Walking In Children Research Articles

Backward walking highlights gait asymmetries in children with cerebral palsy.

To investigate how early injuries to developing motor regions of the brain affect different forms of gait, we compared the spatiotemporal locomotor patterns during forward (FW) and backward (BW) walking in children with cerebral palsy (CP). Bilateral gait kinematics and EMG activity of 11 pairs of leg muscles were recorded in 14 children with CP (9 diplegic, 5 hemiplegic; 3.0-11.1 yr) and 14 typically developing (TD) children (3.3-11.8 yr). During BW, children with CP showed a significant increase of gait asymmetry in foot trajectory characteristics and limb intersegmental coordination. Furthermore, gait asymmetries, which were not evident during FW in diplegic children, became evident during BW. Factorization of the EMG signals revealed a comparable structure of the motor output during FW and BW in all groups of children, but we found differences in the basic temporal activation patterns. Overall, the results are consistent with the idea that both forms of gait share pattern generation control circuits providing similar (though reversed) kinematic patterns. However, BW requires different muscle activation timings associated with muscle modules, highlighting subtle gait asymmetries in diplegic children, and thus provides a more comprehensive assessment of gait pathology in children with CP. The findings suggest that spatiotemporal asymmetry assessments during BW might reflect an impaired state and/or descending control of the spinal locomotor circuitry and can be used for diagnostic purposes and as complementary markers of gait recovery. NEW & NOTEWORTHY Early injuries to developing motor regions of the brain affect both forward progression and other forms of gait. In particular, backward walking highlights prominent gait asymmetries in children with hemiplegia and diplegia from cerebral palsy and can give a more comprehensive assessment of gait pathology. The observed spatiotemporal asymmetry assessments may reflect both impaired supraspinal control and impaired state of the spinal circuitry.

Going Where No Walking School Bus Has Gone Before: The Ottawa Experience ( breakout presentation )

With active school travel rates falling in Canada and elsewhere, the Walking School Bus (WSB) is often promoted as a potentially effective response that addresses an important barrier to walking to school: parental worries about their children walking alone. However, there are several significant barriers to starting and sustaining a traditional WSB including an overreliance on parent or community volunteers, a lack of coordination and support capacity, and risk management concerns. To address those barriers stakeholders involved in the Ottawa School Travel Planning Program came together in the fall of 2014 to launch a 12-week Walking School Bus pilot project at eight schools. It provided for WSB leaders who were screened, trained, insured, supervised and paid to walk children to school. The project also sought to measures attitudes about the WSB, demonstrate to school and community stakeholders how a well-supported daily WSB could increase the number of children walking to school, and identify the operational and financial requirements for a sustainable and successful program. The pilot project laid a solid foundation for what has evolved into an on-going WSB program operating on a daily basis at 13 schools. Registration and participation numbers have consistently increased on most routes and almost half of the children enrolled in the program were previously driven to school. This confirms that, when adequately supported, a WSB can generate significant shifts in the modal share for walking. The program is now administered and funded by a local school bussing agency. See http://www.ottawaschoolbus.ca/helpful-resources/wsb/. The Ottawa WSB experience represents two significant firsts in Canada: (1) Using paid vs. volunteer leaders to ensure a consistent, sustainable WSB service operating on a level playing field with crossing guards and school bus drivers; (2) Direct administrative and financial support from a school transportation authority whose mandate was previously restricted to motorized transport. It can serve as a best practice to be considered in other communities.

Can the theory of planned behaviour explain walking to and from school among Australian children? A social marketing formative research study

Evidence indicates that lower levels of obesity among school‐age children can be achieved through active travel to school. This research aimed to investigate the explanatory potential of constructs in the theory of planned behaviour for carers' decisions about their children's walking to and from school. The data from two online surveys of 1,076 carers in 2 Australian states showed that the theory of planned behaviour explained 35.7% of the variance in walking to and from school. The results indicate that higher perceived behavioural control, social norms, and intentions among carers are associated with higher incidence of walking to and from school by children in Australia. Limitations of the current study and future research directions are outlined.

