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Background and Purpose Independent walking function is a highly desired goal amonst stroke victims, and has been well reported in Western literature. However, few studies have investigated the recovery of gait following stroke in Third World countries, where rehabilitation is often minimal or non-existent. Methods A descriptive survey, using a structured questionnaire, was conducted on stroke victims, 12–14 weeks post-discharge from the Chris Hani Baragwanath Hospital, Soweto, South Africa. Although the questionnaire included a number of aspects of impairment, disability and handicap, this paper only reports on the recovery of walking function. Results A total of 361 patients were screened initially. Only 54 fulfilled all inclusion criteria, 38 (70%) were over 50 years of age and 16 (30%) were aged under 50 years. The average length of stay in hospital of the older group was eight days, and in the younger group, 11.5 days. All 54 subjects interviewed were able to walk prior to their stroke. Twelve to fourteen weeks post-discharge, 23 (66%) subjects in the older group and all (100%) of the younger group said they could walk. Half of the older group and nearly all of the younger group could walk outside their homes, unassisted and without appliances. One-third of the subjects experienced knee pain during walking, but only a small percentage said that this pain prevented them from walking. The ability to catch a taxi in Soweto was used as a measurement of the handicap of gait. Twenty (54%) older group subjects and five (31%) of the younger group never caught a taxi. Conclusions Although the recovery of gait in these subjects appears to have been good, the results cannot be extrapolated to the stroke population in general due to the stringent selection criteria of the study. Further studies are required to acquire a broader cross-section of the stroke population, including longer follow-up periods to gain insight into the continuation of walking function. This information is necessary in order to plan effective and appropriate rehabilitation services. Copyright © 1998 Whurr Publishers Ltd.

International audience; The authors of the present study tested the hypothesis that toddlers initiate lateral body stabilization first at the hip level in order to better control the center of gravity (CG), minimize the upper body destabilization induced by the movement of the feet, and prevent falls. Intersegmental coordination among the hip, the shoulder, and the head was investigated in toddlers during their 1st year of independent walking. The efficiency of locomotor balance control was examined in the frontal plane. An automatic optical TV image processor (ELITE system) was used in analyzing the kinematics of foot, hip, shoulder, and head rotations. For the hip, the shoulder, and the head, appropriate anchoring indices were defined so that comparisons could be made concerning the stabilization of a given body segment with respect to its external space and to the adjacent supporting anatomical segment. Cross-correlation functions were also used for extracting the temporal patterns of the body segments that occurred during locomotion and for obtaining some information about the coupling of 2 consecutive segments such as the head-shoulder and the shoulder-hip. First, hip stabilization in space appeared from the 1st week of independent walking and clearly preceded those of the shoulder and the head, suggesting an ascending progression, with age, in the ability of new walkers to control lateral balance during locomotion. Second, the hip movements occurred before the shoulder movements and the shoulder movements before the head movements, indicating that locomotor balance control is organized temporally in an ascending fashion, from the hip to the head. Third, the high values of the correlation coefficients, mainly between the head and the shoulder, were consistent with a global en bloc operation of the head-trunk unit.

Computer simulations of human infant walking, changing from supported walking with weight support to independent bipedal walking, were conducted to identify the biomechanical factors of the neuro-muscular system necessary to acquire bipedal walking. We simulated the autonomous acquisition of independent walking by repeating walking trials and modifying neuronal structures and parameters so that walking efficiency is maximized, and forces supporting the upper body are minimized. The results of simulation showed that reinforced interaction with the system of body dynamics, such as feedback from somatic senses, especially information concerning angular velocities of joints, is essential to the development of walking. Other significant factors for bipedal walking are the development of neuronal feedback about the hip joint position, which determines the posture of the upper body, and improvements in the extensors' ability to produce joint moments.

