Advanced Gross Motor Skills in Children: Difference between revisions
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== 7 Months == | == 7 Months == | ||
At 7 months, the child can only stand and walk with their hands held. The necessity for external support is due to their underdeveloped balance responses and poor anterior-posterior weighbearing alignment. Gait at this age is marked by a wide base of support with moderate abduction with hip external rotation and pronated feet. The amount of pronation correlates to the amount of abduction and external rotation of the hips. Children at this state will walk with their hip and knees flexed.<ref name=":0">Tecklin JS, editor. | At 7 months, the child can only stand and walk with their hands held. The necessity for external support is due to their underdeveloped balance responses and poor anterior-posterior weighbearing alignment. Gait at this age is marked by a wide base of support with moderate abduction with hip external rotation and pronated feet. The amount of pronation correlates to the amount of abduction and external rotation of the hips. Children at this state will walk with their hip and knees flexed.<ref name=":0">Tecklin JS, editor. Pediatric physical therapy. Lippincott Williams & Wilkins; 2008.</ref> | ||
== Pull-to-Stand == | == Pull-to-Stand == | ||
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== Cruising == | == Cruising == | ||
Once the child is able to pull-to-stand, they will play for long periods of time squatting and standing moving back and forth between furniture and floor. Around 10 months old, they will begin to step sideways holding onto the furniture for support. This supported lateral movement is referred to as cruising, With this newfound mobility, the child is able to work their way along the furniture and eventually able to reach other pieces of furniture in an effort to navigate the room. Cruising gait exhibits less hip and knee flexion and better anterior-posterior alignment. Balance is improved during this time as the child is able to lift one supported hand and rotate their body. They may even take 1-2 steps without support from either upper extremity. Cruising helps the child to strengthen their lower extremity musculature specifically the hip abductors/adductors and ankle evertors/invertors. At 10 months of age, the [https://www.physio-pedia.com/Plantar_Grasp_Reflex?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal plantar grasp reflex] may still be present although considerably diminished. Complete resolution of the reflex is necessary for independent unsupported walking to develop. | Once the child is able to pull-to-stand, they will play for long periods of time squatting and standing moving back and forth between furniture and floor. Around 10 months old, they will begin to step sideways holding onto the furniture for support. This supported lateral movement is referred to as cruising, With this newfound mobility, the child is able to work their way along the furniture and eventually able to reach other pieces of furniture in an effort to navigate the room. Cruising gait exhibits less hip and knee flexion and better anterior-posterior alignment. Balance is improved during this time as the child is able to lift one supported hand and rotate their body. They may even take 1-2 steps without support from either upper extremity. Cruising helps the child to strengthen their lower extremity musculature specifically the hip abductors/adductors and ankle evertors/invertors. At 10 months of age, the [https://www.physio-pedia.com/Plantar_Grasp_Reflex?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal plantar grasp reflex] may still be present although considerably diminished. Complete resolution of the reflex is necessary for independent unsupported walking to develop.<ref name=":0" /> | ||
. | === Standing Independently === | ||
The child will eventually stand independently letting go of their upper extremity support from furniture or an adult. When this occurs, trunk stability is maintained by a high guard position of the upper extremities. | |||
