posterior m.’s cease coactive contracture)possible foot slap but resupination occurs

base of support has loweredincreased duration of single limb supportincreased step and stride length (67.7 cms)decreased cadence: 153 steps/minincreased velocity

Gait at 6 yearsheel to toe gaitnormal propulsionknees on frontal planeincreased stride length ≈ 129 cmCadence ≈ 115 steps/minNB:minor improvements still occur...muscle powercognitive informationenvironmental information

Delayed walking (>18 mths)delayed myelination

congenital defectsfearmechanical problemsintellectual disabilityneuromuscular disease (cerebellum)Special population’s eg. Down syndrome

SummaryCentre of gravity and gait - why are changes required from birth to adult?Development of gait - what are the major milestones?Video