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Assisting and supervising daily long-durational walking is very crucial for patients with lower extremity dysfunction, especially in the stage of recovery towards a state of walking independently. However, due to the shortage of caregivers and high-cost of nursing, long-term manual assistance and supervision is costly. Thus, in this paper, we propose a cane-type walking-aid robot to follow a human user for the safety and supervision of independent walking during rehabilitation training. Strongly motivated by clinical suggestions and user experiences, the human-following rule that the robot should follow the user in the required position within a fixed relative posture (keeping a certain distance in front of the user, 15-20 cm lateral to the healthy side, and 0 to the user's orientation) is established. To guarantee a reliable following, a quantitative human walking intention estimation method is proposed using the on-board Laser Ranger Finder (LRF) and Kalman Filter (KF). To effectively monitor the user's walking, a finite-time control method for the cane robot is also proposed to ensure its human-following performance. Experiments were conducted to demonstrate the effectiveness of the proposed system and methods. The experimental results show that the proposed system can obtain satisfactory performance of human-following and can be made available for different users in different walking modes.

Objetivo: analisar o comportamento do CoP durante a fase de inicializacao da marcha de criancas que se encontram na fase de aquisicao do andar independente com faixa etaria entre 1.7 a 3 anos, sem lesoes neuro-musculo-esqueleticas. Participantes: 45 criancas de ambos os sexos, divididos em tres grupos: G1 (1.7 anos) G2 (2 anos) e G3 (3 anos). Variaveis: Deslocamento anteroposterior (CoPAP) e mediolateral (CoPML) do CoP e velocidade media anteroposterior (VelAP) e mediolateral (VelML) do CoP durante a inicializacao do passo, nas suas tres fases: antecipatoria, execucao do 1o passo e execucao do 2o passo. Resultados: Na fase antecipatoria o grupo G1 apresentou valores menores no CoPAP e CoPML quando comparados com os grupos G2 e G3, ja a velocidade de deslocamento do VelAP o grupo G1 apresentou maior valor quando comparado com os demais grupos. Na fase de execucao do 1o passo o G1 menor deslocamento do CoPAP e CoPML quando comparado com os demais grupos. Na fase de execucao do 2o passo o G1, G2 e G3 apresentaram caracteristicas semelhantes para as variaveis CoPAP, CoPM, VelAP e VelML. Conclusao: O ajuste antecipatorio ainda e pouco consolidado em criancas com pouca experiencia com o andar independente, o que sugere uma estrategia distinta da crianca de 3 anos a fim de garantir o equilibrio na inicializacao da marcha.

Background and Purpose: One systematic review has examined factors that predict walking outcome at one month in initially nonambulatory patients after stroke. The purpose of this systematic review was to examine, in nonambulatory people within a month of stroke, which factors predict independent walking at 3, 6, and 12 months. Methods: Prognostic factors: Any factors measured within one month after stroke with the aim of predicting independent walking. Outcome of interest: Independent walking defined as walking with or without an aid but with no human assistance. Results: Fifteen studies comprising 2344 nonambulatory participants after stroke were included. Risk of bias was low in 7 studies and moderate in 8 studies. Individual meta-analyses of 2 to 4 studies were performed to calculate the pooled estimate of the odds ratio for 12 prognostic factors. Younger age (odds ratio [OR], 3.4, P P P P P =0.006), continence (OR, 2.3, P P P P P P Conclusions: Younger age, an intact corticospinal tract, good leg strength, continence, no cognitive impairment, no neglect, good sitting, and independence in activities of daily living in patients who are nonambulatory early after stroke predict independent walking at 3 months. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/ ; Unique identifier: CRD42018108794.

In this cross-sectional study, we aimed to evaluate the association between generalized hypotonia (GH) and demographic features and clinical characteristics in toddlers (2 to 5 years) with autism spectrum disorder (ASD). Among 93 children, 32 (34.4%) had GH. These patients had a later onset of independent walking (17 vs. 15 months, p < 0.01), a higher proportion of motor stereotypies (65.6 vs. 27.9%, p < 0.01), a lower mean total score in the parental-reported Generic Core Scale of Pediatric Quality of Life Inventory 4.0 (71 vs. 76 points, p 0.03), and a higher mean total score in the Calibrated Severity Score of Autism Diagnostic Observation Schedule version 2 at diagnosis (6 vs. 5 points, p 0.02) compared to the group without GH. Conclusion: Hypotonia is associated with other motor abnormalities and could be an early marker for higher autistic symptom severity and lower quality of life in young children with ASD.

To investigate the relation between cognitive and motor development in preschool aged children with Dravet syndrome, in particular between the age of independent walking and cognitive development.Results of cognitive and motor developmental assessments and the age of independent walking were retrieved retrospectively from the medical records of 33 children (17 males, 16 females; mean age at last evaluation 33.2mo, SD 8.2mo, range 9-48mo) diagnosed with Dravet syndrome. Cognitive and motor developmental age, derived from the Bayley Scales of Infant Development or through standardized neurodevelopmental assessment, were converted into cognitive and motor developmental quotients. Multiple test scores per child were included.A strong positive relation was found between cognitive and motor developmental quotient (Pearson r=0.854; p0.001) in 20 children (slope=0.75; 95% CI: 0.54-0.95). A later age of independent walking was associated with a lower cognitive developmental quotient (28 children; p0.001; slope=-1.01; 95% CI: -1.53 to -0.49). A higher cognitive developmental quotient was seen in children with an age at testing younger than 24 months. The cognitive developmental quotient of children with a delay in independent walking (17.6mo) was significantly lower than those without a delay (p=0.006).A strong relation exists between cognitive and motor development. Furthermore, the age of independent walking might be an important indicator of the development of children with Dravet syndrome.Cognitive and motor development are strongly related in children with Dravet syndrome. Later age of independent walking is associated with worse cognitive development in children with Dravet syndrome.