periods. When this happens, his upper extremities usually assume the high guard position for increased trunk stability. During the development of standing, cruising, and walking, the child develops the ability to squat to play as well as squatting to pick up an object (Fig. 2.68). Often while standing at furniture, such as a sofa, the child can be seen to squat to pick up a toy, stand and place the toy on the sofa, and repeat this process many times. Also, he is able to spend great lengths of time in the squat position while playing. Squatting, therefore, is both a movement used to transition between postures and a posture in itself. Some have theorized that the active squat-to-stance-to-squat sequence facilitates cocontraction, and therefore stability, of the muscles surrounding the ankle joint. The theory is that the prolonged and maximal stretch to the muscle spindles of the ankle musculature fires both primary and secondary afferent endings.59 Independent Bipedal Locomotion First independent forward walking generally occurs between 10 and 15 months of age, with the typical child walking at 12 months of age, plus or minus a month. At first, the child holds his upper extremities in the high guard position, the same position in which he held his arms during first independent sitting, in an attempt to increase stability against gravity by adducting the scapulae (Fig. 2.69). Posture is characterized by improving but continuing poor, vertical alignment, with hips and knees flexed. Abduction and external rotation of the hips continue to provide a wide base of support. The child does not have heel strike initially, and the feet are still in considerable pronation. As forward independent gait progresses over the next months, the shoulders lose much of the flexion of the high guard position, assuming a low guard position with elbows still flexed and hands just above the waist; fingers may be pointed upward or shoulders are adducted, and the hands are stabilized against the body, as shown in Figure 2.70. Then the upper extremities relax into full shoulder extension and hang at the child’s sides. Over the next few weeks, reciprocal arm swing during gait is attained (Fig. 2.71). With practice, the anterior–posterior postural alignment continues to improve with increasing hip and knee extension, decreasing hip abduction with narrowing of the base of support, and lessening of external rotation of the hips. Eventually, the child walks with good postural alignment, a narrow base of support, neutral pronation/supination of the feet, heel strike, push off, and reciprocal arm swing. The plantar fat pad does not completely disappear until approximately 2 years of age, at which time the longitudinal arches become visible. Bipedal locomotion will continue to improve and progress over the next 2 to 4 years. Gait parameters for the 56 Part I Development FIGURE 2.71 Mature independent walking with heel strike and reciprocal arm swing. FIGURE 2.70 Independent walking. A: Note that the high guard position is decreasing, with the right upper extremity still in high guard, the left upper extremity being lowered with shoulder girdle protraction. B: Walking independently with low guard to enhance upright trunk stability. A B 3-year-old child differ from early gait parameters at age 1 year.109 These parameters include alignment of the lower extremities as well as various aspects of the gait cycle. As the child’s gait matures, mediolateral alignment at the hip progresses from hip abduction to adduction, until the feet are approximately shoulders’ width apart. At the knees, mediolateral alignment moves from genu varus at birth to approximately 12 degrees of genu valgus at 3 years of age. Then between 4 and 7 years of age, the valgus resolves to only 7 to 10 degrees. This change in alignment of the knees affects the mediolateral alignment of the hips, ankles, and feet as well.109 Other gait parameters that change with growth and maturation are cadence, step and stride length, and velocity.109 Cadence, the number of steps per minute, starts out very high in first independent walking. The 1-yearold child spends a decreased amount of time in single limb stance, compared with the 3-year-old and the adult. This is because the 1-year-old child has less strength and stability in his hips. Consequently, he takes more steps per minute, resulting in less time in single limb support.109 Gait velocity, the distance one covers in a specified amount of time, starts low and increases as the child ages.109 Velocity is related to the length of one’s step or stride. A step is measured from heel strike of one lower extremity to heel strike of the opposite lower extremity. Stride Chapter 2 Motor Development in the Normal Chil | periods. When this happens, his upper extremities usually assume the high guard position for increased trunk stability. During the development of standing, cruising, and walking, the child develops the ability to squat to play as well as squatting to pick up an object (Fig. 2.68). Often while standing at furniture, such as a sofa, the child can be seen to squat to pick up a toy, stand and place the toy on the sofa, and repeat this process many times. Also, he is able to spend great lengths of time in the squat position while playing. Squatting, therefore, is both a movement used to transition