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.It gives a pressure dis- experienced in the field of gait analysis will result inused for superficial muscles in dynamictribution map of the weight bearing foot.a clearer definition of problems during gait.EMG. Gait30Maturation of walking in childrenCharacteristics of gait in childrenAAA child s gait is different from an adult s until adolescence.Parameter Characteristic Normalizes at ageThe toddler walks with wide, short steps.The foot strikesStep length Short 15the ground with the whole sole.Stance phase knee flexionStep width Increased 4is minimal.The legs are in external rotation throughout theCadence Increased 15swing phase.Reciprocal arm swing is absent.Stance phase islonger in young children compared with swing phase.ThereSpeed Slow 15is increased muscle activity.Stance Longer 4The gait pattern matures as the child grows older [A].HeelMuscle activity Increased 4strike begins at approximately 3 years of age.Stance phaseHeel strike None 2-3knee flexion and external rotation values approach normalKnee flexion Minimal in stance 2-3limits.Step width narrows and reciprocal arm movementsLegs External rotation during swing 2-3begin at approximately 4 years of age.Cadence, step lengthArm swing Absent 4 and speed reach adult values at approximately age 15 years.Types of gait in diplegic and ambulatory totalbody involved childrenBBStability in stance, progression and foot clearance in swingare necessary for efficient walking.Stability is disturbedin CP because of impaired balance, increased muscle toneleading to contractures and muscle weakness.The commonproblems in stance are equinovarus, jump knee, crouch kneeand internal rotation of the legs.Progression of the body isdisturbed because of weakness and contractures as well.Thecommon problems of swing are shortened step length andimpaired foot clearance such as that which occurs in stiffknee gait.Jump gait typical for the young diplegic child.The child s walking pattern changes with age.Diplegicchildren begin standing with the hips, knees and anklesextended and the legs crossed.Later, hip and knee flexion andCCankle plantar flexion occur.Crouch occurs as the child growsolder.Walking patterns are established at approximately 5 to7 years of age.In the sagittal plane, look for three types of pathologicallyabnormal gait: The jump, the crouch and the stiff knee gait.Jump gaitThe child walks with hips in flexion, knees in flexion andCrouch gait occurs in the growing diplegic child.It is characterized by in-ankles in plantar flexion as if getting ready to jump [B].Thiscreased knee fl exion and ankle dorsifl exion during stance.Isolatedis typical for diplegic and ambulatory total body involvedgastrocnemius lengthening or overlengthening weakens push-off and caus-children when they begin to walk.The reason is spasticity ofes crouch.Severe hamstring weakness also causes crouch.hip and knee flexors and ankle plantar flexors.Crouch gaitDDIncreased knee flexion and ankle hyperdorsiflexion occurduring stance phase [C].They occur in older children andafter isolated triceps lengthenings that have been performedwithout addressing the spastic hamstrings.Hip flexors andhamstrings are tight, and quadriceps and triceps are weak.Stiff knee gaitDecreased knee flexion occurs during swing phase [D].Stiff knee gait may accompany crouch.In this case, the quadriceps and theThe rectus femoris muscle is spastic and does not allowhamstring muscles are spastic.Stiff knee gait is easily recognized by shoe-the knee to flex in initial and midswing phases.Limitationwear due to drag in swing.of knee flexion causes difficulty in foot clearance and stairclimbing.EEThese sagittal plane gait patterns coexist with frontal andtransverse plane pathologies.Look for scissoring and trunklurching in the frontal plane.In the frontal and transverse planes look for scissoring gaitand trunk lurching.Scissoring gait and internal hip rotationScissoring gait is defined as crossing over of the legs duringScissoring or crossing over is caused by medial hamstring and adductorgait [E].The cause is hip adductor and medial hamstringmuscle spasticity in the young child.Increased femoral anteversion contrib-spasticity combined with excessive femoral anteversion.utes to the problem in the older. Gait31Trunk lurchingAATrunk lurching is an increase in the side-to-side movementof the trunk during walking [A].It is caused by deficiency ofbalance.It may become worse after surgery and during periodsof rapid growth.Traps to avoid: Apparent equinusThe cause of toe walking may not be gastrocnemius spasticity,but rather insufficient knee extension in certain children.Whenthe patient is unable to extend the knee because of hamstringspasticity or knee flexion contracture, he or she seems to walkThe only remedy for trunk lurch is using a mobility device such as a walkeron tiptoe which can be mistaken for pes equinus.or canes.Strengthening the hip abductors may also be helpful.Types of gait in hemiplegic childrenHemiplegic gait is subdivided into four types.With type 1,BBno active dorsiflexion of the ankle is present, and the foot inequinus.With type 2, a functioning tibialis anterior is present,and the foot is still in equinus because of the spasticity ingastrocnemius.With type 1, even if the gastrocnemius muscleis lengthened, the patient still needs a brace to keep the foot inneutral; however with type 2, lengthening of the gastrocnemiusresults in a more functional gait because the patient is able todorsiflex the ankle.The differentiation between the two typesDistinguish apparent equinus from true equinus.of gait can be made using dynamic electromyography, whichSome children appear to walk in equinus but theirshows the activity in the tibialis anterior.With type 3, abnormalankle is actually in neutral or even dorsiflexed [ Pobierz całość w formacie PDF ]
