Walking Development in Children - Tagged

Overview

• Focus: Walking Development in Children

• Topics: Neurodevelopmental Disorders and Biomechanical Corrections

Walking Development in Children

Age Milestones

• Most children walk independently between 11 and 15 months.

• Mature gait pattern fully appears by the age of 3 years.

Factors Influencing Walking Development

• Neurological Factors: Central Nervous System (CNS) and Peripheral Nervous System (PNS) with myelination.

• Biomechanical Factors: Changes in skeletal structure, size, and mass of body parts.

• Psychological Factors: Motor learning processes.

• Environmental Factors: Amount of handling and opportunities to walk.

Developmental Stages of Walking

10-18 Months

• Children begin walking and typically have:

  • Wide base of support.

  • Some bowing of the legs and external rotation for stability.

  • Flat feet appearance and evident lumbar lordosis.

  • Pre-requisite skills: Sitting, crawling, and sideways walking (cruising).

By 1 Year Old

• Less than 50% exhibit heel strike; many land on a flat foot.

• High cadence with slow walking speed and shortened step length.

• 95% can squat to play on the floor without support since onset of walking.

By 18 Months

• Majority of children demonstrate heel strike.

• Arms often outstretched for balance while running.

• 80% can run with frequent falls; 97% can run by age 2 but lack mature reciprocal arm swing.

By 2 Years

• 90% can walk on tiptoes; difficult to walk on heels (60% can achieve this).

• 50% can stand on one leg for longer than 6 seconds; 95% by age 3.

• Hopping develops slower than single-leg standing; requires greater balance and coordination.

By 3-4 Years

• Age 3: 50% can hop 3 meters, increasing to 95% by age 5.

• Majority can walk on heels; adult movement patterns mostly present by age 3-4.

• Changes in movement velocity, step length, and cadence extend to age 7.

By Age 7

• Children's gait and posture resemble those of adults.

Determinants of Mature Gait

1. Duration of Single Limb Stance:

   • Increases from 32% in first year to 38% by age 4.

2. Step Length:

   • Increases with age and leg length; better hip flexion and longer steps.

3. Cadence:

   • Decreases with age.

4. Velocity:

   • Increases rapidly until age 3.5, then slows down.

5. Base of Support:

   • Defined as distance between ankle joint centers; narrows until age 4 but may be influenced by wearing nappies.

Paediatric Gait Disorders

• Common Disorders:

  • Cerebral Palsy

  • Down syndrome

  • Duchenne's Muscular Dystrophy

  • Spina bifida

  • Traumatic brain injury

  • Club foot

  • Neurodevelopmental disorders (e.g., Rett's syndrome)

  • Ataxia

Surgical Interventions

• Procedures:

  • Epiphyseodesis ("8" plates) - unilateral or bilateral

  • Femoral Osteotomy

  • Selective Dorsal Rhizotomy (SDR)

  • Pre-Operative assessments

Orthotics

• Types of Orthotic Devices:

  • Spinal orthosis

  • Ankle foot orthosis (AFO)

  • Knee ankle foot orthosis (KAFO)

  • Dynamic Ankle-Foot Orthosis (DAFO)

  • Supramalleolar Orthosis (SMO)