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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.

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.

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.

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 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.

[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...

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.

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.

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.

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

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.

Objective Age at onset of walking has been shown as an early predictor of physical activity in infants and children. However, little is known about whether age at onset of walking may predict sedentary behavior (SB). The aim of the present study was to examine the association between the timing of onset of walking and objectively measured SB, and whether this association is mediated by moderate-to-vigorous physical activity (MVPA) in children. Methods The subjects were 388 elementary school children aged 6–12 years. Current weight and height data were collected. Birth weight and the age in months the child first walked independently were reported based on the parents’ recall. Children’s SB and physical activity were objectively measured using a triaxial accelerometer (Active style Pro HJA-350IT, OMRON). The following summary outcome variables were derived from accelerometer data: Time (min/day) spent in SB (≤1.5 metabolic equivalents [METs]) and MVPA (≥3.0 METs). Results The mean ± SD time (min/day) spent in sedentary was 376 ± 62 and MVPA was 67.6 ± 20.8. Multiple linear regression analyses revealed that a later age at independent walking was associated with increased time spent in SB (β = 0.15, P < 0.001) and decreased time spent in MVPA (β = -0. 18, P < 0.001) after adjusting for gender, birth weight, current age, body weight, schools, and time spent wearing the accelerometer. When MVPA was introduced as a covariate in the model predicting SB, the association between the age at independent walking and time spent in SB was completely attenuated (β = 0.04, P = 0.215), while MVPA was significantly associated with SB (β = -0.61, P < 0.001). Conclusions Our results indicate that infants who walked at a later age spent more time in SB in childhood, and this association is mediated by MVPA. Appropriate interventions which focus on increasing MVPA and thereby reducing SB may be beneficial in infants who demonstrate a later age at onset of independent walking.

The main objective of this study was to examine how contact pressure on the dorsal surface of the foot changes with varying shapes. Ten healthy young men (22.1 ± 0.6 years) with independent walking ability were recruited in this study. We measured the anthropometric characteristics of the foot. Shoe size for the experiment was individually decided based on the obtained anthropometric data. Subsequently, FlexiForce® sensors were attached to the dorsal side of the first metatarsophalangeal joint (P1), intermediate cuneiform (P2), and pternion (P3) to measure the contact pressure during walking. In addition, foot switch sensors were used to determine the gait cycle. At P2, some participants with a higher foot height showed a lower increase in contact pressure during the loading response or pre-swing phases than did participants with a lower foot height. The observed distribution of the contact pressure on the dorsal foot might be caused by the change in the shape of the shoes and the foot joint movement during walking.

OBJECTIVE Ankle joint control plays an important role in independent walking. This study investigated the effects of robotic-assisted locomotor training on impaired ankle joint control in individuals with chronic incomplete spinal cord injury. METHODS Sixteen individuals with incomplete spinal cord injury underwent 12 one-h sessions of robotic-assisted locomotor training for 4 weeks, while 16 individuals with incomplete spinal cord injury served as inactive controls. Changes in ankle control measures, torque and co-activation were evaluated during maximal voluntary contractions in dorsi- and plantar-flexion. Changes in walking performance measures using Timed Up and Go (TUG), 10-m walk (10MWT) and 6-min walk (6MWT) tests were evaluated at 2 time points: baseline and after 4 weeks. RESULTS Maximal voluntary contractions torque during both dorsi- and plantar-flexion contractions improved markedly in the robotic-assisted locomotor training group compared with baseline. Furthermore, after the training, co-activation during the dorsi-flexion maximal voluntary contractions decreased in the training group compared with controls. In addition, the training group significantly improved walking mobility (TUG) and speed (10MWT) compared with baseline. Finally, correlation analysis indicated a significant linear relationship between maximal voluntary contraction torques and walking performance measures. CONCLUSION These findings provide evidence that robotic-assisted locomotor training improves ankle joint control, which may translate into enhanced walking performance in individuals with chronic incomplete spinal cord injury.

Background: Normative values are lacking for daily quantity of infant leg movements. This is critical for understanding the relationship between the quantity of leg movements and onset of independent walking, and will begin to inform early therapy intervention for infants at risk for developmental delay. Methods: We used wearable inertial movement sensors to record full-day leg movement activity from 12 infants with typical development, ages 1–12 months. Each infant was tested three times across 5 months, and followed until the onset of independent walking. We developed and validated an algorithm to identify infant-produced leg movements. Results: Infants moved their legs tens of thousands of times per day. There was a significant effect of leg movement quantity on walking onset. Infants who moved their legs more walked later than infants who moved their legs less, even when adjusting for age, developmental level or percentile length. We will need a much larger sample to adequately capture and describe the effect of movement experience on developmental rate. Our algorithm defines a leg movement in a specific way (each pause or change in direction is counted as a new movement), and further assessment of movement characteristics are necessary before we can fully understand and interpret our finding that infants who moved their legs more walked later than infants who moved their legs less. Conclusions: We have shown that typically-developing infants produce thousands of leg movements in a typical day, and that this can be accurately captured in the home environment using wearable sensors. In our small sample we can identify there is an effect of leg movement quantity on walking onset, however we cannot fully explain it.