A model to generate autonomous bipedal walking is proposed; a walking motion is generated through the mutual entrainment between neural oscillations and the pendulous movement of body dynamics. However, in the past model, the initial structure of neural systems had to be determined by trial and error. In this paper, based on the process of human motor training, the structure and parameters of the neural system were determined autonomously. The structure of the neural network and the weights of the connections were encoded by a length-variable chromosome in genetic algorithms. They were searched so as to acquire a walking pattern gradually through some stages from supported walking (i.e., infant walking aided by parents) to independent walking. As a result, we could autonomously acquire the structure and parameters for a neural system generating bipedal walking without any artificial trial and error. Therefore, we improved the practical use of this movement generating model.

This study investigated minimal muscle strength on knee extension as well as muscle endurance required for independent walking. Seventy-seven elderly (29 males and 48 females, mean age: 81.3 years) participated in this study. Subjects were divided into two groups (the independent group and the dependent group) based on the Barthel index score. We measured muscle strength and muscle endurance on knee extension. Muscle endurance was evaluated using the‘sit-to-stand’test which measured the number of times the subject could rise from a chair within 30 sec. Muscle strength on knee extension was evaluated as a percentage of body weight, calculated from the maximal isometric strength of the knee extensors. The results showed a significant difference in muscle strength on knee extension and the number of repetitions on the ‘sit-to-stand’test (p

International audience; : The spatiotemporal features of walking in toddlers are known to be related to the level of maturation of the central nervous system. However, previous studies did not assess whether there could be an effect of clothes on the acquisition of walking. In this study, it was hypothesized that clothes modify the toddlers' walking. To test this hypothesis, 22 healthy toddlers divided into 3 groups of walking experience were assessed in four clothing conditions (Diaper+Trousers; Diaper+Pants of tracksuit; Diaper; Underwear). Results revealed significant effects of clothing on velocity and step length of toddlers from 6 to 18 months of walking experience. These results suggested that biomechanical constraints induced by the textile features alter the walking of toddlers. Therefore, in studies of toddler's gait, the clothing worn should be carefully mentioned and controlled.

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.

In this longitudinal study, the development of automatic postural responses elicited during stance following perturbation of the support surface was investigated. Infants (N = 9) unable to stand without support were tested initially: follow-up tests were performed until the infants were able to stand and walk independently. Surface electromyographic recordings of leg and trunk muscle activity following a postural perturbation induced by a forward or backward translation of the support surface were made for each infant. Muscle onset latencies following the perturbation and the proportion of trials in which muscle activity was recorded were determined. First, infants activated appropriate muscles either in isolation or in pairs and then combined these muscles into functional synergies. Although activation of all three postural muscles was recorded in infants before they were able to stand and walk independently, the three-muscle response was not consistent in the youngest children. The proportion of trials eliciting muscle activity continued to increase (p

Human stepping movements emergein uteroand show several milestones during development to independent walking. Recently, imaging has become an essential tool for investigating the development and function of pattern generation networks in the spinal cord. Here we examine the development of the spinal segmental output by mapping the distribution of motoneuron activity in the lumbosacral spinal cord during stepping in newborns, toddlers, preschoolers, and adults. Newborn stepping is characterized by an alternating bilateral motor output with only two major components that are active at all lumbosacral levels of the spinal cord. This feature was similar across different cycle durations of neonate stepping. The alternating spinal motor output is consistent with a simpler organization of neuronal networks in neonates. Furthermore, a remarkable feature of newborn stepping is a higher overall activation of lumbar versus sacral segments, consistent with a rostrocaudal excitability gradient. In toddlers, the stance-related motor pool activity migrates to the sacral cord segments, while the lumbar motoneurons are separately activated at touchdown. In the adult, the lumbar and sacral patterns become more dissociated with shorter activation times. We conclude that the development of human locomotion from the neonate to the adult starts from a rostrocaudal excitability gradient and involves a gradual functional reorganization of the pattern generation circuitry.