Ontogenetic changes in foot strike pattern and calcaneal loading during walking in young children

The assumption that the morphology of the human calcaneus reflects high and cyclical impact forces at heel strike during adult human walking has never been experimentally tested. Since a walking step with a heel strike is an emergent behavior in children, an ontogenetic study provides a natural experiment to begin testing the relationship between the mechanics of heel strike and calcaneal anatomy. This study examined the ground reaction forces (GRFs) of stepping in children to determine the location of the center of pressure (COP) relative to the calcaneus and the orientation and magnitude of ground reaction forces during foot contact. Three-dimensional kinematic and kinetic data were analyzed for 18 children ranging in age from 11.5 to 43.1 months. Early steppers used a flat foot contact (FFC) and experienced relatively high vertical and resultant GRFs with COP often anterior to the calcaneus. More experienced walkers used an initial heel contact (IHC) in which GRFs were significantly lower but the center of pressure remained under the heel a greater proportion of time. Thus, during FFC the foot experienced higher loading, but the heel itself was relatively wider and the load was distributed more evenly. In IHC walkers load was concentrated on the anterior calcaneus and a narrower heel, suggesting a need for increased calcaneal robusticity during development to mitigate injury. These results provide new insight into foot loading outside of typical mature contact patterns, inform structure-function relationships during development, and illuminate potential causes of heel injury in young walkers.

Muscle synergies are similar when typically developing children walk on a treadmill at different speeds and slopes

BackgroundThe aim of this study was to determine whether changes in synergies relate to changes in gait while walking on a treadmill at multiple speeds and slopes. The hypothesis was that significant changes in movement pattern would not be accompanied by significant changes in synergies, suggesting that synergies are not dependent on the mechanical constraints but are instead neurological in origin. MethodsSixteen typically developing children walked on a treadmill for nine combinations (stages) of different speeds and slopes while simultaneously collecting kinematics, kinetics, and surface electromyography (EMG) data. The kinematics for each stride were summarized using a modified version of the Gait Deviation Index that only includes the sagittal plane. The kinetics for each stride were summarized using a modified version of the Gait Deviation Index – Kinetic which includes sagittal plane moments and powers. Within each synergy group, the correlations of the synergies were calculated between the treadmill stages. ResultsWhile kinematics and kinetics were significantly altered at the highest slope compared to level ground when walking on a treadmill, synergies were similar across stages. ConclusionsThe high correlations between synergies across stages indicate that neuromuscular control strategies do not change as children walk at different speeds and slopes on a treadmill. However, the multiple significant differences in kinematics and kinetics between stages indicate real differences in movement pattern. This supports the theory that synergies are neurological in origin and not simply a response to the biomechanical task constraints.

Changes in admission thresholds in English emergency departments

BackgroundThe most common route to a hospital bed in an emergency is via an Emergency Department (ED). Many recent initiatives and interventions have the objective of reducing the number of...

Robot suit helps children walk

Robot suit helps children walk

Treadmill interventions in children under six years of age at risk of neuromotor delay.

Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development. To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay. In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews. We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population. Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model. This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45). This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.

Dynamic plantar pressure among intellectual disability and normal children during gait

The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. Results: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0 cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe + sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.

Increased gait variability during 5-minute walking in children with cerebral palsy detected with on the feet placed accelerometers

We describe formation and detection of transient radical intermediates and 2e−, 2H+ oxidation products (OPs) of dopamine (DA) by electrospray ionization (ESI) mass spectrometry (MS) which has not been reported previously. The results confirm formation of DA radicals by proton coupled electron transfer pathway. DA radicals and 2e−, 2H+ oxidation products that were identified are of interest because of their reported neurotoxicity. Using different solution compositions and MS detection conditions three different DA radicals were identified that have different stability. DA reactions with reactive oxygen species (ROS) relevant to DA reactivity in vivo are discussed. Detection of DA OPs by electrochemistry/mass spectrometry with a floated on-line electrochemical cell is also illustrated.

