Walking – Starting at the Beginning

So I mentioned in an earlier post that we sat in on a talk on gait deviations by the Hospital for Special Surgery at our physical therapy conference this past January.  There was a lot of interesting information in it including some great treatment ideas to help us change up some of our usual activities.  I thought I would share some of the information we took away (it may be over a few different posts though).

What are the parts of walking?  There are two main pieces.  There is the stance phase (when you are standing on your leg) and the swing phase (when your leg is moving through the air to take a step).  Stance takes up about 60% of the walking cycle and swing takes up the other 40%.  This is because there is generally a portion of time that both feet are touching the ground.

Some prerequisites for walking according to Perry 1985 are:

• Stability in stance – this means the ability to maintain balance in standing, an upright head and body, and bear weight through their legs
• Swing clearance – this means that they are able to stand tall on their stance leg and bend their other leg so that they can clear their foot from the ground to avoid tripping and falling
• Pre-positioning of the foot – Right before the foot hits the ground the child should ideally be able to have their toes lifted in the air so that their foot is primed as a shock absorber when it comes into contact with the ground
• Good step length – in order to walk at a functional walking speed steps need to be of an adequate length so that enough ground is covered
• Energy conservation – Momentum is used during stance and swing to ideally position the center of gravity to minimize muscle contraction and make walking more efficient

Another prerequisite that isn’t mentioned is that a child needs to be able to sit independently in order to walk independently.  I know it seems obvious but I thought I would mention it anyway.

I found this interesting – Normal walking energy expenditure is 2.5 kcal/min.  When walking changes due to musculoskeletal or environmental changes the energy expenditure goes up.  One of the things listed below is an AFO (ankle foot orthosis).  While this increases energy expenditure compared to ‘normal’ walking it may minimize energy based on the way the child was walking before the brace was applied because it can allow for stability and the minimizing of excessive muscle contraction.

Here were some of the factors that they listed:

• AFO – increases 10%
• Backpack – increases 15%
• Stiff knee – increases 25%
• Fast walk – increases 60%
• Using crutches to keep weight off of a foot – increases 300%

These are just factors to consider when trying to help your child maximize their energy expenditure, especially in a school setting where they need energy for academics.

I’ll cover more from this talk in a later post.