Understanding Weightbearing Symmetries During Crawling in Typically Developing Infants and Infants with Limb Loss

Crawling is an almost universal stage of locomotor development in infants; however, it is difficult to quantify using typical motion analysis techniques. The crawling stage therefore has underutilized potential to assess development and detect deviations or abnormalities. This study measured longitudinal weightbearing asymmetries in typically developing (TD) crawling children and compared this population to children with limb loss or limb differences (LLD) using a pressure-sensing mat. The LLD group bore significantly more weight using their arms vs. their legs than the TD group (p < 0.001), but even in cases of unilateral limb loss, bilateral weightbearing symmetry was similar to TD, controlling for body mass and age (p = 0.570). As children in the TD group developed and gained body mass, their weight shifted significantly to their left side (η2 = 0.050) and away from their arms and toward their legs (η2 = 0.255). The results provide insight into the biomechanical development of TD infant crawling, and the ways in which an atypically developing population manages weightbearing during crawling. The establishment of symmetry data will be useful, as crawling can serve as an opportunity for earlier detection of neuromotor conditions such as cerebral palsy. Furthermore, insight into the crawling patterns of children with limb loss and limb difference can inform prosthetic prescription and the need to consider a missing weight shift toward the legs as children develop.