Objective The intensity of pain after surgical treatment of hip fracture has a negative effect on functional recovery. However, the effects of acute postoperative pain on the recovery of walking ability after the surgery remain unclear. This study aimed to investigate the association between acute postoperative pain and the recovery of functional gait among patients who had independent walking ability prior to hip fracture. Methods This was an observational study that included 41 patients with a mean age of 81.3±7.3 years who underwent surgical treatment for traumatic hip fracture at a general hospital. The primary outcome was the time to recovery of independent gait postsurgery. Based on the median time to recovery, patients were classified into an early independent walking group and an independent walking group. Stepwise logistic regression analysis was performed to identify predictive factors of the time to recovery of independent walking. Results The median time to recovery of independent gait was 24 days (range, 7-50 days). In total, 20 patients were classified in the early independent walking group and 21 in the independent walking group. On logistic regression analysis, the total pain intensity, reported during activities of daily living (ADL) on postoperative days 5 and 6, and the knee extensor strength were predictive of the time to recovery of independent walking. Conclusions The degree of recovery of gait function of patients surgically treated for hip fracture was found to be predicted by the pain intensity measured during ADL and the knee extensor strength assessed in the acute phase. Effective management of acute pain after surgical treatment of hip fracture may help improve functional recovery of gait.

Purpose: The purpose of this study was to determine the cut-off value of the weight-bearing rate (WBR) on the paretic lower limb that is needed for independent walking without a cane. Methods: The participants were 128 stroke patients. Age, sex, muscle strength of both the paretic and non-paretic lower limbs, Brunnstrom recovery stage of the lower limbs, deep sensation, and the WBR on both the paretic and non-paretic lower limbs were used as variables. The patients who could independently walk in the hospital without a cane were categorized as independent group, and those who walked with a cane, or observation or assistance by a staff member were dependent group. Results: The WBR on the paretic lower limb was most strongly related to independent walking without a cane, and a WBR value of 80.5% on the paretic lower limb gave a clear cut-off value (p

Visually impaired persons require tactile walking surface indicators (TWSIs) for independent walking. However, if these blocks are installed following guidelines for constructing TWSIs, it's unkind to users. Therefore, we propose LED blocks installed at crosswalk entrances for blind and visually impaired persons. These blocks can be detected through the soles of shoes and through use of residual vision. This study conducted an experiment with amblyopic examinees in which we evaluate the visibility of the LED blocks.

A cross-sectional study. To explore the need of upper limb contribution during sit-to-stand (STS) in ambulatory participants with spinal cord injury (SCI) and compare the lower limb loading during the sit-to-stand (LLL-STS) in those with SCI who performed the task with or without hands as compared to able-bodied individuals. In addition, the study assessed the correlation between the LLL-STS, and sensorimotor scores and functional ability in ambulatory participants with SCI. A tertiary rehabilitation center and community hospitals, Thailand. Forty-three participants with SCI who could perform STS with or without hands, and 10 able-bodied individuals were interviewed and assessed for their demographics, STS, and LLL-STS ability. Moreover, participants with SCI were assessed for SCI characteristics, sensorimotor scores, and functional ability relating to independent walking. More than half of participants with SCI (58%) performed STS using hands. Their LLL-STS, sensorimotor, and functional ability were significantly lower than those with SCI who performed the task without hands. The LLL-STS of participants with SCI, particularly amount, was significantly associated with their sensorimotor scores and functional ability (P

Visual information is the most important element in perceiving environments. People use mostly visual information to orient themselves and find their way to go. However, visually impaired people having handicap in vision has many qualitative and quantitative limitations of their experience [1]. Also they have limitation in mobility and opportunity for interaction with their surrounding space. For that reason, there is a tactile map to help their independent walking. It is made up of protruding dot, line, surface and braille. Visually impaired people can recognize the structure of space by touching the tactile map. However, it is not smart enough to use in their real life. Because of such problems, we have been researching this tactile map to make it more useful device. We met several visually impaired people and interviewed them about actual situation of their independent ambulation and using of the tactile map. In addition, we conducted some experiments to find out mechanism of perceiving the tactile map. We analyzed their touching behavior and discovered the problem of existing tactile maps. Based on these findings, we designed prototype of new tactile map and conducted usability evaluation. The result was successful to enhance utility of the tactile map. And we could verify the potential of the new tactile map device.

