Ambulatory capacity in cerebral palsy: prognostic criteria and consequences for intervention

Abstract

In conclusion, although the importance of encouraging the development of physical abilities remains, in certain cases we cannot simply wait for years to see whether a child will eventually become an effective walker as a result of physiotherapy or orthopaedic interventions. Powered mobility should be considered as a means of providing efficient, autonomous locomotion for children with severe motor disabilities, so enabling them to become more active participants in their own lives rather than remaining spectators. Children with moderate levels of motor impairment could be encouraged to see wheelchair use as beneficial in some circumstances and not an irreversible failure.

Botulinum toxin and cerebral palsy: time for reflection?

“…Some children with spastic diplegic CP, despite an initial improvement in mobility, 47 show a progressive deterioration in mobility in childhood [15][16][17][18] which can continue after skeletal maturity. 19,20,48,49 It is not clear from the literature whether those children with spastic diplegic CP who present with dynamic equinus and those who later develop multilevel fixed lower-limb deformities are different subgroups or represent different stages of the natural history, but there is evidence for a progression in children with diplegia from an equinus gait to crouch gait. Rodda et al 50 described a classification system for sagittal plane kinematics in children with spastic diplegic CP, ranging from dynamic equinus to crouch gait.…”

Toy-Based Technologies for Children with Disabilities Simultaneously Supporting Self-Directed Mobility, Participation, and Function: A Tech Report

“…Despite the adoption of the ICF, the current culture of pediatric rehabilitation and caregivers alike view the use of powered mobility devices as a "last resort, " once all other efforts toward the skill of walking have been exhausted (Bottos and Gericke, 2003;Wiart et al, 2004;Rosen et al, 2009;Feldner et al, 2016). This represents a dichotomous view of thinking suggesting that self-directed mobility should be achieved by either a powered mobility device or walking.…”

“…Emerging research indicates that this sentiment is the consequence, in part, of a lack of positive disability narratives that challenge walking as the only means of "normalcy, " which, left unmitigated, often results in children with disabilities' internalization of stigma and low self-worth (Gibson et al, 2011;Gibson and Teachman, 2012). Several studies cite the role of rehabilitation professionals as key in either maintaining or challenging these established normative views on disability and walking (Wiart and Darrah, 2002;Bottos and Gericke, 2003;Wiart et al, 2004;Gibson et al, 2011;Gibson and Teachman, 2012).…”

Short-term, Early Intensive Power Mobility Training

“…Many pediatric clinicians and clinical researchers are interested in advancing a paradigm shift in which locomotion training and power mobility go together to provide maximum mobility as early as possible. 2, 11, 38, 39 …”