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Policy

Pre-Standing and Walking

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Type

Gait and Milestones

Knee extension

Ankle plantarflexion

Controlling tibial alignment

Forward momentum

gastroc-soleus

Mid-stance to terminal stance with no heel strike at initial contact

Mid-stance at initial contact with minimal terminal stance push-off

Heel strike to mid-stance with minimal terminal stance push-off

heel strike, mid stance, terminal stance push-off

stepping pattern

Carrying heavy objects to increase proprioceptive feedback

Walking with resistance to improve strength and body awareness

Moving from mid-stance to mid-stance without clear phases of the gait cycle

Addressing heel strike and push off in the gait cycle

load and Go

Throughout stance phase

At initial contact

During mid-stance

As the limb is unloaded and the new limb begins to accept weight

buttock to heel

Significantly inclined forward

Inclined backward

Close to vertical

Constantly changing inclination

tibia

Between 18 months and 2 years of age

After 2-3 years of walking experience regardless of age

When they first start independent walking

At 4 - 5 years of age

hip extension

Crouch & CP

Strengthening quadriceps muscles

Improving hamstring length

Changing the alignment of the body over the base of support

Controlling ankle dorsiflexion range

crouch gait strategy

Hamstrings

Gastrocnemius-soleus complex

Quadriceps

Gluteus maximus

crouch muscles

Children with CP do not shift weight at all

There is no difference in weight shifting patterns

Children with CP shift weight from the pelvis, typically developing children from the thorax

Typically developing children shift weight from the pelvis, Children with CP from the thorax

weight shift

7 - 8 years of age

12 - 14 years of age

25 - 30 years of age

40 - 45 years of age

decline

Gait and Milestones (2)

They need to be set at 90 degrees for good stance phase stability

They require motor retraining or are not effective

They are only appropriate when ankle ROM is limited

They limit certain activities like stairs and getting up from the floor so children should have breaks from them

AFOs 1

Sustained 15 degrees of knee flexion in their gait pattern

Less than 5 degrees of DF range of movement

Body weight in front of mid-foot during stance

All of the above

AFO 2

Being able to maintain upright control when weight is displaced

Being able to maintain the head over the pelvis when weight is displaced

Being able to  self-initiate movement with buttocks behind heels

Being able to self-initiate movement and maintain head over the pelvis

weight shifts

To support a typical sequence of development

To learn to control weight shifts over the feet

It's more easily achievable than walking

It's easier to correct alignment issues in standing than walking

standing vs walking

Sagittal plane

Frontal plane

Transverse plane

Typical development is not linear and it depends on the child's environment

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planes of movement

Chronological age

Cognitive development

Amount of practice and experience with active standing

Amount of practice and experience with stepping

variables

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