Introduction: Many studies have been observing infants at the onset of walking in order to evaluate the development of different strategies and coordination [1–3]. These studies regard most of the times small groups (

Objectives The aims of the study were to organise a program of guided walking for sedentary subjects, to analyse the changes of some risk factors for cardiovascular diseases after one year of walking and to check the permanence of unsupervised walking practice months after the program was over. Methods 650 adults and elderly subjects, declaring only occasional physical activity, were enrolled. Weight, height, waist circumference, systolic and diastolic blood pressure and walking speed (measured on a 100 metres course, at an intensity of 12-14 on the Borg scale) were determined at enrolment. Subjects were invited to walk as frequently as possible alone or with one of the several walking groups organised for the project. Walking groups were active five days a week with walking sessions of approximately one hour. The variables measured at enrolment were re-determined after one year. Sixteen month after the end of the project the participants completing the program fill in a questionnaire on the weekly walking hours they were still doing. Results 326 subjects (212 women and 114 men) walked from three to seven days a week and completed the one-year project. After 12 months of walking, highly significant reductions of body weight, BMI, waist circumference, systolic and diastolic blood pressure and highly significant increase in walking speed were documented1(Table 1). Identical results were obtained for both women and men. Sixteen months after the end of the project 258 subjects declared 170 ± 110 minutes a week of independent walking (Figure 1), a time superimposable to the one indicated by the 2008 Physical Activity Guidelines for Americans. Conclusions One year of guided walking has been followed by highly significant reductions of some risk factors for cardiovascular diseases and by a highly significant improvement of the walking speed. Sixteen months after the end of the project, 77% of the participants were independently maintaining the walking practice, indicating that guided walking is effective in permanently modifying the lifestyle of sedentary subjects. Acknowledgments Supported by the Italian Ministry of Education and Scientific Research and the Ministry of Sport. References Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials. Prev Med. 2007;44(5):377–85.

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

Aim Children with Down syndrome have delayed motor development relative to their peers. Estimates of this effect vary in the literature, from 40% of children walking independently by 24 months, to 50% of children walking by 1 year, and many possible causes have been suggested. In terms of management, early physiotherapy is popular with parents; moreover it is recommended, in part for future benefit, within Down syndrome guidelines in the UK, Europe and the USA. However, there is increasing opinion that children with Down syndrome do not benefit from routine physiotherapy and, as such, it is not routinely offered to all children in the UK. The aim of this retrospective study was to identify whether children with Down syndrome who received physiotherapy had an earlier age of independent walking than those who did not. Methods The database of children attending the Down syndrome clinic at St George’s Hospital (United Kingdom) was reviewed. Motor outcome was measured by the age at which healthy children achieved independent walking. Comparative testing was performed between the group that received physiotherapy versus those who did not. Results Results did not demonstrate any significant difference in walking age between the physiotherapy group (n = 11) who walked at a mean of 27.7 months, compared with the non-physiotherapy group (n = 18) who walked at a mean of 22.6 months (p = 0.09). When measuring the number of patients who were mobile at the age of 2 years, 55% of patients who received physiotherapy were walking independently, versus 66% of patients who did not receive physiotherapy. Conclusion Early physiotherapy was not associated with earlier age of walking in children with Down syndrome. This supports our current local practice that physiotherapy should not be offered routinely, and is in contrast with the major guidelines on management of Down syndrome. The observations from this study demonstrate a pressing need for further research, which should be prospective and multi-centre in nature.

Purpose: To develop and clinically evaluate a novel assistive walking system, the Wearable Power-Assist Locomotor (WPAL). Methods: To evaluate the performance of WPAL, a clinical trial is conducted with four paraplegic patients. After fitting the WPAL, patients learned to use the WPAL. The length and duration of independent walking was measured and compared to conventional orthosis (Primewalk). Results: After training, all patients were able to stand, sit, and walk independently with the WPAL. Compared to a conventional orthosis (Primewalk), the duration and distance of independent ambulation increased. The physiological cost index (PCI), perceived exertion and EMG of upper extremities decreased. Conclusions: WPAL might greatly enhance the possibility of restoration gait to paraplegic patients.Implications for RehabilitationWPAL is developed to provide independent and comfortable walking for spinal cord injury patients.WPAL is less demanding physically than conventional orthosis (Primewalk).Even patients ...