Children with CHARGE syndrome (CWCS) are born with multiple physical disabilities, several of which impair balance and the onset of motor milestones. Early motor development problems can include delayed independent walking, which has been found in CWCS. In addition, few studies have examined balance in CWCS and these studies have been limited in scope, necessitating a more comprehensive examination of balance in this population. Motor development occurs as a progression of stages as represented by Seefeldt’s conceptual model. As such, it is essential to examine the association of early development of foundational skills, such as balance, with the onset of motor milestones as they are building blocks to motor competence. The aims of this study are to (1) examine the differential effects of children with and without CHARGE syndrome on balance and (2) examine the association of age of walking to these balance measures. In this study, 27 CWCS and 22 children without CHARGE syndrome, aged 7 to 16 years, were assessed on four components of balance including anticipatory control, reactive postural control, sensory orientation, and dynamic gait using the shortened version of the Balance Evaluation Systems Test (mini-BESTest) and parental reported age of independent walking. Their balance and age of walking were compared to 22 typically developing peers of similar age and gender distribution. Results revealed that CWCS walked three times later than their peers without CHARGE syndrome and had significant deficits on all balance systems assessed with the largest difference occurring in anticipatory control. Anticipatory control is critically important in maintaining static and dynamic postural control. These results indicate a critical need for early functional balance training and compensatory strategies in CWCS.

Mature locomotion involves modular spinal drives generating a set of fundamental patterns of motoneuron activation, each timed at a specific phase of locomotor cycles and associated with a stable muscle synergy. How locomotor modules develop and to what extent they depend on prior experience or intrinsic programs remains unclear. To address these issues, we herein leverage the presence at birth of two types of locomotor-like movements, spontaneous kicking and weight-bearing stepping. The former is expressed thousands of times in utero and postnatally, whereas the latter is elicited de novo by placing the newborn on the ground for the first time. We found that the neuromuscular modules of stepping and kicking differ substantially. Neonates kicked with an adult-like number of temporal activation patterns, which lacked a stable association with systematic muscle synergies across movements. However, on the ground neonates stepped with fewer temporal patterns but all structured in stable synergies. Since kicking and ground-stepping coexist at birth, switching between the two behaviors may depend on a dynamic reconfiguration of the underlying neural circuits as a function of sensory feedback from surface contact. We tracked the development of ground-stepping in 4- to 48-mo-old infants and found that, after the age of 6 mo, the number of temporal patterns increased progressively, reaching adult-like conformation only after independent walking was established. We surmise that mature locomotor modules may derive by combining the multiple patterns of repeated kicking, on the one hand, with synergies resulting from fractionation of those revealed by sporadic weight-bearing stepping, on the other hand.

BackgroundDevelopmental Coordination Disorder (DCD) is a neurodevelopmental condition with high prevalence. Early motor milestones are important markers to identify DCD. The current study aims to evaluate the association between the onset of crawling and independent walking and their transition pattern during infancy and later motor impairments.MethodsA total of 8,395 children aged 3–6 years old in China were included in the final analysis. A parent questionnaire was used to collect early milestone onset data. Children's motor performance was measured using the Movement Assessment Battery for Children-2nd edition (MABC-2). The association between motor milestones and motor impairment was analyzed using a multilevel regression model.ResultsThe result showed that a 1-month delay in crawling onset increased the risk of significant overall motor impairment by 5.3, and 14.0% when adjusting for child and family characteristics. A 1-month delay in walking onset increased the risk of significant overall motor, fine, gross, and balance impairment by 21.7, 8.3, 13.3, and 17.8%. A 1 month increase in the transition time from crawling to independent walking increased the risk of significant overall motor and gross motor impairment by 7.7 and 6.6%. These results were inconsistent across different age bands (each p < 0.05).ConclusionsOur study indicates that even a mild delay in crawling and walking onsets in infancy increase the risk for subsequent motor impairments in childhood, and children with motor impairments revealed a different transition pattern from crawling to walking. The motor abilities of children with motor impairments can be observed to diverge from typically developing children as early as 6–8 months old. The findings can facilitate the early identification of motor impairments in children, and provide early signs to initiate intervention.

Affordances in the home environment are critical to early motor development. Currently, the home environment has not been examined in children with deafblindness or severe disabilities. The present study examined differences in, and relationships between, the home environment and motor development in children with and without CHARGE syndrome. CHARGE syndrome is a low-incidence, complex disorder with sensory and motor impairments. Participants included 28 parents of children with CHARGE syndrome and 32 parents of children without disabilities. Children with CHARGE syndrome achieved motor milestones significantly later and had fewer outside space affordances than children without disabilities. Older children had a greater variety of stimulation and fine motor toys, and those that achieved independent walking later had more outside space and fine and gross motor toys. Early experiences may be more important for children with CHARGE syndrome than children without disabilities. Moreover, parents can play a vital role in their children’s motor development to help them reach their motor milestones.

The aim of the study was to evaluate the outcomes of pedestal cup and METS coned hemipelvis implants for periacetabular reconstruction after type II pelvic resections, including complications, failure rates, and functional outcomes. We retrospectively reviewed 25 patients, divided in two groups, who underwent internal hemipelvectomy and periacetabular reconstruction using either a pedestal cup (Group A = 13) or a METS coned hemipelvis (Group B = 12). The clinical, radiological, and oncological outcomes, as well as the complications, were assessed. There were no differences between the two groups regarding capacity for independent walking at 12 months and functional results. Mechanical and nonmechanical complication rates were also similar for the two groups. The two-year cumulative incidence of failure was 7.6% (95% CI 0.3-18.3) for group A and 8.8% (95% CI 1.7-20.1) for group B, while the four-year cumulative incidence of failure was 11% (95% CI 0.2-28.9) and 14.1% (95% CI 2.2-33.1), respectively. This study showed that both types of pelvic implants are reliable options for periacetabular reconstruction of bone defects after type II oncologic pelvic resections, having similar complication rates and functional results.