P55: Lower limb muscle fatigue during walking in children with spastic cerebral palsy

P55: Lower limb muscle fatigue during walking in children with spastic cerebral palsy

Children’s everyday encounters and affective relations with place: experiences of hyperdiversity in Auckland neighbourhoods

This paper investigates children’s experiences of hyperdiversity in public spaces in inner city and suburban neighbourhoods in Auckland, New Zealand. As children walk through, and talk about, their everyday places of play and mobility they sense and reveal material and relational diversity in the places and people they encounter. We examine temporal and affective changes in children’s experiences of familiar places when in the presence of strangers – older youth and homeless people. We draw on walking interview and/or focus group data gathered from children aged 9–12 years living in socio economically and ethnically diverse neighbourhoods. Declining rates of physical activity and independent mobility in children and calls for urban spaces that nurture children’s agency and wellbeing provide the research context. Ideas of enabling places are adapted to explore the way constructs of otherness, inclusion and difference can be fortified through social and material expressions of hyperdiversity in the urban landscape. We explore the contention that how children and adults behave, identify and feel within particular urban spaces arises from everyday encounters and affective relations with place itself. In so doing, we seek a conceptual broadening of place as an enabler of children’s mobility, agency and wellbeing.

Reliability and Validity of the 50-ft Walk Test for Idiopathic Toe Walking.

To evaluate interrater reliability and concurrent validity of the 50-ft walk test (FWT) for children with idiopathic toe walking (ITW). Thirty children, 6 to 13 years old, with ITW participated. During the 50-FWT, an accelerometer counted total steps. A physical therapist counted the number of toe-walking steps. The number of toe-walking steps was divided by the total steps to calculate a toe-walking percentage. Interrater reliability was assessed by correlating the toe-walking percentage obtained by 2 raters using an intraclass correlation coefficient. Concurrent validity was evaluated by correlating the toe-walking percentage calculated by the GAITRite and therapist using a Spearman ρ. There was excellent interrater reliability and concurrent validity. Experience level did not impact the therapist's ability to identify a toe-walking step. The 50-FWT demonstrated excellent interrater reliability and concurrent validity. It can be used to obtain a percentage of toe walking in children 6-13 years of age with ITW.

Children's incidental social interaction during travel international case studies from Canada, Japan, and Sweden

Incidental social interactions such as seeing a known person while travelling are theorized to contribute to community connections and social capital. It is argued in such work that walking may be a critical factor, but the frequency of such interactions is generally unknown. For children, these community connections may increase independent travel and contribute to their well-being. Previous research out of Japan found that walking was indeed more likely to result in children seeing people in general and seeing a known person. However, it is not clear whether that is a culturally anecdotal finding, or whether similar findings would occur in different cultural and transportation contexts. Reasons why it may be anecdotal include: in most cases, all elementary school children walk to school in Japan; many trips occur at a local level and are conducted by non-motorized modes in Japan; greeting others (aisatsu) is a cultural value in Japan. This study examines whether one's transport mode relates to having incidental social interaction during their trips for children aged 10–11 in Canada (177), Japan (178), and Sweden (144). Further to previous work, the research carried out here asked the children what type of interaction occurred (spoke, waved, no interaction, or other) which would relate to building or maintaining community connections. The findings demonstrate that the results are internationally applicable and that most incidental social interactions result in a verbal communication in all three countries.

The impact of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with cerebral palsy.

