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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.

Purpose To determine whether supramalleolar orthoses use during upright play contributes to decreased upper extremity support in infants with Down syndrome. Method Seventeen children with Down syndrome were assigned to 2 groups. Infants in the control group received treadmill training. Infants in the experimental group wore supramalleolar orthoses in addition to treadmill training. The participants were followed every other month from pull to stand until independent walking. Each child was videotaped playing at a table for 20 minutes. Researchers coded the tapes to determine whether the child's trunk was leaning or not and whether he or she was using 0, 1, or 2 hands for support. Results No group differences were found in hand support during time in the upright position. All children decreased the amount of 2-hand support over time (P = .05). Conclusion The use of supramalleolar orthoses may improve upright stability but it does not decrease upper extremity support in infants with Down syndrome.

Kagaya H, Takahashi H, Sugawara K, Dobashi M, Kiyokawa N, Ebina H: Predicting outcomes after hip fracture repair. Am J Phys Med Rehabil 2005;84:46-51. Objective: To compare the activities of daily living before and after hip fracture and construct a statistical model for discharge destination and independent walking. The classification accuracy of the model was determined from an independent sample. Design: Prospective study: FIM prefracture, at discharge, and at 6-mo follow-up were obtained from 63 patients who underwent operations for acute hip fractures. A statistical model for discharge destination and independent walking was made and classification accuracy was checked using 78 independent samples. Results: The motor FIM scores at prefracture decreased significantly at discharge (P < 0.0001) and at 6-mo follow-up (P < 0.0001), but at 6-mo follow-up, they had increased significantly compared with those at discharge (P = 0.0103). A mobility subscale was used to predict discharge destination, and mobility and social cognition subscales were related to independent walking. The predictive accuracy was 87%. Conclusions: Motor FIM scores increase for at least 6 mos after hip fracture, and discharge destination and independent walking were highly predictable from FIM mobility and social cognition subscales.

Purpose The purpose of this study was to examine the heart rate and walking velocity of children with low and midlumbar myelomeningocele (MMC) using two types of orthoses. Methods Eight children with low and midlumbar myelomeningocele (mean age = 10.7 years) participated in the study. A clinical examination of muscle strength in the lower limbs was performed, and level of functional ambulation was defined. Weight and height were documented, and body mass index was calculated. Heart rate was recorded by a transmitter detecting heart beats, and walking time was registered as the children walked as far as possible along a straight corridor of 102 meters at a self-selected velocity. Two orthosis types were tested, each three times. Results All children showed higher heart rate than peers who were nondisabled. No steady-state heart rate level that could be used as a basis for calculating physiological cost index was achieved in any subject. In this study group, no difference was seen in heart rate trends with respect to the two tested orthoses. The children who were household ambulators, all with weaker hip abductors and hip extensors, walked with lower velocity than those who were community ambulators (all with stronger hip muscles). The children in the former group also walked significantly shorter distances, however, with similar heart rate. Conclusions Pausing when the heart rate reaches a strenuous activity level is interpreted as a solution to maintain functional walking by keeping the heart rate and thus the energy expenditure at a comfortable level.

The course of spinal muscular atrophy (SMA) is not well established except for those patients whose age of onset is before 6 months and who achieve only "sit with support" as their maximum function (Werdnig-Hoffmann disease or SMA I). This study shows that there is another group of SMA patients whose age of onset and maximum function achieved can be used as prognostic guides. Fifty percent of SMA patients who could walk without assistance and whose onset was prior to age 2 years lost the ability to walk independently by age 12. Fifty percent of SMA patients who walked and whose onset was between 2 and 6 years of age lost walking ability by age 44 years. Fifty percent of SMA patients who could walk with assistance as their best function ever achieved lost this ability by age 7 years, unrelated to age of onset; none could walk with assistance after age 14 years. Seventy-five percent of SMA patients who developed the ability to sit independently as their best function were still sitting after age 7 years independent of age of onset; 50% of this group could sit independently after age 14 years. Eighty-five percent of SMA patients who could walk could not negotiate stairs without holding onto a rail. They could raise their hands above the head; however, as they lost walking ability, they lost this function as well. Only one SMA patient whose maximum function was sitting independently could get to the sitting position on his own. Only two of these patients could hold their hands above their heads. All patients with SMA lose function over time. This function loss occurs slowly and is related primarily to maximum function achieved; knowledge of age of onset provides helpful information, especially for predicting the loss of independent walking.

This study measured the rate of acquisition of head and trunk postural control during the two early developmental periods of independent walking, as defined by global gait parameters. Gait parameters were observed longitudinally in four children. The maximum angular deviations of the trunk and head oscillations were computed in the frontal and sagittal planes. These decreased most dramatically during the first 10-15 weeks of independent walking, during the same period when global gait parameters changed rapidly. This head and trunk stabilization may be a fundamental process that help to maintain equilibrium during walking, and may be a necessary step prior to the development of fine posturo-motor control. Language: en

We used biochemical and clinical variables to develop a method to predict the expected duration of independent walking following surgery and bracing in patients with Duchenne muscular dystrophy. Data from the records of fifty patients were analyzed by linear and multiple regression. The most useful factors, applied in combination, in predicting the duration of walking ability after bracing were: percentage of residual muscle strength, vital capacity, creatinine coefficient, motivation of the patient at the time of bracing, and decrease in creatinine coefficient in the two years prior to bracing. This system uses readily available variables to predict the response to bracing in patients with Duchenne muscular dystrophy. Improvement in the criteria for the selection of patients for surgery and bracing is important in view of the economic cost as well as the demands on the time and energy of these children and their parents.