[Purpose] The purpose of this longitudinal study was to investigate the diversity in infant crawling and examine the quantitative regularity in crawling variations necessary for the acquisition of walking in infants with typical development. [Participants and Methods] Infants with no neurological or orthopedic problems participated in this study. Using Internet Protocol (IP) cameras, crawling was simultaneously filmed from six different angles. Filming was continued until the acquisition of independent walking. The crawling movement in the video was coded. We considered the number of different completed codes as the number of variations and examined the cumulative number during the filming period in each participant. [Results] Nineteen infants completed the study. The pattern of change in the cumulative number of variations with increasing age (in days) varied between cases. Although the cumulative number of crawling variations at the time of acquisition of independent walking was inconsistent, it was negatively correlated with the crawling start age (in days). [Conclusion] Diversity exists in infant crawling. Infants who start crawling at a younger age tend to express more variation, whereas infants who start crawling when older tend to express less variation.

Age of first walking (AOW) is reported to be later in autism spectrum disorder (ASD) compared with typical development. However, the relationship between AOW and variations in ASD symptoms across different neurodevelopmental disorders is largely unknown. This study investigated AOW and its association with autism symptom severity in a large sample of children (N = 490, 23% females) clinically evaluated for suspected ASD, differentiated into ASD (n = 376) and non-ASD (n = 114) diagnoses. Children with ASD achieved independent walking significantly later than children with non-ASD diagnoses. AOW was significantly associated with ASD symptom severity, and females had a non-significant later AOW. The current findings suggest that in cases with delayed AOW, ASD should be considered as an actual differential diagnosis, perhaps particularly in girls.

To study changes in muscular postural strategies and general motor behaviour during the transition to independent walking. Postural control was assessed at its two functional levels: (1) direction specificity, in which dorsal muscles are primarily activated when reaching forward; and (2) fine-tuning of direction specificity.In an explorative longitudinal study, surface electromyograms of the arm, trunk, and neck muscles of 28 typically developing infants were recorded during reaching while sitting. Each infant was assessed in three developmental phases: during pull-to-stand (T0), first independent steps (T1), and 1 month after T1 (T2). Motor behaviour was assessed using the Infant Motor Profile (IMP). The effect on developmental outcome measures (postural parameters and IMP) of the developmental phases (T0, T1, T2) was estimated using linear mixed-effects models.None of the postural parameters changed significantly over time. However, individual developmental trajectories showed infant-specific postural reorganizational changes. Total IMP score decreased between T0 and T1 (mean IMP score 95% and 91% respectively; p0.001); between T1 and T2 IMP scores did not change (91% and 93%; p=0.073).Typically developing infants do not show consistent patterns of postural reorganization but show individual muscular strategies during the transition to independent walking. However, signs of reorganization of general motor behaviour are present.Infants show signs of reorganization of motor behaviour when learning to walk. Infants show individual strategies of postural reorganization when learning to walk.CONTROL POSTURAL DEL TRONCO EN LA SEDESTACIÓN Y COMPORTAMIENTO MOTOR GENERAL DURANTE EL APRENDIZAJE DE MARCHA: OBJETIVO: Estudiar los cambios en las estrategias posturales musculares y el comportamiento general motor en la transición a la marcha independiente. El control postural fue evaluado en dos niveles funcionales: 1) especificidad de dirección, en el cual los músculos dorsales son primariamente activados al inclinarse hacia adelante; y 2) y ajuste en la dirección específica.En un estudio longitudinal exploratorio, electromiogramas de superficie en los músculos de los miembros superiores, tronco, y cuello de 28 niños con desarrollo típico fue registrado durante el control postural, específicamente durante el alcance mientras estaban sentados. A su vez, cada niño fue evaluado en tres fases del desarrollo: durante la tracción para pararse (T0); primeros pasos independientes (T1) y 1 mes después de T1 (T2). El comportamiento motor se evaluó utilizando el perfil motor infantil (Infant Motor Profile [IMP]). El efecto sobre las medidas de resultado del desarrollo (parámetros posturales y IMP) de las fases de desarrollo (T0, T1, T2) se estimó utilizando modelos lineales de efectos mixtos.Ninguno de los parámetros posturales cambiaron significativamente en el tiempo. Sin embargo, las trayectorias del desarrollo individual mostraron cambios en la reorganización postural de algunos niños. El total de los valores de IMP disminuyeron entre T0 y T1 (media de valores de IMP 95% y 91% respectivamente; p0.001); entre T1 y T2 no hubo cambios de IMP (91% y 93%; p=0.073).Los niños con desarrollo típico no mostraron patrones consistentes de reorganización postural, pero mostraron estrategias musculares individuales durante la transición hacia la marcha independiente. Sin embargo, se vieron signos de reorganización en el comportamiento motor general.CONTROLE POSTURAL DURANTE O ALCANCE NA POSTURA SENTADA E COMPORTAMENTO MOTOR GERAL AO APRENDER A ANDAR: OBJETIVO: Estudar mudanças nas estratégias de músculos posturais e comportamento motor geral durante a transição para a marcha independente. O controle postural foi avaliado em dois níveis funcionais: (1) especificidade direcional, em que os músculos dorsais são ativados primariamente durante o alcance anterior; e 2) refinamento da especificidade direcional. MÉTODO: Em um estudo exploratório longitudinal, eletromiogramas de músculos do braço, tronco e pescoço de 28 lactentes com desenvolvimento típico foram registrados durante o alcance na postura sentada. Cada lactente foi avaliado em três fases do desenvolvimento: durante o segurar-se para levantar (T0), primeiros passos independentes (T1) e um mês após T1 (T2). O comportamento motor foi avaliado usando o Perfil Motor infantil (IMP). O efeito das fases do desenvolvimento (T0, T1 e T2) sobre as medidas de desfecho do desenvolvimento (parâmetros posturais e IMP) foi estimado usando modelos lineares de efeitos mistos. RESULTADOS: Nenhum dos parâmetros posturais mudou significativamente com o tempo. No entanto, as trajetórias desenvolvimentais individuais mostraram mudanças posturais reorganizacionais lactente-específicas. O escore IMP total diminuiu entre T0 e T1 (escore médio IMP 95% e 91% respectivamente; p0,001); entre T1 e T2 os escores IMP não mudaram (91% e 93%; p=0,073). INTERPRETAÇÃO: Lactentes com desenvolvimento típico não mostraram padrões consistentes de reorganização postural, mas mostrarm estratégias musculares individuais durante a transição para a marcha independente. No entanto, sinais de reorganização do padrão motor geral estão presentes.

