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Department
of Podiatry
Paediatric
Development of Gait
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Outline
Centre of gravity and gait
Development of gait
Video: Normal gait development in the child
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Centre
of Gravity & Gait
adults = anterior to S2 vertebra (55% of height)
at birth = above umbilicus
basic principle: to guard against and neutralize major displacements
of the centre of gravity
Dr. John Napier,
on 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"
Locomotion
made difficult in humans as only two contact points
very difficult to construct a machine to simulate two-legged gait
how to maintain balance? running even harder than walking
Basic
movements affecting COG during gait:
pelvis rotation
pelvis tilting
knee flexion (@ heel strike and heel lift especially)
foot and ankle motion in stance
cancelling of ankle rise by knee flexion
lateral pelvic displacement as weight is shifted
exaggerations
in these movements affect other factors
motion
of foot, ankle and knee smooth out the path of the COG in the plane
of progression
Gait
in children
beginning
walker - confident walker
Development
of gait: 1 year
staccato in rhythm (jerky movements)
arms flexed at shoulder, lack of arm swing
lateral sway of torso (external fem & 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 stabilization)
full
foot strike
wide
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 velocity
low
walking velocity, short step length (stride length 43 cm)
Gait
at 2 years
arms by their side although lacks co-ordination
foot flat, fails to resupinate
hips still externally rotated
decrease in cadence: 156 steps/min
stride
length: 54.9 cms
Gait
at 3 years
reciprocal arm swing
lordosis with anterior pelvic tilt
possible knee hyperextension
possible negative angle of gait (internal femoral position - internal
hip position)
hip extension
appearance of knee flexion wave
genu 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 lowered
increased duration of single limb support
increased step and stride length (67.7 cms)
decreased cadence: 153 steps/min
increased velocity
Gait
at 6 years
heel to toe gait
normal propulsion
knees on frontal plane
increased stride length 129 cm
Cadence 115 steps/min
NB:
minor improvements still occur in muscle power, cognitive information
and environmental information
Delayed
walking (>18 mths)
delayed
myelination
congenital
defects
fear
mechanical
problems
mental
retardation
neuromuscular
disease (cerebellum)
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'Creeping'
Reaching
out to play on hands and knees
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'Bear-stand'
elongates
hamstrings, triceps surae, toe flexors, intrinsic
foot muscles & plantar fascia
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kneel-stand
to half kneel
activates
hip stabilizing muscles
elongates
hip flexors
initial
pull to stand
weight
distributed over both feet
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'Cruising'
begins
on the frontal plane then progresses to rotary motion
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Summary
Centre of gravity and gait - why are changes required from birth to
adult?
Development of gait - what are the major milestones?
References
Tax,
HR (1980) Podopaediatrics, Williams & Wilkins
Bundoora
AV: Normal gait development in the child AVV 612.76 NOR:T U-Matic
New
Paeds video from Uni of South Australia...
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