Biomechanics of Gait of Normal Child - Case Study Example

Walking is one of the primitive of human functions and is understood to be the most basic form of human travel. Easy and free joint movement and appropriate muscle force helps in better walking organization and body posture (Craik & Oatis, p.28). In a typical gait cycle (GC) when the body moves forward, one limb is the supporter and provides support to the body while the other limb moves to be the next support limb. This cycle is comprised of 2 phases, namely “stance” and “swing” phases. In particular, we can then expand the stance phase into three categories i.e. the initial double, the single limb, along with the terminal double limb (Craik & Oatis, p.54) . Before we go into the specifics of gait, we’ll quickly review the bones involved. There are 2 main bones involved namely, the talus and calcaneus, which is found at the ankle. The two bones come together to form a joint which is known as the “subtalar joint”. Two other bones that are integral are the cuboid and the navicular. After this we come to the “mid-tarsal joint” which is shaped by the talus, calcaneus, navicular and cuboid bones. The bones in the leg are made up of the femur, the tibia, the fibula and anterior to the tibia is the patella.(Tachdjian, p. 28) Biomechanics of gait of normal child The gait cycle is divided into two phases known as the stance phase and the swing phase. Stance means “posture,” and basically this is the period of time in which the child’s foot stays on the ground, at rest, whereas the swing phase is, as the name suggests, the instance where the child may be swinging the foot forward. The shift from stance to swing phases change as the speed at which the child is moving increases (Bellman & Peile, p. 67). The faster the child runs, the time spent on the stance phase decreases and swing phase increases. During this time, a sub phase is present called as the float phase in which neither foot is on the ground (Bellman & Peile p. 72). As stated earlier, the stance phase is further divided into three part, first of which is the contact phase. This phase begins with the heel touches the ground. It completes as soon as the rest of his foot comes into contact with the ground. Next is mid stance phase which begins right where the contact phase ends, which is when the entire foot comes in contact with the ground. The weight of the body is passed over the foot as the rest of the body moves forward. The other leg is completely off the ground and the foot touching the ground is carrying the entire weight of the body.(Bellman & Peile, p.102) The terminal double limb stance or propulsion phase begins after the heel is off the ground and ends when the toe is off the ground. The body moves forward in this phase as the body shifts weight from opposite foot as it makes contact with the ground. (Umphred, Darcy Ann. & Carlson, Connie, p.54). The swing phase begins as soon as the toe is off the ground. The first part of this phase is the “forward swing” in which the foot is “swings forward” or is carried forward. The next part is foot descent and that’s when the foot is positioned in preparation for bearing the weight of the body and muscles are alleviating to cushion the impact when the heel touches the ground. At this point, the swing phase ends and a new cycle beings.(Bellman & Peile, p. 106) Gait analysis of a child with Down syndrome Down syndrome is related to mental retardation and is one of the most common non-innate cases of mental impairment. It is very rare and has a rate of 1:1000 with every birth. As all congenital disorders, there are a few medical problems connected with this syndrome, them being heart conditions and breathing problems. Leg movement and muscle problems are very common among children with Down Syndrome and include exaggerated motion and a lengthier reaction period, balance deficits, body positioning deficits and contractures of agonistic muscles. The motor problems in children with Down syndrome can be attributed to the fact that they have extremely weak muscle control which is often called “clumsiness”. The development of motor muscles in DS children is often delayed and slow and its common cause is generalized muscle hypotonia and ligament laxity (Cohen, Nadel & Madnick, p.15). The gait pattern of children with Down syndrome shows “poor heel-tow rocking” during the stance phase and “overstated abduction” of the lower limb to aid foot clearance. Along with delayed hip flexion during the “gait cycle”, an increase in the flexion of the knee at first contact and major variations in the movement of the ankle during the entire gait cycle (Week, Chua & Elliott, p. 48). It has been suggested by physiotherapists and occupational therapists alike to start early physiotherapy in young DS children to facilitate motor control and coordination so that proper developmental milestones can be achieved.