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.It gives a pressure dis- experienced in the field of gait analysis will result inused for superficial muscles in dynamictribution map of the weight bearing foot.a clearer definition of problems during gait.EMG. Gait30Maturation of walking in childrenCharacteristics of gait in childrenAAA child s gait is different from an adult s until adolescence.Parameter Characteristic Normalizes at ageThe toddler walks with wide, short steps.The foot strikesStep length Short 15the ground with the whole sole.Stance phase knee flexionStep width Increased 4is minimal.The legs are in external rotation throughout theCadence Increased 15swing phase.Reciprocal arm swing is absent.Stance phase islonger in young children compared with swing phase.ThereSpeed Slow 15is increased muscle activity.Stance Longer 4The gait pattern matures as the child grows older [A].HeelMuscle activity Increased 4strike begins at approximately 3 years of age.Stance phaseHeel strike None 2-3knee flexion and external rotation values approach normalKnee flexion Minimal in stance 2-3limits.Step width narrows and reciprocal arm movementsLegs External rotation during swing 2-3begin at approximately 4 years of age.Cadence, step lengthArm swing Absent 4 and speed reach adult values at approximately age 15 years.Types of gait in diplegic and ambulatory totalbody involved childrenBBStability in stance, progression and foot clearance in swingare necessary for efficient walking.Stability is disturbedin CP because of impaired balance, increased muscle toneleading to contractures and muscle weakness.The commonproblems in stance are equinovarus, jump knee, crouch kneeand internal rotation of the legs.Progression of the body isdisturbed because of weakness and contractures as well.Thecommon problems of swing are shortened step length andimpaired foot clearance such as that which occurs in stiffknee gait.Jump gait typical for the young diplegic child.The child s walking pattern changes with age.Diplegicchildren begin standing with the hips, knees and anklesextended and the legs crossed.Later, hip and knee flexion andCCankle plantar flexion occur.Crouch occurs as the child growsolder.Walking patterns are established at approximately 5 to7 years of age.In the sagittal plane, look for three types of pathologicallyabnormal gait: The jump, the crouch and the stiff knee gait.Jump gaitThe child walks with hips in flexion, knees in flexion andCrouch gait occurs in the growing diplegic child.It is characterized by in-ankles in plantar flexion as if getting ready to jump [B].Thiscreased knee fl exion and ankle dorsifl exion during stance.Isolatedis typical for diplegic and ambulatory total body involvedgastrocnemius lengthening or overlengthening weakens push-off and caus-children when they begin to walk.The reason is spasticity ofes crouch.Severe hamstring weakness also causes crouch.hip and knee flexors and ankle plantar flexors.Crouch gaitDDIncreased knee flexion and ankle hyperdorsiflexion occurduring stance phase [C].They occur in older children andafter isolated triceps lengthenings that have been performedwithout addressing the spastic hamstrings.Hip flexors andhamstrings are tight, and quadriceps and triceps are weak.Stiff knee gaitDecreased knee flexion occurs during swing phase [D].Stiff knee gait may accompany crouch.In this case, the quadriceps and theThe rectus femoris muscle is spastic and does not allowhamstring muscles are spastic.Stiff knee gait is easily recognized by shoe-the knee to flex in initial and midswing phases.Limitationwear due to drag in swing.of knee flexion causes difficulty in foot clearance and stairclimbing.EEThese sagittal plane gait patterns coexist with frontal andtransverse plane pathologies.Look for scissoring and trunklurching in the frontal plane.In the frontal and transverse planes look for scissoring gaitand trunk lurching.Scissoring gait and internal hip rotationScissoring gait is defined as crossing over of the legs duringScissoring or crossing over is caused by medial hamstring and adductorgait [E].The cause is hip adductor and medial hamstringmuscle spasticity in the young child.Increased femoral anteversion contrib-spasticity combined with excessive femoral anteversion.utes to the problem in the older. Gait31Trunk lurchingAATrunk lurching is an increase in the side-to-side movementof the trunk during walking [A].It is caused by deficiency ofbalance.It may become worse after surgery and during periodsof rapid growth.Traps to avoid: Apparent equinusThe cause of toe walking may not be gastrocnemius spasticity,but rather insufficient knee extension in certain children.Whenthe patient is unable to extend the knee because of hamstringspasticity or knee flexion contracture, he or she seems to walkThe only remedy for trunk lurch is using a mobility device such as a walkeron tiptoe which can be mistaken for pes equinus.or canes.Strengthening the hip abductors may also be helpful.Types of gait in hemiplegic childrenHemiplegic gait is subdivided into four types.With type 1,BBno active dorsiflexion of the ankle is present, and the foot inequinus.With type 2, a functioning tibialis anterior is present,and the foot is still in equinus because of the spasticity ingastrocnemius.With type 1, even if the gastrocnemius muscleis lengthened, the patient still needs a brace to keep the foot inneutral; however with type 2, lengthening of the gastrocnemiusresults in a more functional gait because the patient is able todorsiflex the ankle.The differentiation between the two typesDistinguish apparent equinus from true equinus.of gait can be made using dynamic electromyography, whichSome children appear to walk in equinus but theirshows the activity in the tibialis anterior.With type 3, abnormalankle is actually in neutral or even dorsiflexed [ Pobierz całość w formacie PDF ]