between postures and a posture in itself. Some have theorized that the active squat-to-stance-to-squat sequence facilitates cocontraction, and therefore stability, of the muscles surrounding the ankle joint. The theory is that the prolonged and maximal stretch to the muscle spindles of the ankle musculature fires both primary and secondary afferent endings.59 Independent Bipedal Locomotion First independent forward walking generally occurs between 10 and 15 months of age, with the typical child walking at 12 months of age, plus or minus a month. At first, the child holds his upper extremities in the high guard position, the same position in which he held his arms during first independent sitting, in an attempt to increase stability against gravity by adducting the scapulae (Fig. 2.69). Posture is characterized by improving but continuing poor, vertical alignment, with hips and knees flexed. Abduction and external rotation of the hips continue to provide a wide base of support. The child does not have heel strike initially, and the feet are still in considerable pronation. As forward independent gait progresses over the next months, the shoulders lose much of the flexion of the high guard position, assuming a low guard position with elbows still flexed and hands just above the waist; fingers may be pointed upward or shoulders are adducted, and the hands are stabilized against the body, as shown in Figure 2.70. Then the upper extremities relax into full shoulder extension and hang at the child’s sides. Over the next few weeks, reciprocal arm swing during gait is attained (Fig. 2.71). With practice, the anterior–posterior postural alignment continues to improve with increasing hip and knee extension, decreasing hip abduction with narrowing of the base of support, and lessening of external rotation of the hips. Eventually, the child walks with good postural alignment, a narrow base of support, neutral pronation/supination of the feet, heel strike, push off, and reciprocal arm swing. The plantar fat pad does not completely disappear until approximately 2 years of age, at which time the longitudinal arches become visible. Bipedal locomotion will continue to improve and progress over the next 2 to 4 years. Gait parameters for the 56 Part I Development FIGURE 2.71 Mature independent walking with heel strike and reciprocal arm swing. FIGURE 2.70 Independent walking. A: Note that the high guard position is decreasing, with the right upper extremity still in high guard, the left upper extremity being lowered with shoulder girdle protraction. B: Walking independently with low guard to enhance upright trunk stability. A B 3-year-old child differ from early gait parameters at age 1 year.109 These parameters include alignment of the lower extremities as well as various aspects of the gait cycle. As the child’s gait matures, mediolateral alignment at the hip progresses from hip abduction to adduction, until the feet are approximately shoulders’ width apart. At the knees, mediolateral alignment moves from genu varus at birth to approximately 12 degrees of genu valgus at 3 years of age. Then between 4 and 7 years of age, the valgus resolves to only 7 to 10 degrees. This change in alignment of the knees affects the mediolateral alignment of the hips, ankles, and feet as well.109 Other gait parameters that change with growth and maturation are cadence, step and stride length, and velocity.109 Cadence, the number of steps per minute, starts out very high in first independent walking. The 1-yearold child spends a decreased amount of time in single limb stance, compared with the 3-year-old and the adult. This is because the 1-year-old child has less strength and stability in his hips. Consequently, he takes more steps per minute, resulting in less time in single limb support.109 Gait velocity, the distance one covers in a specified amount of time, starts low and increases as the child ages.109 Velocity is related to the length of one’s step or stride. A step is measured from heel strike of one lower extremity to heel strike of the opposite lower extremity. Stride Chapter 2 Motor Development in the Normal Chil | ||