(Hall & Brody, p.32) Walking is achieved a little delayed but by the age of one year or a year and 6 months, through proper physiotherapy, although the kind of clinical activities involved in this procedure is important because as stated earlier, Down children are likely to develop numerous problems which can be orthopedic as well as respiratory and parents should make sure to help them avoid such problems with proper physiotherapy (Hall & Brody, p. 47). As is evident from the above comparison of the gait of a normal child and the gait of a Down syndrome child, the main problem is the development of motor muscles. That is the main function to be fixed when putting the child through physiotherapy and once the leg muscles or motor muscles of the child have been properly trained, as is evident from many such studies done, the gait of a child can be drastically improved (Campbell, Palisano & Linden, p.56). The activity in discussion will be “horseback riding” or “hippotherapy” also know as equestrian activities and their implications for clinical practice are that they will help is correction of the child’s gait problems (Strauss, p.27). Studies done on the topic have shown remarkable results. And many organizations such as “saddle up” and “Trinity Equestrian centre” work on the same goals and objectives that were to help children with documented disabilities. The main purpose of horseback riding and its implications for clinical practice is the fact that it helps in more than one area of the body (Strauss, p.34). While looking at different studies and researches done on this topic, it shows that it helps in the development of stability of the head and neck area, adaptation to a new postural challenge, helps in postural correction, and coordination of the head and trunk (Scott, p.15). The first of the situations or studies in which the activity has been used is in a study which was to investigate the effect of horse back riding on the angular kinematics of the ankle and the knee in children with Down syndrome. There were three male children each of seven years of age. They were enrolled in horse back riding lessons which lasted fifty minutes each and there was an interval of seven days between each session. Each activity was designed to stimulate different tone fine-tuning and adjustments’; keeping in mind that hypotonia is part of the motor problems, characteristic of DS children. The activities followed a proper chalked out education/reeducation program and were held in a safe, children-friendly and simulative environment. The analyses after the sessions, were done, were carried out individually and the post-test was carried out after thirteen treatment sessions (Scott, p. 28). After the sessions the collection of ankle and knee angular movement pre- and post-treatment was recorded using the PeakMotus movement analysis system. Results showed statistical difference in the movement of the ankle joint. Graphs drawn pre-activities and post-activities had a margin of difference in them, in all three subjects. Whereas when it came to the knee-joint movement, the difference was not that far and different and had no observable trend. Concluding the fact that horse riding therapy helped produce a positive change in the angular behavior of the ankle (Scott, p. 35). The next study involves the hypothesis that whether or not the stimulation induced by the movement of the horse creates a new postural challenge, improves trunk and head control in the subject Down syndrome children and improves gross motor function in the subject Down syndrome children. The subjects in the study were two preschool age Down syndrome children with limited communication and use of sign language. The activities, thirteen in total, lasted one hour each. The total time period of the therapy was eleven weeks with 20-30 minutes on horseback with two evaluation sessions with accelerometry. The therapy included different positions on horseback which the child was to adopt. Results show that horseback riding showed marked improvements in the child’s walking, running, jumping, and head-trunk coordination. Motor variability was recognized, reflecting adaptive mechanism in the CNS. In conclusion it was stated that based on the successful nature of this study, hippotherapy can be used in future researches and studies as a way to further improve various motor functions in Down Syndrome children (Lim, Bee-oh, Han, Dong-ki & Kwon, Young-Hoo, P. 67). All isokinetic variables, in the 1st activity, showed significant increase in muscle torque, work and power, as if