Normale neuromotorische ontwikkeling_Els Ortibus.pdf

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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 20-10-2012 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 20-10-2012 Ontwikkeling van stappen Normale motorische ontwikkeling 20-10-2012 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
Determinants of walking Step length: The longitudinal distance between the two feet, it increases through out childhood until growth is completed. This parameter is closely related to change in height and leg length Cadence: The frequency of steps taken in a given amount of time (Steps / min), it gradually decreases with age through out childhood. The most reduction between 1-2 years. The duration of single limb in stance. It is the length of time during which only one foot is on the ground during the stance phase, if it increases, it implies a measure of increasing stability. Walking velocity: It is the rate of walking; it can be expressed as the product of step length and cadence. It increases with age 1 to 7 years, but the rate of change decreases from 4 to7. Normale motorische ontwikkeling Ontwikkelingsonderzoek Delay Dissociation Normale motorische ontwikkeling 20-10-2012 Difference between the developmental rates of two domains Deviancy Nonsequential unevenness in achieving milestones in one or more domains of development, atypical at any age Regression Screening tests Denver developmental screen 113 Ontwikkelingsneurologie HA kring Halle 20-10-2012 8-12-2010 WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: Windows of achievement for six gross motor development Welke screening? milestones. Acta Paediatrica Supplement 2006;450:86- 95. 112 114 The normal walking has five major attributes: •Stability in stance. •Sufficient foot clearance in swing. •Appropriate preposition of the foot for contact. •Adequate step length. •Energy conservation. Normale motorische ontwikkeling Ontwikkelingsneurologie HA kring Halle Ontwikkelingsneurologie HA kring Halle 20-10-2012 8-12-2010 8-12-2010
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