length, measured from heel strike of one foot to heel strike of the same foot, is approximately twice the step length.109 However, in a case where the step length of the two extremities differs considerably because of pathology affecting only one limb, in order to be accurate both step and stride length must be measured, instead of calculating stride length by multiplying the step length by two. From 1 to 3 years of age, a child’s step length and stride length increase, as do velocity and single limb stance time.109 Single limb stance increases with increasing strength and balance abilities. Length of step and/or stride, and therefore gait velocity, increases as the child’s lower extremities continue to grow in length, even well after age 3. Otherwise, gait at age 3 is considered to have parameters similar to those of an adult.109 Various gait parameters at ages 1 year and 3 years are shown in Table 2.5. Even though a toddler is able to walk fast, and his parents will often insist he is running, true running does not develop until 3 to 4 years of age. A true run is characterized by having both feet off the ground at the same time, unlike walking, where one foot does not leave the ground until the other foot makes initial contact. Stair Climbing Stairs present a considerable challenge to toddlers, as one might imagine. The typical rise of a step in a flight of stairs is 7 to 8 inches. For a 15-month-old child to negotiate stairs in erect standing would be the equivalent of an adult attempting to climb stairs with a knee-high rise (Fig. 2.72). The ability to ascend and descend stairs is affected by a number of factors, most particularly, opportunity. Therefore, the age of achieving this milestone has considerable variability, although the sequence of achievement FIGURE 2.72 Descending stairs with hand held; note the rise of the step in relationship to the length of the child’s lower extremity. Gait Parameter 1 Year of Age 3 Years of Age Direction of Change Base of support (pelvic span to ankle spread) <1 ≥1 ↓ Step length 20 cm 33 cm ↑ Stride length (double the step length) 40 cm 66 cm ↑ Single limb stance 32% of gait cycle 35% of gait cycle ↑ Cadence (step frequency) 180 steps per minute 154 steps per minute ↓ Velocity (speed) 60 cm/sec 105 cm/ sec ↑ a From Long TM, Toscano K. Handbook of Pediatric Physical Therapy. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. Gait Parameters in 1- and 3-Year-Old Childrena TABLE 2.5 58 Part I Development. is much the same from one child to the next. A child who lives in a home without stairs, or at least without stairs that the child is permitted to climb, often develops stair-climbing skills at a later age than the child who has frequent daily encounters with stairs to get to and from his bedroom and/ or toys. The first ability to ascend and descend stairs is usually in the quadruped position (Fig. 2.73). The child learns to go up the stairs on his hands and knees, followed soon by coming down the stairs backward on his hands and knees. Sometimes children, in their first attempts at descending stairs, will try to do so in quadruped, but head first, with disastrous results if a caregiver is not nearby. With a bit of coaching, the child quickly learns through trial and error to descend the stairs backward on his hands and knees. Ascending stairs generally develops to a more skillful level before descending stairs develops to the same level of skill. This sequence generally repeats itself in bipedal locomotion after the child has developed the ability to go up and down stairs using quadrupedal locomotion. Another feature of stair climbing that develops in a rather typical pattern is apparent once the child is climbing stairs while standing. Initially, bipedal stair climbing is performed by placing both feet on each step, in a manner that is called marking time. 48 Generally, the child will not begin doing steps one over one. (i.e., only one foot to each step) until he is close to 3 years of age, depending of course on how much trial and error and practice on stairs he has been afforded. This pattern of the feet is also dependent on the type of upper extremity support that is available. Stair climbing progresses as the upper extremity support decreases from using one handrail and/ or an adult hand for support, to needing a handrail but no adult, and finally to needing no upper extremity support (Fig. 2.74). Of course, the speed with which the child develops increasingly more skillful stair-climbing abilities varies greatly, and like other skills, the ability to locomote on stairs may temporarily digress as unique and/or challenging circumstances, such as unusually steep stairs or the absence of a handrail, present themselves.