With the constant development of an aging population, the elderly have the increasingly demands and higher requirements for assistive products for walking. Traditional assistive products for walking can't satisfy demands for independent walking, use friendliness and maintenance of walking ability anymore, thus a new-type assistive product for walking is required in the potential market of the elderly. By aiming at the problem that the traditional man-machine interaction fails to meet demands of the elderly, tactile and slip sensor is used to drive and control a walking assistant robot. First of all, walking intention of general users is described. By aiming at movement features of users, k-nearest neighbor method, clustering method and support vector machine are used to identify walking intention of users. At last, with experimental comparison and analysis, identification effect of walking intention based on the clustering method is the worst. The identification effect based on support vector machine is slightly improved. The identification algorithm performance based on k-nearest neighbor method is the best. As a result, according to experimental results, k-nearest neighbor method is applied to do experimental study on identifying the walking intention.

The purpose of this work was to quantify plantar pressures and contact areas (and variability thereof) in natural independent walking in infants.

Decreased range of motion (ROM) of the ankle and dorsiflexor strength due to the aging process has been associated with increased risk of trips and falls. However, the impact of dual-task on the ankle ROM in elderly is not clear. It was our objective to evaluate the ankle ROM in community elderly during usual gait and two simultaneous task conditions (functional and cognitive). Thirty-two community elderly (66.8 ± 4.7 years) of both sexes, non-fallers, who had independent walking were recruited. The dorsiflexion and plantar flexion of the ankle were assessed in three situations: usual gait, gait with functional task and gait with cognitive task, using 8 cameras Qualisys Pro-reflex Oqus 300®. Analysis of variance (ANOVA) were applied and comparisons were made by Newman-Keuls using SPSS (version 16.0) adopting a significance level of 5% (p£ 0.05). There were no differences among tasks (p> 0.05) in the dorsiflexion and plantar flexion in the elderly, however, during the usual gait the dorsiflexion ROM of the elderly was lower than the normative values described in literature. The performance of tasks during walking have no influence on ankle ROM in non-fallers community-elderly. However, more studies including older adults who have previously fallen are necessary., Motricidade, Vol 12 No 4 (2016)

Objective. To assess the dynamics of neurological disorders after surgical treatment in pediatric patients with complicated fractures of the thoracic and lumbar spine using ASIA scale. Material and Methods. Outcomes of surgical treatment in 32 children aged from 3 to 17 years with isolated injuries of the thoracic and lumbar spine accompanied by neurological disorders were analyzed. Type A3 fractures occurred in 50.0 %, type B in 6.3 %, and type C in 43.7 % of cases. Patients were divided into 2 groups: Group I included 12 patients with complete spinal cord injury, and Group II - 20 patients with incomplete injury. Results. In all patients, a vertebral-medullary conflict was eliminated and a rigid fixation of the damaged spinal motion segments was achieved. Voluntary movements in lower limbs of patients from Group I did not recover. Patients from Group II had significant decrease in paresis degree and sensitivity recovery in lower limbs: the ability of independent walking without aids and assistance was completely restored in 37.5 %, the ability to walk with one/two-sided assistive devices was achieved in 18.8 %, and significant improvement in lower limb support ability - in 6.3 % of cases. Conclusion. Surgical treatment of children with complicated spinal injury should include the elimination of vertebral-medullary conflict, complete reduction, and rigid stabilization with reconstruction of physiological profiles of injured spinal motion segments.

Introduction/Background Alberta Infant Motor Scale is an assessment tool to evaluate the gross motor development of the infant between birth until independent walking. It is a clinical practical assessment tool to be used and has been used broadly. The aim of this study was to examine the concurrent validity of Alberta Infant Motor Scale (AIMS) in Chinese with gross motor scale of Peabody Developmental Motor Scale II (PDMS-II) when used in high-risk infants. Material and Method One hundred and eighteen high-risk infants with the average age of 7.76 ± 3.93 months (from 2 to 17 months) were recruited to this study. Three investigators experienced in AIMS and PDMS-II participated in this study. Each investigator administered the AIMS and PDMS-II to the infants within one week and recorded the assessment results. The raw scores of AIMS and PDMS-II-GM for each infant were analyzed for the concurrent validity. Results The Pearson correlation coefficient of AIMS with PDMS-II was 0.97. For the 0∼4 month group, the Pearson correlation coefficient was 0.94. For the 4∼8 month group, Pearson correlation coefficient was 0.95. For the 8∼12 month group, Pearson correlation coefficient was 0.94. For the >12 month group, Pearson correlation coefficient was 0.91. Conclusion The AIMS in Chinese had high concurrent validity with PDMS-II when used in high-risk infants at very early age.