evident from the fact that the ankle movements (where muscle is involved more than joint movement) were improved and developed a positive change (Scott, p. 29). Increased postural stability with smaller metro-lateral sway of the body and more upright body posture with increased hip joint angle were also significant changes noted in the DS child after the allotted activities (Scott, p. 43). Proving the fact that horseback riding is an activity which can be well debated upon whether it has clinical implications of helping children with DS improve their gait problems (Copetti F, Mota CB, Menezes KM, Venturini EB, p. 92). The use of such activities as horseback riding have proven to be a good source of therapy and its use has increased considerably in the last decade. The activity of riding gives adults and teachers a platform to come together to help disabled children and form a place where children can learn to over come their fears, forget about their disabilities even if its for a short time, and build up their self confidence and self esteem. The child, who doesn’t have much control over his own body, is given the sense of control through a horse. An important factor about horseback riding is that it does two important things for the child while not making it seem like work at all. It teaches the child a new skill, riding, and helps improve his muscle tone, his balance and coordination. When a child interacts with a horse from time to time, it helps him extend this social behavior to other people, and form more meaningful relationships with them. It is both emotional and psychologically fulfilling for a child to have a bond with an animal, especially if the child is disabled in any way. The trust he builds with the animal, shows the child how important personal relationships are. Horses help the child feel in control, as there is a direct association between action and reaction. In such schools and activities, the trainers encourage the child to look after their horse, the horse they train with, and in order to learn how to care for and ride a horse, the child needs to talk and communicate with the instructor as well as the horse. In this way, the child is obliged to communicate and socialize (Molnar, Gabriella E. & Alexander, Michael Allen, p. 103). Hippotherapy or Equine therapy uses horses as a driving force, or a means to promote physical, educational and possibly psychological increase. As we have seen from the studies, it’s a recent discovery and still needs a little research. (Winchester, p. 7). Studies have shown discrepancies between the statistical data obtained and the results observed by professionals. Studies have also shown immense improvement in gross motor functioning after therapy with hippotherapy, especially in the areas of gait and running performances. In addition it has shown psychological and social benefits (Strauss, p. 68). References Lim, Bee-oh, Han, Dong-ki & Kwon, Young-Hoo: The Effects of Muscle Training on Gait Characteristics in Children with Down Syndrome: Biomechanics Laboratory, Texas Woman’s University, Denton, TX 76204-5647 Copetti F, Mota CB, Menezes KM, Venturini EB: Angular Kinematics of the gait of children with Down’s syndrome after intervention with Hippotherapy: Rev. bras. fisioter., São Carlos, v. 11, n. 6, p. 503-507, nov./dec. 2007 Umphred, Darcy Ann. & Carlson, Connie. Neurorehabilitation for the physical therapist assistant: SLACK Incorporated, 2006 Molnar, Gabriella E. & Alexander, Michael Allen: Pediatric rehabilitation: Hanley & Belfus, 1999, Original from the University of Michigan Winchester, Partricia. The Effect of Therapeutic Horseback Riding on Gross Motor Function and Gait Speed in Children Who Are Developmentally Delayed: http://www.ncbi.nlm.nih.gov/pubmed/12506820 Cohen, William I., Nadel, Lynn. & Madnick, Myra E. Down syndrome: visions for the 21st century: John Wiley and Sons, 2002 Craik, R. & Oatis, Carolyn A., Gait analysis: theory and application: Mosby, 1995 Scott, Naomi, Special needs, special horses: a guide to the benefits of therapeutic riding, University of North Texas Press, 2005 Campbell, Suzann K., Palisano, Robert J., Vanderlinder, Darl W., Physical therapy for children, Elsevier Saunders, 2006 Hall, Carrie M., Brody, Lory Thein, Therapeutic exercise: moving toward function, Lippincott Williams & Wilkins, 2005 Elliott, Digby., Chua, Romeo., Weeks, Daniel J., Perceptual-motor behavior in Down syndrome: Human Kinetics, 2000. Hay, James G., A bibliography of biomechanics literature: s.n., 1976 Tachdjian, Mihran O., Pediatric orthopedics, Volume 4: Gulf Professional Publishing, 2002 Bellman, Martin., Piele, Ed., The Normal Child: Churchill Livingstone, 1987, Original fromthe University of Michigan Read More