Many studies have been observing infants at the onset of walking in order to evaluate the development of different strategies and coordination [Kubo, 2006, Roncesvalles, 2000, Yvanenko, 2005]. These studies regard most of the times small groups (20) using inertial sensors over a 5-months period after onset of independent walking (period in which the most dramatic changes of maturation of many gait parameters occurs [Yvanenko, 2007]. This database will allow evaluating the changes in gait temporal parameters, postural stability and coordination at the beginning of independent walking. Moreover it will permit to evaluate when and how the development of pendulum mechanism occurs. The results presented here are only preliminary because they refer to five infants and only one test for each one.

This study analyses the incidence of anatomical (mass, height, inertia) and mechanical (gravity) parameters on the duration of gait initiation, from a standing posture, in children. Twenty-one children, aged 4, 6 and 8 years, participated in the study. Experimental and theoretical values of the duration of gait initiation are compared. The experimental data are computed from children's gait executed on a force plate. The theoretical data are computed by using an inverted-pendulum model. The results show that (1) duration of gait initiation is independent of gait velocity, as it is in adults; (2) the experimental values are very close to the theoretical values. These findings suggest that children's biomechanical constants are determining factors for initiating movement. It is hypothesized that the capacity to combine and adapt properties of the body with dynamics of the context is acquired through practice of independent walking.

O objetivo do presente estudo foi comparar as variáveis espaço-temporais entre o andar para frente (AF) e para trás (AT) em indivíduos com hemiparesia. Dez participantes com hemiparesia crônica (30,6±25,1 meses), comprometimento motor leve (20-31 pontos no Fugl-Meyer-membro inferior), bom equilíbrio (escore=50±7 na escala de Berg) e marcha independente (capaz de caminhar 10 metros sem auxilio) foram filmados caminhando em velocidade confortável, com marcadores reflexivos nos maléolos laterais. As variáveis comprimento, duração e velocidade da passada, bem como duração do apoio foram analisadas pela ANOVA com 2 fatores: tarefa e membro inferior. O comprimento da passada foi menor (~44cm) no AT do que no AF (F(1,18)=130,94; p≤0,001), assim como a velocidade da passada (F(1,18)=163,78;p≤0,001) e da marcha (t19=10,99;p≤0,001). A duração da passada e do apoio foram respectivamente maiores, ~0,18s e ~8%, no AT do que no AF, (F(1,18)=11,98; p=0,003; F(1,18)=32,00; p≤0,001, respectivamente). Embora o comprimento da passada do AT seja reduzido, o maior tempo do MI parético suportando o peso do corpo no AT pode ser um indicador relevante na reabilitação motora. The present study aimed to compare spatial temporal variables between forward (FW) and backward walking (BW) in individuals with hemiparesis. Ten adults with chronic hemiparesis (30.6±25.1 months), mild motor impairment (20-31 points on Fugl-Meyer lower limb test), good balance (score=50±7 in the Berg scale) and independent walking (able to walk 10 meters without aid) were videotaped walking at comfortable speed with reflexive markers placed on lateral malleolus. The variables stride length, duration and speed and stance phase duration were analyzed with a two-way ANOVA: task and lower limb (LL). Stride length was lower (~44cm) in BW than in FW (F(1,18)=130,94; p≤0,001), as well as for stride (F(1,18)=163,78;p≤0,001) and walking speed (t19=10,99;p≤0,001). Stride and stance duration were ~0,18s e ~8%, respectively larger in BW than in FW (F(1,18)=11,98; p=0,003; F(1,18)=32,00; p≤0,001, respectively). Although the stride length in BW was reduced, the fact that the affected LL remained longer in stance in BW compared to FW indicates that the BW might be a relevant parameter in motor rehabilitation.