We hypothesized that gait treatment with a wearable cyborg Hybrid Assistive Limb (HAL) would improve the walking ability of patients with hemiparesis after stroke. This study aims to evaluate the efficacy and safety of gait treatment using HAL versus conventional gait training (CGT) in hemiplegic patients with acute stroke and establish a protocol for doctor-initiated clinical trials for acute stroke. We will enroll patients with acute stroke at the University of Tsukuba Hospital. This study is a single-center, randomized, parallel-group, controlled trial (HAL group, n = 20; control group, n = 20) that will include three phases: (1) pre-observation phase (patient enrollment, baseline assessment, and randomization); (2) treatment phase (nine sessions, twice or thrice per week over 3−4 weeks; the HAL and control groups will perform gait treatment using HAL or CGT, respectively, and finally (3) post-treatment evaluation phase. The Functional Ambulation Category score will be the primary outcome measure, and the following secondary outcome measures will be assessed: Mini-Mental State Examination, Brunnstrom recovery stage of lower limbs, Fugl–Meyer assessment of lower limbs, 6-min walking distance, comfortable gait speed, step length, cadence, Barthel Index, Functional Independence Measure, gait posture, motion analysis (muscle activity), amount of activity (evaluated using an activity meter), stroke-specific QOL, and modified Rankin Scale score. The baseline assessment, post-treatment evaluation, and follow-up assessment will evaluate the overall outcome measures; for other evaluations, physical function evaluation centered on walking will be performed exclusively, excluding ADL and QOL scores. This study is a randomized controlled trial that aims to clarify the efficacy and safety of gait treatment using HAL compared with CGT in hemiplegic patients with acute stroke. In addition, we aim to establish a protocol for doctor-initiated clinical trials for acute stroke based on the study results. If our results demonstrate the effectiveness of the proposed treatment regarding outcomes of patients with hemiplegic acute stroke, this study will promote the treatment of these patients using the HAL system as an effective tool in future stroke rehabilitation programs. The study protocol was registered with the Japan Registry of Clinical Trials on October 14, 2020 (jRCTs032200151).

Early brain lesions which produce cerebral palsy (CP) may affect the development of walking. It is unclear whether or how neuromuscular control, as evaluated by muscle synergy analysis, differs in young children with CP compared to typically developing (TD) children with the same walking ability, before and after the onset of independent walking. Here we grouped twenty children with (high risk of) CP and twenty TD children (age 6.5–52.4 months) based on their walking ability, supported or independent walking. Muscle synergies were extracted from electromyography data of bilateral leg muscles using non-negative matrix factorization. Number, synergies’ structure and variability accounted for when extracting one (VAF1 ) or two (VAF2 ) synergies were compared between CP and TD. Children in the CP group recruited fewer synergies with higher VAF1 and VAF2 compared to TD children in the supported and independent walking group. The most affected side in children with asymmetric CP walking independently recruited fewer synergies with higher VAF1 compared to the least affected side. Our findings suggest that early brain lesions result in early alterations of neuromuscular control, specific for the most affected side in asymmetric CP.

Background: During the spread of COVID-19, the need for scientifically based methodological assistance to students when walking and running was most evident in order to improve optimal body functions and maintain health. The aim of the study was to develop a program for monitoring students' walking and running according to the system " 10,000 steps a day " during the spread of COVID-19 and to prove its effectiveness through improving body mass index and improving physical health. Study participants: students regardless of gender (n = 114). Interventions: The pedagogical research was carried out for 4 months. During the experiment, the students of the experimental group (n = 71) carried out self-monitoring of aerobic physical activity, consisting of walking and running, using the author's program according to the principle of " 10,000 steps per day " in daily, weekly and monthly cycles. The study used diagnostics of general physical health, the level of functional readiness to perform loads and body mass index. Main outcome measures. The effectiveness of the implementation of the author's program for monitoring aerobic physical activity of students is statistically significant at p < .01 and p < .05. The implementation of the author's model of independent walking and running is effective only under the condition of systematic fulfilment of aerobic physical loads. Findings. The obtained research data showed that during the period of the spread of COVID-19, an active lifestyle of students, including daily walking and running, is possible and effective for physical health and the prevention of overweight.

This chapter will examine movement among individuals with deafblindness. It should be noted that the causes and the severity of deafblindness are heterogenous in nature, making generalities quite challenging. Currently, there is a dearth of research on deafblindness, with most focused on individuals with CHARGE syndrome. This chapter will examine age of independent walking, balance assessments, fundamental motor skill performance, physical activity levels, as well as qualitative assessments on barriers to physical activity and parental perceptions of physical education. The need for additional research focusing on deafblindness and movement cannot be overstated, as there are many research gaps which should be examined. Ultimately, research should lead toward policy change to increase adequate and appropriate movement-related opportunities (e.g., physical education) for youth with deafblindness to better lead them to more activity and healthy lives.

Background Data relating to weight-bearing or lower limb loading ability (LLLA) has been reported wildly in several individuals, mostly with unilateral impairments, but not in ambulatory individuals with spinal cord injury (SCI) who have bilateral sensorimotor deterioration. Aim To assess the LLLA of ambulatory individuals with SCI who walk independently with and without a walking device, and explore the optimal threshold of the LLLA to determine the independence and safety of these individuals. Design Cross-sectional study. Setting Tertiary rehabilitation centres and communities. Population Ninety ambulatory participants with SCI. Methods Participants were assessed for their LLLA during stepping of the contralateral leg using a digital load cell. In addition, they were assessed using functional mobility tests and interviewed for fall data over the past six months. Results Participants who walked independently with or without a walking device had an average LLLA of at least 79% of their bodyweight. In addition, the amount of LLLA at least 94%-95% of the bodyweight had moderate diagnostic properties to indicate the independence and safety of these individuals (sensitivity = 68%-77%, specificity = 66%-81%, and AUC = 0.73-0.80). Conclusions The clear and objective data relating to LLLA can be used as a critical indicator for the safe and steady mobility, specifically for ambulatory individuals with SCI. These data can be used as an optimal threshold in rehabilitation training, screening and monitoring of their functional alteration over time in clinical, community, and home-based settings. Clinical rehabilitation impact The LLLA of at least 79% of the bodyweight could determine the ability of independent walking with a walking device, while an LLLA of at least 94%-95% of the bodyweight could indicate the ability of walking without a walking device and no multiple falls. These data can be used as an optimal target in rehabilitation training, screening and monitoring of functional alteration over time in various clinical and homebased settings, specifically for ambulatory individuals with SCI.

