PT 724 Pediatric Gait Analysis

what is the main goal for gait

to be efficient

____ the amount of useful energy that can be derived from a given energy supply

efficiency

what are the biomechanical factors of walking

- adequate strength

- adequate ROM

- appropriate bone structure and composition

- body composition

______ is measured from the heel center of the current footprint to the heel center of the previous footprint on the opposite foot

- step length

can a step length be negative?

yes if the subjects fails to bring landing foot heel point forward of the stationary foot heel point

____ is the measurement between the heel points of 2 consecutive footprints of the same foot

- stride length

_____ is measured as the total number of steps divided by ambulation time

cadence

during what age is the primary goal gaining postural control

- birth to 9 months

what are the typical characteristics of a 9-15yr old walker

- widened BOS

- muscles getting used to pull of gravity

- more power and stability

what are the typical characteristics of a 18-24 month old walker

- knee extension develops during stance

- lowered center of mass

- heel strike emerges by 2

- more Anter/post movement

what are the typical characteristics of a 3-3.5 year old walker

- max genu valgum

- boundaries of movement

what are the typical characteristics of a 4-6 year old walke

- walking velocity begins to normalize with height

what are the typical characteristics of a 6 year old walker

- improved balance and postural control of integrating all systems

- improved muscle coordination

- arch in foot fully formed

how do we address gait dysfunctions

- address the impairments that constrain function

- prevent secondary impairments resulting from inefficient movement

how do we address the impairments that constrain function

- alignment assessments

- utilize orthotics and external support if necessary for stability

what are the 5 major attributes for typical walking

- stability in stance

- foot clearance in swing

- appropriate pre-positioning for initial contact

- adequate step length

- energy conservation

what are interventions for stance phase stability

- single leg stability

- trunk stability

- balance in single and double limb

- hip strengthening

what is needed for stance phase stability

- postural control of lateral weight shift over single limb

- lateral trunk elongation with weightbearing

- muscle balance hip extension/flexion

- stance limb alignment

- static and dynamic double limb balance prior to steps

what is needed for foot clearance in swing phase

- passive and active DF

- adequate motor control of hip flexion with proximal trunk stability

how can we address motor control of hip flexion with proximal trunk stability

- address hip flexion

- address DF

- address SLS

- address trunk stability with hip flexion

what is needed for appropriate pre-position of the foot for initial contact and adequate step length

- DF

- knee extension in terminal swing

- contralateral limb and trunk stability

- distal control

what are interventions to address foot placement in initial contact

- stretch to hamstrings/PF

- strengthen quads/DF

- proximal stability

- articulating or solid AFO

what are interventions for energy conservation

- metronome

- obstacle course

what are commonly seen gait abnormalities

- toe walking

- in toeing

- foot drop/toe dragging

what are the causes of toe walking

- MSK

- neurological

- sensory

- idiopathic

what are the MSK causes of toe walking

- tight heel cords

- weak posterior chain

- poor positioning

what are the neurological causes of toe walking

- tone/spasticity

- CP

what are the sensory causes of toe walking

- avoiding or seeking sensory input

what are the idiopathic causes of toe walking

- familial trait

what is the first step to treating toe walking

- get the range of motion by stretching, serial casting, or bracing

what is the second step to treating toe walking

motor control

- practice correct movement

- weight bearing through entire food

- dynamic and static balance

- wedges or braces

what is the third step to treating toe walking

- different settings with different cues and surfaces

what are the external supports for toe walking

- wedges

what do wedges provide for toe walking

- tactile input to heel and up the chain for more efficient muscle activation

what are the causes of in-toeing

- hip restriction

- antetrosion

- tibial torsion

- forefoot adductus

what are interventions for in-toeing gait

- tandem

- stretching

- DF in single plane

what are the causes of foot drop/toe dragging

- weak ankles and poor DF

- sensory input needs

- neurological reasions