Chapter 10
Mobility, Locomotion and Gait Sequences

Children with locomotor disorders represent a large proportion of the population of children treated by pediatric physical therapists. Thus this chapter will present an overview of mobility, locomotion and gait through a developmental process.

Neonate Meonatal reciprocal stepping with upper body supported; legs display positive support reaction when upper body supported
7 - 10 weeks Neonatal stepping disappears
Birth - 3 months Quadrupedal extremity efforts, sometimes reciprocal that contributes to position changes when placed prone on a firm surface
3 - 7 months Pivot prone rotation; infant elevates and rotates upper body in a circular fashion
5 - 7 months Sequential rolling may be utilized by some infant to move
5 - 7 months Commando crawling with the infant advancing trunk forward primarily with arms is present in many infants
7 - 9 month Variety of pre-walking locomotor patterns may be observed including bottom scooting, creeping, crawling
8 - 11 months Supported sidestepping and furniture cruising; some infants may walk without support
12 months Independent walking present in most infants characterized by short, uneven steps, wide base of support, absence of knee wave during stance, high guard arm position, and many falls
18 months Heel strike replaces flat foot or forefoot at initial contact; reciprocal arm swing present in about half of all children
2 years Knee flexion wave consistently present during stance phase; most children can run
2 years, 6 months Majority of children can toe-walk, 60% of children can heel walk
3 years Most children can heel walk, mature gait patter present except for increased cadence, decreased step length
3 years, 6 months Base of support equal to or less than pelvic span
4 years Reciprocal arm swing should be present; majority of children can hop

Delays or issues in gait will be a primary focus for therapists as the infant matures. Generally, a developmental approach is recommended for gait training to work toward integration of each locomotor step prior to attempting to advance. However, there are children that do walk independently that never attain several or all of the milestones leading up to independent ambulation. Thus, the therapist should use multiple interventions and treatment regimes when designing a specific program for each child.

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