<ref name=":0" /> | length, measured from heel strike of one foot to heel strike of the same foot, is approximately twice the step length.109 However, in a case where the step length of the two extremities differs considerably because of pathology affecting only one limb, in order to be accurate both step and stride length must be measured, instead of calculating stride length by multiplying the step length by two. From 1 to 3 years of age, a child’s step length and stride length increase, as do velocity and single limb stance time.109 Single limb stance increases with increasing strength and balance abilities. Length of step and/or stride, and therefore gait velocity, increases as the child’s lower extremities continue to grow in length, even well after age 3. Otherwise, gait at age 3 is considered to have parameters similar to those of an adult.109 Various gait parameters at ages 1 year and 3 years are shown in Table 2.5. Even though a toddler is able to walk fast, and his parents will often insist he is running, true running does not develop until 3 to 4 years of age. A true run is characterized by having both feet off the ground at the same time, unlike walking, where one foot does not leave the ground until the other foot makes initial contact. Stair Climbing Stairs present a considerable challenge to toddlers, as one might imagine. The typical rise of a step in a flight of stairs is 7 to 8 inches. For a 15-month-old child to negotiate stairs in erect standing would be the equivalent of an adult attempting to climb stairs with a knee-high rise (Fig. 2.72). The ability to ascend and descend stairs is affected by a number of factors, most particularly, opportunity. Therefore, the age of achieving this milestone has considerable variability, although the sequence of achievement FIGURE 2.72 Descending stairs with hand held; note the rise of the step in relationship to the length of the child’s lower extremity. Gait Parameter 1 Year of Age 3 Years of Age Direction of Change Base of support (pelvic span to ankle spread) <1 ≥1 ↓ Step length 20 cm 33 cm ↑ Stride length (double the step length) 40 cm 66 cm ↑ Single limb stance 32% of gait cycle 35% of gait cycle ↑ Cadence (step frequency) 180 steps per minute 154 steps per minute ↓ Velocity (speed) 60 cm/sec 105 cm/ sec ↑ a From Long TM, Toscano K. Handbook of Pediatric Physical Therapy. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. Gait Parameters in 1- and 3-Year-Old Childrena TABLE 2.5 58 Part I Development. is much the same from one child to the next. A child who lives in a home without stairs, or at least without stairs that the child is permitted to climb, often develops stair-climbing skills at a later age than the child who has frequent daily encounters with stairs to get to and from his bedroom and/ or toys. The first ability to ascend and descend stairs is usually in the quadruped position (Fig. 2.73). The child learns to go up the stairs on his hands and knees, followed soon by coming down the stairs backward on his hands and knees. Sometimes children, in their first attempts at descending stairs, will try to do so in quadruped, but head first, with disastrous results if a caregiver is not nearby. With a bit of coaching, the child quickly learns through trial and error to descend the stairs backward on his hands and knees. Ascending stairs generally develops to a more skillful level before descending stairs develops to the same level of skill. This sequence generally repeats itself in bipedal locomotion after the child has developed the ability to go up and down stairs using quadrupedal locomotion. Another feature of stair climbing that develops in a rather typical pattern is apparent once the child is climbing stairs while standing. Initially, bipedal stair climbing is performed by placing both feet on each step, in a manner that is called marking time. 48 Generally, the child will not begin doing steps one over one. (i.e., only one foot to each step) until he is close to 3 years of age, depending of course on how much trial and error and practice on stairs he has been afforded. This pattern of the feet is also dependent on the type of upper extremity support that is available. Stair climbing progresses as the upper extremity support decreases from using one handrail and/ or an adult hand for support, to needing a handrail but no adult, and finally to needing no upper extremity support (Fig. 2.74). Of course, the speed with which the child develops increasingly more skillful stair-climbing abilities varies greatly, and like other skills, the ability to locomote on stairs may temporarily digress as unique and/or challenging circumstances, such as unusually steep stairs or the absence of a handrail, present themselves.<ref name=":0" /> | ||
Revision as of 15:58, 13 March 2023
Intro Mulder H, Oudgenoeg-Paz O, Verhagen J, van der Ham IJ, Van der Stigchel S. Infant walking experience is related to the development of selective attention. Journal of Experimental Child Psychology. 2022 Aug 1;220:105425.https://www.sciencedirect.com/science/article/pii/S0022096522000546
Thurman SL, Corbetta D. Changes in posture and interactive behaviors as infants progress from sitting to walking: A longitudinal study. Frontiers in psychology. 2019 Apr 12;10:822.https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00822/full
