Temporal and Spatial Parameters of Crawling in Children With Limb Loss: Implications on Prosthetic Knee Prescription

Abstract

In Brief Children with limb loss at or above the knee face unique challenges at different stages of development. When transitioning from crawling to walking, and during the intermediate activity of pull-to-stand, a prosthesis must accomplish disparate goals: the mobility necessary for crawling and the stability necessary for standing and walking. This investigation tested the hypothesis that crawling mobility would be reduced when the traditional treatment protocol of a prosthesis lacking an articulating knee joint is followed. Crawling pattern, velocity, and cadence were measured in five children within 3 weeks of the fitting of their first prosthesis, which included an articulating knee. Two conditions were tested: prosthetic knee in its fully articulating state and prosthetic knee locked into extension. In all cases, the locked knee condition reduced velocity and cadence. With one exception, the children exhibited a more typical “step-through” crawling pattern when the knee was unlocked and a less efficient “step-to” pattern when the knee was locked. These data indicate that the traditional prescription protocol for children with transfemoral limb loss may inhibit crawling, which may in turn have long-term implications on motor development. A prosthesis for children with limb loss at or above the knee must accomplish disparate goals when transitioning from crawling to walking: the mobility necessary for crawling and the stability necessary for standing and walking. This investigation tested the hypothesis that crawling mobility would be reduced when the traditional treatment protocol of a prosthesis lacking an articulating knee joint is followed. Two conditions were tested: prosthetic knee in its fully articulating state and prosthetic knee locked into extension. Results indicate that the traditional prescription protocol for children with transfemoral limb loss may inhibit crawling, which may in turn have long-term implications on motor development.