We studied the effects of an anti-gravity treadmill (AlterG) training on walking capacity and corticospinal tract structure in children with Cerebral Palsy (CP). AlterG can help CP children walk on the treadmill by reducing their weights up to 80% and maintain their balance during locomotion. AlterG training thus has the potential to improve walking capacity permanently as it can provide systematic and intense locomotor training for sufficiently long period of time and produce brain neuroplasticity. AlterG training was given for 45 minutes, three times a week for two months. The neuroplasticity of corticospinal tract was evaluated using Diffusion Tensor Imaging (DTI). The fractional Anisotropy (FA) feature was extracted to quantify structural changes of the corticospinal tract. Walking capacity was evaluated using popular clinical measurements of gait; i.e., walking speed, mobility and balance. The evaluations were done before and after training. Our results revealed that AlterG training resulted in an increase in average FA value of the corticospinal tract following the training. The outcome measures of clinical assessments of gait presented enhanced walking capacity of the CP subjects. Our findings indicated that the improved walking capacity was concurrent with the enhancement of the corticospinal tract structure. The clinical implication is that AlterG training may be considered as a therapeutic tool for permanent gait improvement in CP children.

The relationship between obesity in children ages 9 - 12 years and pattern of playing activities

Obesity is excess weight as a result of stockpiling body fat excessive and could happen to all citizen including on children. The cause of obesity that one of them caused by the imbalance between intake of nutrients with physical activity that is playing. Good physical activity, the body metabolic processes will make the children walk with a maximum intake of calories that can be obtained from food directly in use in both by the body. The aim of this research is to determine the relationship between the obese on 9 to 12 years old kids are playing with a pattern. From the graph is used for children and teenager to define obesity using the Center for Disease Control and Prevention (CDC). Method used by persentil graph body mass index (bmi to age 2 to 20 years in the male and female). Analytic research is the correlation with spearman. The result of research shows that there is no correlation between obesity with a pattern of the activity of playing on children aged 9 to 12 years. Because the value of a correlation coefficient (0.053 > 0.025). It is also avidenced by the result of a coefficient that marked negative and having meaning the absence of correlation ( - 0.209 ). Of the result we can conclude that there are a lot of the main factor in addition to the activity of playing that can cause a child suffering from obesity including genetic factor, and the pattern of hormonal feeding on such a child.

The Relationship Between Transitions in Children's Travel Behaviour and Mental and Physical Health in Japan

Background In Japan, car use is increasing steadily, especially in local regions. Car use is known to cause traffic congestion and global environmental problems, and is also related to health problems such as metabolic syndrome. Adult travel behaviour is habitual, and Senda and Kamioka (2009) reported that the formation of travel habits begin in childhood. Therefore, it is important to analyse the travel behaviour of children and the related social effects when planning future urban transport. We investigated the transitions in Japanese children's travel behaviour, and the differences between children and adults, using Japanese Nationwide Person Trip Survey data (PT data) in 1987, 1992, 2005, 2010, and 2015. We also investigated the relationship between children's travel behaviour, children's obesity, and traffic accidents. Finally, we investigated the influence of habitual car use during childhood on adult mental disposition. Methods First, we examined PT data about Japanese children aged 5–17 years from 63 cities in Japan. We then collected data from the Annual Report of School Health Statistics Research (MEXT, 2010) and data about traffic accidents causing injuries and fatalities (ITARDA, 2010). Finally, we conducted an online questionnaire among adults aged 30–70 years (n=1000) regarding their mental disposition and habitual car use during childhood. We explored the relationships in the data using simple linear and multiple regression analyses. Results The proportion of time children spend traveling by car has increased steadily in Japan, while walking has decreased. In 2015, the proportion of trips by car was higher among children than among adults. The results also revealed more travel by car was associated with more children's obesity, but a lower risk of fatality from traffic accidents. The online survey revealed that adults tended to be more arrogant they had a strong habit of car use during childhood. Conclusions In Japan, children are travelling by car more frequently and walking less. This transition in travel behaviour is one explanation for the increase in children's obesity in Japan. Whereas the decreasing frequency of children's walking is associated with fewer fatalities in traffic accidents, because most traffic fatalities involve children as pedestrians, definitely not because of improvements in Japanese traffic safety. The survey also suggested that habitual car use during childhood is associated with arrogance in adulthood. Therefore, it is important to consider the relationship between children's travel behaviour and physical and mental health when planning improvements to urban transport.