Price C, Morrison S. What happens to babies’ feet when they are learning to walk?. Frontiers for Young Minds. 2023 Jan 6.https://kids.frontiersin.org/articles/10.3389/frym.2022.968225
Messerli-Bürgy N, Kakebeeke TH, Meyer AH, Arhab A, Zysset AE, Stülb K, Leeger-Aschmann CS, Schmutz EA, Kriemler S, Puder JJ, Munsch S. Walking onset: a poor predictor for motor and cognitive skills in healthy preschool children. BMC pediatrics. 2021 Dec;21(1):1-7. https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02828-4
Mowbray R, Cowie D. Mind your step: learning to walk in complex environments. Experimental brain research. 2020 Jun;238(6):1455-65. https://link.springer.com/article/10.1007/s00221-020-05821-y
stairs\
Berger SE, Theuring C, Adolph KE. How and when infants learn to climb stairs. Infant Behavior and Development. 2007 Feb 1;30(1):36-49.https://www.sciencedirect.com/science/article/abs/pii/S0163638306000750running
bike
gallop/skio
Introduction[edit | edit source]
The child begins pulling himself to standing in his crib at about this time (7 to 8 months). At first, this is accomplished by using the newly developed strength of the upper extremities, while the lower extremities remain essentially passive. Once standing, the child will frequently hold onto the crib rails for support while he bounces and experiments with this newly discovered standing ability. During his earliest attempts at supported standing in the crib, he finds that he is unable to get down. Lowering himself slowly to the mattress requires strong eccentric control of his hips and knees, something that he has not developed. Frustrated and tired of standing, he may simply let go of the crib rails and drop to sitting, thanks to gravity, or he may begin to cry, signaling to his parent his need for help. A parent will come and either take the child from the crib or put him down inparagraph about transitioning to walking
7 Months[edit | edit source]
At 7 months, the child can only stand and walk with their hands held. The necessity for external support is due to their underdeveloped balance responses and poor anterior-posterior weighbearing alignment. Gait at this age is marked by a wide base of support with moderate abduction with hip external rotation and pronated feet. The amount of pronation correlates to the amount of abduction and external rotation of the hips. Children at this state will walk with their hip and knees flexed.[1]
Pull-to-Stand[edit | edit source]
Around 10 months old, the child is able to pull themselves up to standing using a low table or sofa. From this position, the child is able to get down to the floor with control. The process of pull to stand moves through tall-kneeling and half-kneeling.
- Tall-kneeling:
- weight on both knees
- wide base of support
- use of upper extremities to pull up
- Half-kneeling:
- shift weight to one side
- elongated trunk on weight shifted side
- unweighted leg moves forward to place foot flat on floor
- use of hip and knee extensors to facilitate moving against gravity
Moving back to the floor uses the same half-kneeling and tall-kneeling positions. Initially these movements may be them letting go and quickly dropping to the floor. With time and practice, these movements will become very quick and controlled.[1]
Cruising[edit | edit source]
Once the child is able to pull-to-stand, they will play for long periods of time squatting and standing moving back and forth between furniture and floor. Around 10 months old, they will begin to step sideways holding onto the furniture for support. This supported lateral movement is referred to as cruising, With this newfound mobility, the child is able to work their way along the furniture and eventually able to reach other pieces of furniture in an effort to navigate the room. Cruising gait exhibits less hip and knee flexion and better anterior-posterior alignment. Balance is improved during this time as the child is able to lift one supported hand and rotate their body. They may even take 1-2 steps without support from either upper extremity. Cruising helps the child to strengthen their lower extremity musculature specifically the hip abductors/adductors and ankle evertors/invertors. At 10 months of age, the plantar grasp reflex may still be present although considerably diminished. Complete resolution of the reflex is necessary for independent unsupported walking to develop.[1]
Standing Independently[edit | edit source]
The child will eventually stand independently letting go of their upper extremity support from furniture or an adult. When this occurs, trunk stability is maintained by a high guard position of the upper extremities.