Learning to walk is a dynamic process requiring the fine coordination, assembly, and balancing of many body segments at once. For the young walker, coordinating all these behavioral levels may be quite daunting. In this study, we examine the whole-body strategies to which infants resort to produce their first independent steps and progress over the first months of walking experience. Six infants were followed weekly from the onset of independent upright locomotion for 8 weeks, and then every other week until 4 months of walking experience. The walking kinematics from the infants' earliest steps were cluster-analyzed and the infants were classified into 3 groups. Follow-up comparisons with kinematics recordings were used to quantify the infants' strategies more precisely and track how these early forms of walking evolved over time. Results revealed that in the first weeks of independent walking, 3 infants used a stepping strategy, 1 used a twisting strategy, and 2 used a falling strategy to move their body forward and perform their first unsupported steps. As the infants gained walking experience, their walking patterns became more similar. These findings indicate that infants discover different solutions to use their body and control their balance when beginning to walk. With time, infants adopt a more efficient solution that incorporates and integrates elements of the different strategies.

[Purpose] We report a case of an elderly patient with rheumatoid arthritis who underwent hip disarticulation because of necrotizing fasciitis and regained the ability to walk independently with a prosthetic limb. [Participant and Methods] A 61-year-old female patient underwent right hip disarticulation due to severe necrotizing fasciitis of the right lower limb. Her chief complaint was that she was not able to walk inside her house or outdoors to perform instrumental activities of daily living. We applied a Canadian-type hip disarticulation prosthesis to the stump. The patient received in-hospital physical therapy, occupational therapy, and clinical psychology counselling for 145 days. As her hands and fingers were weakened by rheumatism, we made several modifications to the prosthesis to enable the patient to attach and detach it independently. [Results] The patient was able to use the prosthesis to walk continuously for 45 m, perform various housework duties, drive a car, and go out, thus accomplishing the desired daily activities. [Conclusion] Our patient, an elderly hip disarticulation amputee with rheumatoid arthritis, was able to walk independently using a prosthetic limb. The application of prosthetic limbs may be appropriate even for hip disarticulation amputees with comorbidities that make it difficult to acquire a prosthetic gait.

Objective: Independent walking is the most essential prerequisite to maintain quality of life in older persons. The purpose of this review was to...

Introduction. The increased attention from the state to the organization of rehabilitation measures, especially among children, requires evaluation and development of measures to improve the effectiveness of all areas of rehabilitation – medical, social and professional rehabilitation. The development of measures increasing efficiency is especially important among children, since children are the main potential of the country. The objective of the study was to evaluate the medical and social effectiveness of the rehabilitation measures carried out for children after neuroinfections. Material and methods. During the study, parents of children after neuroinfections were interviewed, as well as the examination of changes in large motor functions and functional state was carried out by doctors of the Clinic of “Scientific and Research Institution of Children’s Infections”. Medical experts used special evaluation scales in order to objectify the research.Results. The overwhelming majority of parents (90.4 %) note an improvement in the condition of their children in terms of medical and social adaptation. More than one third of parents (35.9 %) note the improvement of their children’s condition, according to all seven criteria proposed for the answer (formation of independent walking skills, stabilization of emotional-volitional activity, acquisition of new social household skills, ability to sit, decrease of muscle tone, speech development and improvement of manipulative functions of the hand). According to the expert opinion of the doctors of the Clinic, 78.8 % of children suffered from the disruption of large motor functions, and children of the first level, i.e. the lightest, according to the classification scale for large motor functions (GMFCS), was only 17 %. After four courses of rehabilitation in the Clinic, the proportion of children of the first level increased significantly and amounted to 48.2 %. Improvements in the opinion of medical experts, based on the results of the questioning, were also observed in functional status, in such positions as communication, everyday life skills, socialization and motor skills.Сonclusion. Thus, the effectiveness of rehabilitation measures for children after neuroinfections has been proved. Moreover, with the increase in the number of rehabilitation courses, the state of children improves both by the medical and social criteria.

Achievement of early motor milestones in infancy affords new opportunities for social interaction and communication. Research has shown that both motor and social deficits are observed in infants who later develop autism spectrum disorder (ASD). The current study examined associations between motor and social-communication skills in 12-month-old infant siblings of children with ASD who are at heightened risk for developmental delays (N=86) and low-risk, typically developing infants (N=113). Infants were classified into one of three groups based on their walking ability: walkers (walks independently), standers (stands independently), or pre-walkers (does not yet stand or walk independently). Social-communication and cognitive skills were assessed with two standardized assessments (Communication and Symbolic Behaviors Scales [CSBS] and Mullen Scales of Early Learning) and compared across the three walking groups. Results demonstrated that high-risk walkers showed superior social-communication skills, but commensurate cognitive skills, compared to high-risk pre-walkers. In contrast, social-communication and cognitive skills were largely comparable for low-risk infants, regardless of walking status. Findings suggest that for high-risk infants, who are already vulnerable to developmental delays and ASD, independent walking may facilitate the emergence of social-communication abilities. Pivotal motor milestones may serve as useful indicators of social-communication delays and targets for intervention.

It is well documented that in Japan, the population is ageing rapidly. Indeed, people aged 65 and older already make up one-quarter of the country's total population, and this is expected to reach one-third by the year 2036. The health and wellbeing of the elderly is at risk, with a burden of chronic illness in the older population, as well as issues associated with decreased mobility and increased likelihood of falls. Tomotaka Ito, based at Shizuoka University, Japan is working to develop a group of robotic tools to support the elderly to walk independently and live full and healthy lives. Ito's research involves exploring innovative ways to assist the elderly in living independent and fully functional lives. He is doing this through robotic tools that can help with day-to-day activities such as walking and help to prevent falls.

