Basic gait and symmetry measures for primary school-aged children and young adults whilst walking barefoot and with shoes
Introduction
Normative or reference gait data sets are required to assess a child's walking pattern. Does a child, for example, display normal gait characteristics for his/her age group or is the pattern immature, delayed or compromised by disease or injury? Although the literature advocates that children exhibit a mature gait pattern by 3 years of age [14], with maturation complete by 7 years [2], [3], [7], there is evidence to suggest that maturation occurs later [4]. Investigations have also shown a child's gait is affected by body weight and delayed motor development [5], [17] yet it is difficult to assess the level of gait deviation without a normative data set. Moreover, little is known about the symmetry of a child's gait pattern or the effect of footwear on gait. This investigation recorded reference gait data, including measures of symmetry, from a large sample of healthy school-aged children whilst walking barefoot and with shoes. It also re-examined the issue of gait maturation by comparing the children's gait to young adults.
In a landmark study, Sutherland et al. [14] recorded the gait of children aged 1–7 years (n = 309) and found mature patterns to be well established by the age of 3 years. Typical indicators were the presence of reciprocal arm swing and heel-strike, increased walking velocity, step length and single support coupled with a reduction in cadence. In 2006, Dusing and Thorpe [3] recorded the gait of children aged 1–10 years (n = 438) and found normalized velocity and step length increased gradually from 1 to 4 years and stabilized from 5 to 10 years.
Recently, Holm et al. [7] recorded the gait patterns of children aged 7–10 years (n = 360) and found normalized gait measures showed little change with age suggesting gait is mature from 7 years of age. Other research, however, supports the premise that gait may not be mature by the age of 7 years. Ganley and Powers [4], for example, found that when accounting for age-specific anthropometrics, 7-year old children (n = 15) produce less peak plantar-flexor moment and ankle power absorption/generation during late stance than adults (n = 15) walking at the same speed. This led to the conclusion that children aged 7 years may lack the neuromuscular maturity to generate an adult-like gait pattern at the ankle.
Obesity has been shown to affect gait in children. A study by Hills and Parker [5] found obese children (n = 10) exhibit lower cadence and gait velocity, a longer stance period and greater step length asymmetry compared to normal-weight children. Wilson et al. [17] found children classified as overweight or obese (n = 8) spend a longer time in double support (p < 0.05), exhibit a larger support base and walk more slowly than normal-weight children (n = 80). It is possible, however, that these differences may have resulted from impairment or developmental delay since five of the overweight children in the study exhibited higher levels of motor impairment than the group of normal-weight children.
In general, most studies of normative gait have involved small age-band sample sizes, limited trial numbers [3], [7], [14], excluded measures of symmetry [3], [7], focused on barefoot walking [3], [7], [14] and imposed arbitrary walking speeds [7]. It is acknowledged that limited trial numbers (i.e. two walks) can reduce the reliability of gait data and that several practice walks followed by at least four walks should be performed when collecting normative data [3]. As with Dusing and Thorpe [3], Holm et al. [7] only recorded two walk trials for a series of self-selected speeds that were described as “slow”, “a little faster”, “faster”, “as fast as you can”. Only the trials where children walked 1.4–1.6 m s−1 were analyzed. This speed range is well above the average walking velocity of 1.14 cm s−1 (SD = 0.17 cm s−1) reported by Sutherland et al. [14] for children aged 7 years.
Limited knowledge exists about the gait characteristics, including symmetry, of healthy school-aged children. This is partly due to the shortcomings of past gait technology that restricted studies to low participant numbers and limited walking trials. Instrumented gait mats currently allow easy collection and examination of numerous gait parameters over many trials for large groups of participants within a laboratory or field setting. The aim of this investigation was threefold. Firstly, to record normative or reference gait data, including measures of symmetry, from a large sample of healthy school-aged children whilst walking barefoot and shod. Secondly, to use this database to ascertain whether basic spatio-temporal measures of gait can be used to identify gait maturation. Finally, to re-examine the issue of gait maturation by comparing the children's gait characteristics to those of a young adult population.
Section snippets
Participants
A sample of 980 healthy able-bodied children and young adults from Australia participated in this study in 2006–2007. The sample was divided into the following age bands: 5, 6, 7, 8, 9, 10, 11, 12–13 and 19 years. The children were recruited from schools located in the North, East, South and Western Metropolitan Regions of a major Australian city. Seventeen percent of the children and adolescents were recruited from schools in the Northern Region, 29% from the Eastern, 32% from the Southern and
Age
No significant height, mass or leg length differences were found between the male and female children aged 5–11 years. On average, participants took 33.0 ± 10.3 steps in the barefoot condition and 31.0 ± 10.4 steps when wearing shoes (Table 1). The non-normalized measures of gait speed, step length, stride length, support base, foot angle, step and stride time increased with age whereas cadence reduced with age (refer to Table 2). The equivalent normalized measures were unaffected by age (refer to
Discussion
It is important to ascertain the level of gait deviation that results from factors such as reduced physical activity levels, obesity, delayed motor development, disease and injury, and to monitor gait restoration following therapy or treatment. The specific aims of this investigation were to record normative or reference gait data from a large sample of healthy primary school-aged children and to use this database to ascertain whether basic spatio-temporal measures of gait can be used to
Acknowledgements
Funding for this project was granted by the Early Career Researchers Grant Scheme funded by the Faculty of Medicine, Health Sciences and Dentistry, University of Melbourne.
Conflict of interest
The authors have no financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work.
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