Locomotor skills and balance strategies in children with internal rotations of the lower limbs.

The purpose of this study was to investigate the functional effects of a structural deformation, internal rotations (IR) of the lower limbs, on upper body balance strategies used during locomotion in 5-6 year-old and 7-10 year-old children. Balance control was examined in terms of rotation around the longitudinal axis in horizontal plane (yaw) and around the sagittal axis in a frontal plane (roll). Kinematics of foot, pelvis, shoulder, and head rotations were measured with an automatic optical TV image processor and used to calculate angular dispersions and segmental stabilizations. Older children with IR showed a lower gait velocity, particularly in difficult balance conditions than typically developing (TD) children. In younger children, the effect of the local biomechanical deficit remained limited to the lower limbs and did not affect upper body coordination. By contrast, in older children with IR, the development of head stabilization in space was affected. This was demonstrated by an "en bloc" instead of an articulated mode of head-trunk unit systematically adopted by the control group. As pelvic stabilization remains the main reference frame to organize balance control in older children with IR, we conclude that the structural deformity of the legs affect and possibly delay the acquisition of the head stabilization in space strategy. (c) 2007 Orthopaedic Research Society.