Due to increased metabolic demands during walking, ∼50% of children with myelomeningocele transition to wheelchair use during adolescence/early adulthood. The purpose of our pilot study involving children with myelomeningocele was to determine: (a) energy expenditure needs during acute use of common assistive devices and (b) if walking poles are a feasible assistive device. Oxygen uptake was recorded for eight (5–12 years old) children in four conditions: independent, walker, crutches, and poles. Acute pole use did not significantly differ from independent walking net energy consumption or cost. Participants consumed more energy while walking with the walker than independently. Our pilot results suggest that (a) acute use of common assistive devices while walking increases energy consumption and cost versus independent and (b) poles are feasible assistive devices, resulting in slightly increased energy requirements. Poles may have provided “just enough” support with minimal change in energy requirements for our participants and, with practice, may enable children with myelomeningocele to remain community ambulators.

Background: In typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk.Methods: Ten typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated.Results: In both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants.Conclusion: Increasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit.

School travel patterns have changed over the past half-century, with more students driven and fewer walking independently. This study examines how individual, household and built environment correlates associate with school travel related children’s independent mobility in the City of Toronto, Canada. Parents and children (aged 9–13 years) completed activity-travel surveys and route mapping. Mapped routes were used to measure environmental correlates of independent walking to and from school. Separate to and from school travel models were estimated using binomial logistic regression models. Findings suggest that distance, age, gender, traffic volume and flexible parental work arrangements related to independent mobility. Getting children to walk to and from school may reduce the number of vehicles around the school, reduce safety concerns and possibly increase opportunities for independent mobility in childhood.

Background and Objective. The likelihood of regaining independent walking after stroke is of concern to patients and their families and influences hospital discharge planning. The objective of this study was to explore factors that could be combined in an algorithm for predicting whether and when a patient will walk independently after stroke. Methods. Adults with new lower limb weakness were recruited within 3 days of having a stroke. Clinical assessment, transcranial magnetic stimulation, and magnetic resonance imaging were completed 1 to 2 weeks poststroke. Classification and regression tree (CART) analysis was used to identify factors that predicted whether a patient achieved independent walking by 6 or 12 weeks, or remained dependent at 12 weeks. Results. We recruited 41 patients (24 women; median age 72 years, range 43-96 years). The CART analysis results were used to create the Time to Walking Independently after STroke (TWIST) algorithm, which made accurate predictions for 95% of patients. Patients with a trunk control test score >40 at 1 week walked independently within 6 weeks. Patients with a trunk control test score

Commentary On: Hicks K.E., Zhao Y., Fallah N, Rivers C, Noonan V, Plashkes T, Wai EK, Roffey DM, Tsai E, Paquet J, Attabib N, Marion T, Ahn H, Phan P. A simplified clinical prediction rule for prognosticating independent walking after spinal cord injury: a prospective study from a Canadian multicenter spinal cord injury registry. The Spine Journal. Article in press.

Background Direction changes while walking are more likely to cause a hip fracture than is falling while walking in a straight line. Trunk stability is an important contributor to safe and effective walking, and arm movements influence trunk movement while walking. However, the difference in the trunk stability during semicircular turns performed by elderly women with a light bag has not been examined. Objective To investigate the effects of carrying a bag on trunk stability during semicircular turns in elderly women. Methods We enrolled 15 community-dwelling elderly women capable of independent walking. Participants walked with and without a bag at a self-selected speed along a marked path, which included semicircular turns, while fitted with an accelerometer attached over the L3 spinous process. Results Gait velocity was faster during semicircular turning with a bag versus without a bag. The normalized medial-lateral center of mass acceleration was lower during semicircular turning with a bag versus without a bag. Conclusions We suggest that a light additional arm load and increased arm swing contributes to trunk stability and efficient walking during semicircular turning by elderly women.

Background Behavioral problems are an important issue for people with CHARGE syndrome. The similarity of their behavioral traits with those of people with autism raises questions. In a large national cross-sectional study, we used specific standardized tools for diagnosing autism (Autism Diagnostic Interview-Revised and Diagnostic and Statistical Manual of Mental Disorders, 5th edition, DSM-5) and evaluating behavioral disorders (Developmental Behavior Checklist-Parents, DBC-P) to investigate a series of individuals with CHARGE syndrome, defined by Verloes’s criteria. We evaluated their adaptive functioning level and sensory particularities and extracted several data items from medical files to assess as potential risk factors for autism and/or behavioral disorders. Results We investigated 64 individuals with CHARGE syndrome (35 females; mean age 10.7 years, SD 7.1 years). Among 46 participants with complete results for the Autism Diagnostic Interview-Revised (ADI-R), 13 (28%) had a diagnosis of autism according to the ADI-R, and 25 (54%) had a diagnosis of autism spectrum disorder (ASD) according to the DSM-5 criteria. The frequency of autistic traits in the entire group was a continuum. We did not identify any risk factor for ASD but found a negative correlation between the ADI-R score and adaptive functioning level. Among 48 participants with data for the DBC-P, 26 (55%) had behavioral disorders, which were more frequent in patients with radiological brain anomalies, impaired adaptive functioning, later independent walking, and more sensory particularities. Conclusions ASD should be considered to be an independent risk requiring early screening and management in children born with CHARGE syndrome.