Predictive factors for achieving independent walking in children with Guillain-Barre syndrome.

BackgroundTo determine the predictors of achieving independent walking at 2 and 6 months after onset of weakness in children with Guillain-Barre syndrome (GBS).MethodsChildren with GBS admitted to the Tabriz Children's Hospital were studied prospectively. All patients had frequent clinical evaluations until achieving independent walking. Unaided walking at 2 and 6 months and factors influencing these outcomes were determined using both univariate and multiple analyses.ResultsBetween 2003 and 2014, 324 children (mean age: 5.3±3.66 years) were admitted. The mean duration to independent walking was 2.97±3.02 months; 90.5% of patients could walk independently at 6 months. In the univariate analysis, disability score of >3 (P=0.03), autonomic nerve involvement (P=0.003), cranial nerve involvement (P=0.008), and absent compound muscle action potential (CMAP; P=0.048) were found to be significantly associated with poor walking outcome at 6 months. In the multivariate analysis, cranial nerve involvement (P=0.008) and absence of CMAP (P=0.022) were independently associated with poor functional outcome.ConclusionDisability score >3, cranial and autonomic nerve involvement, and absence of CMAP were predictors of independent walking in childhood GBS in this study; early rehabilitation program may prevent further impairments secondary to immobility in these patients.

Early Intensive Leg Training to Enhance Walking in Children With Perinatal Stroke: Protocol for a Randomized Controlled Trial.

Development of motor pathways is modulated by activity in these pathways, when they are maturing (ie, critical period). Perinatal stroke injures motor pathways, including the corticospinal tracts, reducing their activity and impairing motor function. Current intervention for the lower limb emphasizes passive approaches (stretching, braces, botulinum toxin injections). The study hypothesis was that intensive, early, child-initiated activity during the critical period will enhance connectivity of motor pathways to the legs and improve motor function. The study objective was to determine whether early intervention with intensive activity is better than standard care, intervention delivered during the proposed critical period is better than after, and the outcomes are different when the intervention is delivered by a physical therapist in an institution vs. a parent at home. A prospective, delay-group, single-blind, randomized controlled trial (RCT) and a parallel, cohort study of children living beyond commuting distance and receiving an intervention delivered by their parent. The RCT intervention was provided in university laboratories, and parent training was provided in the childs home. Children 8 months to 3 years old with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. Intensive, play-based leg activity with weights for the affected leg and foot, 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 score. Secondary outcomes were motion analysis of walking, full-day step counts, motor evoked potentials from transcranial magnetic stimulation, and patellar tendon reflexes. Inter-individual heterogeneity in the severity of the stroke and behavioral differences are substantial but measurable. Differences in intervention delivery and assessment scoring are minimized by standardization and training. The intervention, contrary to current practice, could change physical therapy interventions for children with perinatal stroke.

Attentional load of walking in children aged 7–12 and in adults

The amount of attentional resources necessary to walk in children, and how they evolve during childhood remains unclear. This study examined children's gait parameters in different dual-task conditions. 53 children, divided into two age groups (7–9 and 10–12 years old), and 18 adults walked on a mat in three different cognitive conditions: watching a video (video condition), listening its soundtrack (audio condition), and without any additional task (control condition). Questions were asked at the end of the video and audio conditions to make sure that participants were paying attention to the stimuli. A GAITRite® system was used for recording the gait data. Results showed an increase of velocity and step duration, and a decrease of cadence and percentage of double limb support duration from 7 years of age to adulthood during dual-task walking compared with single-task walking. This improvement seemed to be linear from 7 years to adults' age. The interference of dual-task on gait was larger for the video than for the auditory task and decreased with age. We concluded that walking requires a significant amount of attentional resources in children and that children rely more than adults on visual processes for walking.