What is gait?
A repetitive sequence of limb movements that safely advance the body forward with minimal energy expenditure.
What factor influence gait development?
Gait must be energy efficient.
- all components of the body must be ready for gait (e.g. cardiac, motor, environment, anatomy, sensory, respiratory, CNS)
- birth history is important - prematurity, low birth weight, complicated pregnancies/births can impact
- environmental factors - trauma/abuse, excessive equipment use, lack of opportunity
- illness - e.g. extended hospital stay, bed bound
What must a child first be able to do before it can walk?
sit, creep (quad rock), bear stand, kneel, cruise and squat (not always)
What are the 5 determinants of gait?
- Duration of single leg stance (should increase with age)
- Walking velocity (should increase with age)
- Step length (should increase with age)
- Ratio of pelvic span to ankle spread (increase with age)
- Cadence - (decreases with age, becomes more energy efficient)
What gait features would you expect to see in a new walker?
- wide base of gait
- increased knee/ankle flexion
- abducted arms, extended elbows
- ER of hips in swing
- no reciprocal arm swing
- flat foot fall pattern
- sporadic movements
- increase cadence to increase speed
What gait features would you expect to see in a 2 y.o. walker?
- narrowed base of gait
- step length increases
- walking velocity increases
- pelvic tilt and ER of hips diminishes
- more ext during propulsion
- heel strike may emerge
- reciprocal arm swing emerges
What gait features would you expect to see in a 3 y.o. walker?
Adult walking pattern achieved, except shorter stride length and higher cadence.
- further narrowed base of gait
- low walking velocity
- smoother movements (more coordinated)
- more obvious heel strike
- less ER of hips again
- genu valgum and lateral tibial torsion
What gait features would you expect to see in a 4-7 y.o. walker?
- increased lumbar lordosis (due to ant pelvic tilt)
- genu valgum should resolve
- tibial torsion reaches maturity by 7
- hip ER and IR equalise
What gait features distinguish a 7 y.o. child from a 3 y.o. child?
Gait pattern is very similar to 3 y.o. but stride length increases and a mature walking pattern is easily distinguishable.