[Purpose] The purpose of the present study was to investigate the reliability of isometric knee extension muscle strength measurement of patients who underwent femoral neck fracture surgery, as well as the relationship between independent mobility in the ward and knee muscle strength. [Subjects] The subjects were 75 patients who underwent femoral neck fracture surgery. [Methods] We used a hand-held dynamometer and a belt to measure isometric knee extension muscle strength three times, and used intraclass correlation coefficients (ICCs) to investigate the reliability of the measurements. We used a receiver operating characteristic curve to investigate the cutoff values for independent walking with walking sticks and non-independent mobility. [Results] ICCs (1, 1) were 0.9 or higher. The cutoff value for independent walking with walking sticks was 0.289 kgf/kg on the non-fractured side, 0.193 kgf/kg on the fractured side, and the average of both limbs was 0.238 kgf/kg. [Conclusion] We consider that the test-retest reliability of isometric knee extension muscle strength measurement of patients who have undergone femoral neck fracture surgery is high. We also consider that isometric knee extension muscle strength is useful for investigating means of independent mobility in the ward.

Background Age for onset of independent walking (AOW) is frequently used as an indicator of the progress of motor development in early life. Yet there is considerable uncertainty in the research literature about the age we should expect children to walk independently, and also whether prewalking strategies are of importance for this milestone. In clinical practice we commonly experience that children start walking at later ages than the standards presented in the Alberta Infant Motor Scale (AIMS), the most frequently used standardized instrument of gross motor development in Norway. Aims To investigate the normal distribution of AOW among Norwegian children, which prewalking locomotor strategies (PLS) children used before AOW, and if children who crawled on hands and knees started to walk earlier than children with other strategies. Design and methods This cross-sectional study was based on parental self reports from two data sources, i.e. the Norwegian Mother and Child Cohort Study (MoBa, n = 47,515), and project specific regionally collected data ( n = 636). Results Half of the Norwegian children had started to walk at 13 months (median). Twenty-five percent walked at 12 months and 75% of the children walked at 14 months. Mean AOW, claiming at least 5 independent steps, was 13.1 (1.91) months. Children who used crawling on hands and knees (84.5%) as PLS started to walk unaided 0.9 months earlier (95% CI = 0.32–1.49, p Conclusion Norwegian children start to walk considerably later than standards reported in AIMS. Crawling on hands and knees is associated with an earlier onset of walking.

Purpose: To explore parents’ perspectives on rehabilitation of their child with cerebral palsy and their information needs. Methods: Semistructured interviews were conducted with parents of children with CP from India (n = 11) and Canada (n = 7). Data were analyzed through an interpretive description approach using the International Classification of Functioning, Disability and Health framework. Results:Body Structure and Function: Indian parents were more focused on fixing body structure and function challenges, and independent walking, than Canadian parents. Activity and Participation: All Canadian children were actively involved in school and fun activities in the community. Due to lack of accessible services, Indian children had less school and community participation. Environmental factors: accessible communities, occupational therapy services and greater use of assistive devices enabled Canadian children. Social and cultural beliefs, lack of access to services and inaccessible communities were the barriers experienced by Indian parents. Information needs: both groups needed information to make their child more functional. Conclusion: Canadian parents experience a more enabling environment and express a more social view of their child’s health, suggesting both education on the International Classification of Functioning, Disability and Health principles and services are needed to better enable and empower Indian parents. There remains a need for healthcare professionals and services in both countries to be more family-centered.Implications for rehabilitationTo help parents in rehabilitating their children with cerebral palsy (CP), in India, there is a need to (1) incorporate ICF education into medical curricula and clinical practice; (2) increase the availability of skilled healthcare professionals and centers; (3) make infrastructural and policy reforms to make the society more accessible for the disabled children.Education, counseling and awareness about CP might help both groups of parents, society, and HCPs to change their beliefs and attitudes regarding CP and its rehabilitation.Both countries would benefit from user-friendly and transparent policies. This will help parents to become more aware of them and use them in the rehabilitation process. To help parents in rehabilitating their children with cerebral palsy (CP), in India, there is a need to (1) incorporate ICF education into medical curricula and clinical practice; (2) increase the availability of skilled healthcare professionals and centers; (3) make infrastructural and policy reforms to make the society more accessible for the disabled children. Education, counseling and awareness about CP might help both groups of parents, society, and HCPs to change their beliefs and attitudes regarding CP and its rehabilitation. Both countries would benefit from user-friendly and transparent policies. This will help parents to become more aware of them and use them in the rehabilitation process.