periods. When this happens, his upper extremities usually assume the high guard position for increased trunk stability. During the development of standing, cruising, and walking, the child develops the ability to squat to play as well as squatting to pick up an object (Fig. 2.68). Often while standing at furniture, such as a sofa, the child can be seen to squat to pick up a toy, stand and place the toy on the sofa, and repeat this process many times. Also, he is able to spend great lengths of time in the squat position while playing. Squatting, therefore, is both a movement used to transition between postures and a posture in itself. Some have theorized that the active squat-to-stance-to-squat sequence facilitates cocontraction, and therefore stability, of the muscles surrounding the ankle joint. The theory is that the prolonged and maximal stretch to the muscle spindles of the ankle musculature fires both primary and secondary afferent endings.59 Independent Bipedal Locomotion First independent forward walking generally occurs between 10 and 15 months of age, with the typical child walking at 12 months of age, plus or minus a month. At first, the child holds his upper extremities in the high guard position, the same position in which he held his arms during first independent sitting, in an attempt to increase stability against gravity by adducting the scapulae (Fig. 2.69). Posture is characterized by improving but continuing poor, vertical alignment, with hips and knees flexed. Abduction and external rotation of the hips continue to provide a wide base of support. The child does not have heel strike initially, and the feet are still in considerable pronation. As forward independent gait progresses over the next months, the shoulders lose much of the flexion of the high guard position, assuming a low guard position with elbows still flexed and hands just above the waist; fingers may be pointed upward or shoulders are adducted, and the hands are stabilized against the body, as shown in Figure 2.70. Then the upper extremities relax into full shoulder extension and hang at the child’s sides. Over the next few weeks, reciprocal arm swing during gait is attained (Fig. 2.71). With practice, the anterior–posterior postural alignment continues to improve with increasing hip and knee extension, decreasing hip abduction with narrowing of the base of support, and lessening of external rotation of the hips. Eventually, the child walks with good postural alignment, a narrow base of support, neutral pronation/supination of the feet, heel strike, push off, and reciprocal arm swing. The plantar fat pad does not completely disappear until approximately 2 years of age, at which time the longitudinal arches become visible. Bipedal locomotion will continue to improve and progress over the next 2 to 4 years. Gait parameters for the 56 Part I Development FIGURE 2.71 Mature independent walking with heel strike and reciprocal arm swing. FIGURE 2.70 Independent walking. A: Note that the high guard position is decreasing, with the right upper extremity still in high guard, the left upper extremity being lowered with shoulder girdle protraction. B: Walking independently with low guard to enhance upright trunk stability. A B 3-year-old child differ from early gait parameters at age 1 year.109 These parameters include alignment of the lower extremities as well as various aspects of the gait cycle. As the child’s gait matures, mediolateral alignment at the hip progresses from hip abduction to adduction, until the feet are approximately shoulders’ width apart. At the knees, mediolateral alignment moves from genu varus at birth to approximately 12 degrees of genu valgus at 3 years of age. Then between 4 and 7 years of age, the valgus resolves to only 7 to 10 degrees. This change in alignment of the knees affects the mediolateral alignment of the hips, ankles, and feet as well.109 Other gait parameters that change with growth and maturation are cadence, step and stride length, and velocity.109 Cadence, the number of steps per minute, starts out very high in first independent walking. The 1-yearold child spends a decreased amount of time in single limb stance, compared with the 3-year-old and the adult. This is because the 1-year-old child has less strength and stability in his hips. Consequently, he takes more steps per minute, resulting in less time in single limb support.109 Gait velocity, the distance one covers in a specified amount of time, starts low and increases as the child ages.109 Velocity is related to the length of one’s step or stride. A step is measured from heel strike of one lower extremity to heel strike of the opposite lower extremity. Stride Chapter 2 Motor Development in the Normal Chil
