Scientific Basis for Orthosis Prescription to Improve Gait in Children

Presented by Lisa Selby-Silverstein

This course reviews specific gait biomechanics to empower physical therapists to identify key problems and develop an effective plan of care, which may include an orthosis prescription, to improve a child’s gait. It discusses how weight shifting, the multi-joint nature of many extrinsic foot muscles, and alignment of various body parts affects alignment and movement, proximally and distally. It also discusses how using an orthosis may affect a child’s gait, mobility, sensation, strength, and range of motion. Understanding the factors described in this course are critical to developing an examination and intervention plan that addresses gait. The terms "center of mass" and "center of pressure" will be explained, and therapists will be challenged to envision the likely location of these points when watching a patient walk. Implications of location and motion of the center of mass and center of pressure have implications for understanding gait and foot and ankle motion and how they might be modified to improve gait.

This course is part of a four course series:.

Meet your instructor

A smiling woman with short brown hair and glasses wears a black top, representing Medbridge’s innovative approach to hybrid healthcare education.

Lisa Selby-Silverstein

Dr. Selby-Silverstein is a Professor at Neumann University teaching in the Physical Therapy Program. She previously was on faculty at Thomas Jefferson University, where she also was Director of the Human Performance Laboratory. She has been a PT in rehabilitation settings, gait laboratories, developmental centers, early…

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Chapters & learning objectives

1. Development, Anatomy of the Lower Extremity, and Implications of Muscles Crossing Multiple Joints

During normal gait, joint motions are coordinated so that musculotendinous units do not lengthen (or shorten) over all the joints they cross at the same time. Poorly timed weight shifts, motor control problems, limited range of motion, spasticity, deformity, or motions blocked by braces can lead to a loss of normal inter-joint motion coordination. Atypical interjoint motion coordination that necessitates shortening over more than one joint at the same time can result in active muscle insufficiency; lengthening over more than one joint at time can result in passive insufficiency.

2. Dynamic Balance and Foot Motion are Interrelated

During normal gait, the center of mass of the body moves in a three-dimensional sinusoidal (Lissajous) pattern. Since the ground reaction force is a function of how a person moves their weight during stance phase and the ground reaction force starts at the center of pressure, foot movement is related to how someone moves their weight. If the center of mass displacement pattern is atypical foot and ankle motion will be atypical; and if foot/ankle motion is atypical, center of mass displacement during gait will be atypical. This has implications for examining and treating children (or adults) who have problems related to weight shifting, foot and ankle passive range of motion, motor control, strength, or sensation. Typical gait deviations at each phase of gait are reviewed in this chapter.

3. Effects of Alignment and Range of Motion in the Closed Kinetic Chain

In addition to the dynamics associated with gait and weight shift, passive range of motion, posture, weakness, motor control problems, and orthoses or footwear can affect configuration of the toe break, shank vertical angle, or leg length. Any of these have potential implications for body alignment and gait. These factors need to be examined, evaluated, understood, and attended to when planning physical therapy interventions, including prescription of orthoses.

More courses in this series