We hypothesized that a single-leg version of the Hybrid Assistive Limb (HAL) system could improve the gait and physical function of patients with hemiparesis following a stroke. In this pilot study, we therefore compared the efficacy of HAL-based gait training with that of conventional gait training (CGT) in patients with acute stroke. Patients admitted to the participating university hospital were assigned to the HAL group, whereas those admitted to outside teaching hospitals under the same rehabilitation program who did not use the HAL were assigned to the control group. Over 3 weeks, all participants completed nine 20 min sessions of gait training, using either HAL (i.e., the single-leg version of HAL on the paretic side) or conventional methods (i.e., walking aids and gait orthoses). Outcome measures were evaluated before and after the nine training sessions. The Functional Ambulation Category (FAC) was the primary outcome measure, but the following secondary outcome measures were also assessed: National Institutes of Health Stroke Scale, Fugl–Meyer Assessment (Lower Extremity), comfortable walking speed, step length, cadence, 6-min walk distance, Barthel Index, and Functional Independence Measure. In total, 22 post-stroke participants completed the clinical trial: 12 in the HAL group and 10 in the CGT group. No serious adverse events occurred in either group. The HAL group showed significant improvement in FAC after nine sessions when compared with the CGT group (P = 0.014). However, secondary outcomes did not differ significantly between the groups. Our results demonstrate that HAL-based gait therapy may improve independent walking in patients with acute stroke hemiplegia who are dependent on ambulatory assistance. A larger-scale randomized controlled trial is needed to clarify the effectiveness of single-leg HAL therapy. Clinical Trial Registration: UMIN Clinical Trials Registry, identifier UMIN000022410.

The crawling behavior of sixty 2-day-old newborns was studied while they were supported prone on a mini skateboard and on a pediatric mattress without additional support. Analyses of the number and types of limb movements and their characteristics, the coactivation of limb pairs, and the displacement across the surface, revealed that newborns can crawl with locomotor patterns similar to those documented during quadrupedal locomotion in animals and human adults. This was particularly apparent on the skateboard. This discovery suggests that locomotor circuitry underlying quadrupedal locomotion develops during fetal life. Drawing upon other evidence for a quadrupedal organization underlying bipedal gait, we argue that early quadrupedal training may enhance interventions designed to hasten the onset of independent walking.

A severely comminuted and contaminated open tibial pilon fracture is one of the most challenging fractures we face. Although nowadays conducting multiple operations over various stages is a common treatment option taking into account the possibility of soft tissue damage, a gold standard protocol for severe pilon fractures has not yet been established. This case concerns a 56-year-old gentleman who suffered a severely comminuted and contaminated Gustilo 3b open tibial pilon fracture (AO 43C3.3) that was successfully treated using a circular frame external fixator without flap. Two years six months after the injury, there were no indications of any skin conditions at the site of the open wound, the range of ankle motion had been maintained and independent walking was possible. The score under the JSSF (Japanese Society of Surgery of the foot) ankle/hind foot scale was 81. This indicates that use of a circular frame external fixator is a useful treatment method in the event of a severe open pilon fracture where there is a large osteochondral bone defect.

Background Physical inactivity is common during hospitalisation and poses a threat to functional capacity and independency in the elderly. Aim We aimed to assess the effect of physical activity measurements with visual feedback about time spent in various activities on the average daily time spent out of bed during hospitalisation. Methods We recorded physical activity during hospitalisation by accelerometers and compared the effect of the visual feedback (intervention) with no feedback (control) on time spent out of bed. Patients admitted to the pulmonary ward were invited and assigned to intervention with feedback or control with no feedback in 6 alternating waves of approximately 18 patients each. The order of feedback/no feedback was randomised at the outset of the study. The visual feedback intervention group was provided with visual feedback of the daily time spent in bed, sitting, standing, and walking. The control group did not receive feedback. Results 93 patients completed the study with a median length of stay of 5 days. Across all patients there were no statistically significant group differences in daily time out of bed; however, patients with independent mobility spent 51 minutes (95% CI 0 to 102; P = .049) more out of bed when provided with visual feedback compared to no feedback. Conclusions A simple technology assisted physical activity intervention with visual feedback to encourage mobility was not effective at increasing time spent out of bed among hospitalised patients. With feedback, a subgroup of patients with independent walking abilities increased time out of bed and may benefit from this type of intervention. Trial registration: clinicaltrials.gov Identifier: NCT01945749.

This study aimed to compare rates of participation in physical activity according to the type of disability, sex, point of disability diagnosis (congenital vs. acquired), and ability to walk independently. The study involved individuals who were registered as disabled based on the 2020 Sports Survey for the Disabled project of the Korea Ministry of Health and Welfare. Participants (mean age: 49.94 ± 12.35 years) included those with physical disabilities (n = 889), visual impairments (n = 523), hearing/speech impairments (n = 412), intellectual disabilities (n = 561), and disabilities associated with brain lesions (n = 364). Rates of severe (100%) and congenital disability (65.95%) were highest in the intellectual disability group. Acquired disability was most frequent in the physical disability group (94.71%). The highest frequency of independent walking ability was observed in the hearing/speech impairment group (99.27%). The rate of participation in physical activity was significantly higher in the acquired (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.12–1.87, p = 0.005) and independent walking (OR = 1.43, 95% CI = 1.11–1.84, p = 0.005) hearing/speech impairment groups than in the corresponding physical disability groups after adjusting for age, sex, and severity. Our findings highlight the need to promote physical activity for people with physical and intellectual disabilities based on the factors examined in this study.

OBJECTIVE: To examine the evidence for a training effect on the lower limb of functional electrical stimulation. DESIGN: Cohort study. PATIENTS: A total of 133 patients >6 months post-stroke. METHODS: Training and orthotic effects were determined from walking speed over 10 m, associated minimal and substantial clinically important differences (i.e. >0.05 and >0.10 m/s), and Functional Ambulation Category (FAC), ranging from household walking to independent walking in the community. RESULTS: An overall significant (p

Early gross motor development is a major indicator of global milestones in the first year of life, affecting the walking ability of a child. There has been limited research reporting on early motor development and the age of independent walking of orphaned infants compared to typical home-raised infants. The purpose of this study was to compare the mean scores of early gross motor movement at 4, 6 and 8months of age and at the age of walking attainment of typically raised infants and orphaned infants. In addition, we looked to compare the walking age between these same infants.This cross-sectional study recruited 59 typical home-raised infants and 62 orphans. Their gross motor development was assessed using the Alberta Infant Motor Scale (AIMS). The age of walking attainment was also prospectively monitored and ascertained. The Student's independent t-test was used to analyse the differences of the AIMS scores at 4, 6 and 8months of age and at the age of independent walking between the two groups.The orphans showed significantly lower AIMS scores at 4, 6 and 8months of age and the age of independent walking (P-value0.05). The orphan group had a 5-month older mean age of walking attainment (15.0±4.2months) compared with typical home-raised infants (9.9±1.4months).Orphans have delays in early gross motor development and walk independently at an older age, compared with home-raised infants.

