Pediatric Gait Analysis and Orthotic Management
Functional outcomes are always a goal in physical therapy and rehabilitation. Gait analysis, or assessment of someone’s walking pattern, is something physical therapists spend a lot of time doing. Even static standing can be a goal for some children suffering from various diseases such as cerebral palsy and spina bifida, for example.
When walking, the passenger unit is generally described as the head, arms, and trunk; it is responsible for postural integrity but passive as it is carried forward during ambulation by the locomotor unit: the pelvis, thigh, shank, and foot. All aspects of typical human gait are designed to allow walking while reducing energy expenditure during this day-to-day activity. Atypical gait patterns involve increased energy expenditure and abnormal muscle development due to compensations present to attempt to achieve full gait cycle.
A gait cycle is composed of stand phase and swing phase of each lower limb. In typical gait pattern trained eyes are able to observe full knee extension of the stance limb at 40% gait cycle completion, with the contralateral limb perpendicular to the floor; followed by, initial contact or heel strike, occurring at 50% gait cycle, as well as maximal hip extension in the stance limb; another key moment within a gait cycle is temporal midstance, which occurs when the passenger unit is directly over the stance foot. The position of joints in the lower extremities are strategic as well for longevity/sustenance of the joints throughout a lifetime of walking.
There are gait labs in children’s hospitals across the country that look to measure and observe the ground reaction force (GRF) during barefoot walking as well as walking within orthotic devices. Children with ankle instability, lower extremity muscular weakness, lower extremity spasticity can benefit from orthotics to help them achieve the most efficient and normalized gait pattern possible. When breaking down the gait cycle by slow-motion video and watching the trajectory of the GRF, it becomes clearer why full extension is not being obtained by the hips or knees at these keys points within the gait cycle.
Muscle weakness, spasticity, contractures, orthotics and adaptive footwear are all considered when looking for a normalized gait cycle in a pediatric patient; there are several ways to adapt and tune an orthotic and footwear to best achieve the points in a gait cycle leading to efficient forward progression.
The most interesting thing discussed during the course was placing children’s shank (lower leg) at various angles to “vertical”, sometimes in a flexed or plantarflexed position with a rocker built into the bottom of their shoe at a specific measured point to cause a child with varying gait abnormalities to achieve full knee and hip extensions based on the studied point of GRF and ideal placement throughout the gait cycle. The long-term goals of these adaptations are to minimize effort during functional walking and decrease abnormal force through their lower extremity joints during gait.
I am looking forward to putting this course to use during my sessions in the clinic, and pursue further communication between various providers that are active in my kids’ lives. Pediatric physical therapists, orthotists and orthopaedists would also benefit from Elaine Owen’s course on Pediatric Gait Analysis and Orthotic Management.
Lindsey Wilson, PT, DPT