length, measured from heel strike of one foot to heel strike of the same foot, is approximately twice the step length.109 However, in a case where the step length of the two extremities differs considerably because of pathology affecting only one limb, in order to be accurate both step and stride length must be measured, instead of calculating stride length by multiplying the step length by two. From 1 to 3 years of age, a child’s step length and stride length increase, as do velocity and single limb stance time.109 Single limb stance increases with increasing strength and balance abilities. Length of step and/or stride, and therefore gait velocity, increases as the child’s lower extremities continue to grow in length, even well after age 3. Otherwise, gait at age 3 is considered to have parameters similar to those of an adult.109 Various gait parameters at ages 1 year and 3 years are shown in Table 2.5. Even though a toddler is able to walk fast, and his parents will often insist he is running, true running does not develop until 3 to 4 years of age. A true run is characterized by having both feet off the ground at the same time, unlike walking, where one foot does not leave the ground until the other foot makes initial contact. Stair Climbing Stairs present a considerable challenge to toddlers, as one might imagine. The typical rise of a step in a flight of stairs is 7 to 8 inches. For a 15-month-old child to negotiate stairs in erect standing would be the equivalent of an adult attempting to climb stairs with a knee-high rise (Fig. 2.72). The ability to ascend and descend stairs is affected by a number of factors, most particularly, opportunity. Therefore, the age of achieving this milestone has considerable variability, although the sequence of achievement FIGURE 2.72 Descending stairs with hand held; note the rise of the step in relationship to the length of the child’s lower extremity. Gait Parameter 1 Year of Age 3 Years of Age Direction of Change Base of support (pelvic span to ankle spread) <1 ≥1 ↓ Step length 20 cm 33 cm ↑ Stride length (double the step length) 40 cm 66 cm ↑ Single limb stance 32% of gait cycle 35% of gait cycle ↑ Cadence (step frequency) 180 steps per minute 154 steps per minute ↓ Velocity (speed) 60 cm/sec 105 cm/ sec ↑ a From Long TM, Toscano K. Handbook of Pediatric Physical Therapy. Philadelphia, PA: Lippincott Williams & Wilkins; 2001. Gait Parameters in 1- and 3-Year-Old Childrena TABLE 2.5 58 Part I Development. is much the same from one child to the next. A child who lives in a home without stairs, or at least without stairs that the child is permitted to climb, often develops stair-climbing skills at a later age than the child who has frequent daily encounters with stairs to get to and from his bedroom and/ or toys. The first ability to ascend and descend stairs is usually in the quadruped position (Fig. 2.73). The child learns to go up the stairs on his hands and knees, followed soon by coming down the stairs backward on his hands and knees. Sometimes children, in their first attempts at descending stairs, will try to do so in quadruped, but head first, with disastrous results if a caregiver is not nearby. With a bit of coaching, the child quickly learns through trial and error to descend the stairs backward on his hands and knees. Ascending stairs generally develops to a more skillful level before descending stairs develops to the same level of skill. This sequence generally repeats itself in bipedal locomotion after the child has developed the ability to go up and down stairs using quadrupedal locomotion. Another feature of stair climbing that develops in a rather typical pattern is apparent once the child is climbing stairs while standing. Initially, bipedal stair climbing is performed by placing both feet on each step, in a manner that is called marking time. 48 Generally, the child will not begin doing steps one over one. (i.e., only one foot to each step) until he is close to 3 years of age, depending of course on how much trial and error and practice on stairs he has been afforded. This pattern of the feet is also dependent on the type of upper extremity support that is available. Stair climbing progresses as the upper extremity support decreases from using one handrail and/ or an adult hand for support, to needing a handrail but no adult, and finally to needing no upper extremity support (Fig. 2.74). Of course, the speed with which the child develops increasingly more skillful stair-climbing abilities varies greatly, and like other skills, the ability to locomote on stairs may temporarily digress as unique and/or challenging circumstances, such as unusually steep stairs or the absence of a handrail, present themselves.[1]