BACKGROUND Hip fracture and its consequences are one of the major causes of morbidity and disability in the elderly. The purpose of this study was to collect epidemiologic data and assess the daily activities and walking ability of patients 3 months and 1 year following surgery because of a hip fracture. MATERIAL AND METHODS We prospectively obtained data of all consecutive patients more than 50 years of age with any type of hip fracture from 2008 to 2013. After excluding pathologic fractures, hip fracture dislocations, non-surgically treated cases, and dead patients, functional status of the subjects at 3 months and 1 year after surgery was evaluated using a 10-degree scale of pain, modified Barthel index of daily activity, and independent walking ability. RESULTS In total, 1015 cases were enrolled. Mean age was 75.6 year with a female to male ratio of 1.33. Left-sided hip fractures were seen in 51.7 % of cases. Intertrochanteric fractures were the most common type (72.1 %), followed by femoral neck (24.0 %) and subtrochanteric fractures (3.9 %). At both 3-month and 1-year follow-up visits, 562 subjects (317 women and 245 men) completed the questionnaires. Activities of daily living and independent walking ability were improved significantly at 1 year and the improvements were statistically superior to the results obtained at 3 months (p-value < 0.001 for both variables). CONCLUSION By continuing rehabilitation of elderly patients with surgically-treated hip fractures for one year, improvement in activities of life and walking independence can be expected even if they have a poor result after the first 3 months of rehabilitation.

Background: The diagnosis of sarcopenia through clinical assessment has some limitations. The literature advises studies that include objective markers along with clinical assessment in order to improve the sensitivity and specificity of current diagnostic criteria. The decrease of muscle quality precedes the loss of quantity, so we studied the role magnetic resonance imaging biomarkers as indicators of the quantity and quality of muscle in sarcopenia patients. Methods: a cross-sectional analysis was performed to analyze what MR-derived imaging parameters correlate better with sarcopenia diagnostic criteria in women of 70 years of age and over (independent walking and community-dwelling women who were sarcopenic in accordance with EWGSOP criteria with muscle mass adjusted to Spanish population were chosen). Results: The study included 26 women; 81 ± 8 years old. A strong correlation was obtained between cineanthropometric variables (BMI; thigh perimeter and fat mass) and imaging biomarkers (muscle/fat ratio, fatty infiltration, muscle T2*, water diffusion coefficient, and proton density fat fraction) with coefficients around 0.7 (absolute value). Conclusions: Knowing the correlation of clinical parameters and imaging-derived muscle quality indicators can help to identify older women at risk of developing sarcopenia at an early stage. This may allow taking preventive actions to decrease disability, morbidity, and mortality in sarcopenia patients.

Sixty-six patients with possible or probable MSA (multiple system atrophy) cerebellar type, personally observed between 2006 and 2018 were retrospectively reviewed. The time point of data collection was January 1, 2019. Forty-nine patients lost independent walking after a median time of 5 years (95% C. I. 4–6). Thirty-two patients were confined to wheelchair after a median time of 7 years (95% C. I. 7–8). Twenty-seven patients were deceased after a median time of 9 years (95% C. I. 8–10). A later onset predicted an earlier loss of independent walking (HR 1.07; 95% C.I. 1.03–1.11; p = 0.001). Higher UMSARS score predicted shorter time to loss of independent walking (HR 1.04; 95% C.I. 1.02–1.06; p = 0.001) and to wheelchair (HR 1.03; 95% C.I. 1.01–1.06; p = 0.021). No predictor of time to death was found.

Among children with Down syndrome, the frequency of motor rehabilitation intervention and the age at the start of this intervention are independently related to the age at onset of independent walking. Early motor rehabilitation, before age 6 months, may be effective in reducing motor delay in children with Down syndrome.

PURPOSE: To investigate how the onset of independent walking in children with Cerebral Palsy (CP) influences the Passive Range of Motion (PROM) of lower limb joints.METHOD: Sixteen children with CP, GMFCS levels I and II, and 16 Typical Development (TD) children who had just begun independent walking participated in the study. The PROM of the hip abduction and external rotation, knee extension, popliteal angle, and ankle dorsiflexion was recorded with a goniometer at the onset of independent walking and 8 months later. A repeated-measures two-way ANOVA was conducted to compare the main effects of "walking experience" and "group of children" and the interaction effect between them on PROM of lower extremities' joints.RESULTS: The effect of "group of children" in the PROM was significant; differences were observed between children with CP and TD children for all joints (p< 0.05). The effect of "walking experience" did not have a significant impact on PROM changes and the interaction effect of "group of children" and "walking experience" was also not significant for all the variables.CONCLUSIONS: The alternative gait pattern spontaneously adopted by children with CP does not significantly impact their PROM during the initial stages of walking development. The lower PROM in highly functional children with CP compared to TD children cannot be attributed to gait initiation with an "atypical" pattern, but possibly to other factors such as reduced voluntary movement and age.

This article focuses on the potentialities of employing the practice of walking as a critical public pedagogy in the context of the transforming territories of northern Istanbul. It will initially give background information on the current processes of neoliberal urbanization taking place in northern Istanbul. It will then, based on the experience of the independent walking project Istanbul Walkabouts, discuss how walking can be used as a critical methodology outside and in academia to question hegemonic approaches to land, record the terra incognita areas of cities, and produce alternative modes of mapping. Ultimately, it will emphasize how performing critical walking in the precarious geographies of northern Istanbul with diverse publics can trigger experiential and place-based (un)learning, produce multiple epistemologies, and generate a community that is critically engaged with top-down approaches to urbanization., Journal of Public Pedagogies, 4, ISBN:2207-4422