Normale neuromotorische ontwikkeling_Els Ortibus.pdf

Normale motorische ontwikkeling 20-10-2012
1. In-Toed Gait
This may result from one of the following three postures caused by anatomical variations
at one of three levels - hips, legs and feet.
Inset Hips
This is explained by the angle of the thigh bone (femur) into the hip socket, referred to as
femoral anteversion. Due to this angulation in inset hips, the range of internal rotation
exceeds that of external rotation. Inset hips is common between the ages of three and
eight years. However, as the thigh bones grow, the range of internal rotation decreases.
By adolescence, the thigh bones take on an oblique shape, understandably greater in girls,
due to the greater breadth of pelvis and relative shortness of the thigh bones.
Leg (internal torsion of the tibia)
This is commonly present from the age of walking up to two-and-a-half years.
Feet (metatarsus adductus)
Commonly present from birth to four years and frequently seen after the child has begun
to walk. It improves slowly over a variable period of time up to the age of fix or six years
- although most have corrected spontaneously before that age.
Normale motorische ontwikkeling
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3. Flat Feet
Persistent flat feet over six years of age will not improve through exercise or the
use of special inserts or shoes. Arch supports may restore the medial longitudinal
arch, but the posture of flat fleet returns, once the footwear is removed.
Therefore, expensive footwear will not correct flat feet.
When To Refer for Concerns About Variations in Gait
Again, few children will present with variations in posture that require
intervention. If postures such as in-toed gait, knock knees and flat feet persist
beyond the normal age and are painful, or cause personal stress to the child or
family, then referral to the child's general practitioner is required for coordination
of a specialist referral and more comprehensive assessment.
Normale motorische ontwikkeling
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Ontwikkeling van stappen
Normale motorische ontwikkeling
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2. Knock Knees
Knock knees occurs because of the way the upper thigh bone (femur) and
lower limb bone (tibia), relate to each other. Therefore, in the older child, no
amount of exercise to stretch or strengthen muscles will alter the relationship
of the bones of the upper thigh to the lower limb.
The knock-kneed posture of the young child usually corrects by the age of
seven to eight years (with knees together, ankles should just touch). However,
a knock-kneed appearance continues into adulthood for some children (diagram
2 at '7-8 years').
Normale motorische ontwikkeling
The prerequisite for Gait development:
•C.N.S. maturation.
•Adequate motor control.
•Adequate R.O.M.
•Muscle strength.
•Appropriate bone structure.
•Intact sensation.
20-10-2012
Normale motorische ontwikkeling
20-10-2012