Case Studies

Question 1

Toddler walking (6)

Answer 1

• wide base of support
• excessive hip and knee flexion
• anterior tilt of pelvis
• ankle joint pronation - foot flat
• toe curling
• upper limb abduction and elbow flexion

Question 2

3 components to gait development (3)

Answer 2

• neurophysiological
• motor learning
• biomechanical

Question 3

Neurophysiological component of gait development (5)

Answer 3

Myelination of cns, increased vascularity to brain, primitive reflexes
-neonatal placing response
-positive supporting reflex
-spontaneous stepping reflex
Eg blind child centre of gravity in base of support

Question 4

Motor learning component of gait development (6)

Answer 4

Stored sets of motor demands innate and learned
Closed and open loop theories
Closed
-peripheral and sensorimotor feedback
Open
-central control and monitoring mechanism

Question 5

Biomechanical component of gait development (6)

Answer 5

Normal anatomical alignment for age
Weight bearing pattern
Ground reaction force effect on growing
-centre of gravity lowers
-limb length increases
-limb stability increases

Question 6

Sutherland et al. As the child matures… (1)

Answer 6

Cadence decreases while walking velocity and step length increases

Question 7

Tibial torsion (5)

Answer 7

A pattern of gradually increasing external rotatiob with age

• at 1 year =4 degrees
• by 1 1/2 years = 6 degrees
• by 7 years = 10 degrees
• mean adult transmalleolar axis 10 degrees

Question 8

Femoral/tibial alignment (7)

Answer 8

Median alignment 1 year = neutral
-distribution shows both varus and valgus
Mean time for transition from varus to valgus = 22 months
Valgus maximal at 3 years
-(salenius et al 1975)
Valgus then decreases till about 6 years
Knee varum at birth to adult valgum = 7 degrees

Question 9

Normal developmental milestones (5)

Answer 9

Idependant standing 
-9.5 months (6-12 months)
Cruising 
Independent walking
-13 months (10-22 months)