Patients after stroke who are nonambulatory require resources, and independent walking becomes a major determinant of the ability to participate in activities of daily living. Our objective was to determine the probability of walking for patients who are nonambulatory in the first month after stroke. We performed a systematic review and meta-analysis of consecutive, prospective studies of nonambulatory patients within the first month after stroke in rehabilitation and acute units. The outcomes were the probability of achieving independent walking at three-, six- and 12 months after stroke. Twenty-six studies were included in the review. Seventeen studies comprising 2856 participants were entered into meta-analyses. For initially nonambulatory stroke patients managed in a rehabilitation unit, the probability of independent walking was 0·60 (95% CI 0·47–0·74, 1373 participants) at three-months, 0·65 (95% CI 0·53–0·77, 444 participants) at six-months and 0·91 (95% CI 0·81–1·00, 24 participants) at 12 months. For patients managed in an acute unit, the probability of independent walking was 0·39 (95% CI 0·27–0·52, 634 participants) at three-months, 0·69 (95% CI 0·46–0·92, 405 participants) at six-months and 0·74 (95% CI 0·59–0·88, 34 participants) at 12 months. 60% of patients managed in a rehabilitation unit who are nonambulatory in the first month after stroke will regain independent walking compared with 39% of those managed in an acute unit. This information can be used clinically to make decisions about allocation of rehabilitation resources, education of patients and carers, and for discharge planning.

Productive vocabulary was measured every four months in 16- to 28-months-olds. Attainment of motor-milestones was also measured. An earlier age of sitting and walking predicted a higher intercept and a larger slope (growth) of productive vocabulary respectively, suggesting that attainment of walking propels linguistic development.

In this article, a simple CPG network is shown to model early infant walking, in particular the onset of independent walking. The difference between early infant walking and early adult walking is addressed with respect to the underlying neurophysiology and evaluated according to gait attributes. Based on this, we successfully model the early infant walking gait on the NAO robot and compare its motion dynamics and performance to those of infants. Our model is able to capture the core properties of early infant walking. We identify differences in the morphologies between the robot and infant and the effect of this on their respective performance. In conclusion, early infant walking can be seen to develop as a function of the CPG network and morphological characteristics.

OBJETIVOS: Investigar o processo de locomoção em pacientes com osteogênese imperfeita (OI) e os fatores que o influenciam, sublinhando pontos clínicos relevantes à reabilitação motora. MÉTODOS: Estudo transversal, retrospectivo, realizado no ambulatório de fisioterapia motora do Instituto Fernandes Figueira. Foram incluídos todos os pacientes com diagnóstico clínico de OI. Foram excluídos os que apresentavam comorbidades e idade inferior a dois anos. Utilizou-se o Epi-Info versão 3.4 para construção do banco de dados e o SPSS versão 15 para análise estatística. Foi calculado risco relativo para mensurar associação de características clínicas com a marcha independente, adotando-se nível de significância de 5% para as análises. RESULTADOS: Foram incluídos 69 pacientes. Dentre eles, 43,5% tinham OI tipo I; 37,7% tipo III e 18,8% tipo IV. 76,8% apresentavam deformidades em ossos longos. Observou-se associação negativa entre hipotonia, número de fraturas e marcha independente e positiva entre marcha independente e OI tipo I. CONCLUSÕES: A clínica fisioterápica, como complementar à ortopédica e à administração de fármacos da família dos bifosfonatos, é de fundamental importância para a reabilitação da capacidade motora dos indivíduos com OI. Nivel de Evidência, estudos transversais. OBJECTIVES: Investigation of the locomotion process in patients with osteogenesis imperfecta (OI), and the factors that influence it, with special attention to clinical aspects relating to motor rehabilitation. METHODS: a retrospective, cross-sectional study was carried out at the physical therapy outpatient clinic of the Instituto Fernandes Figueira. All patients with a clinical diagnosis of OI were included. Patients with other diseases, and those aged under two years, old were excluded. Epi-Info version 3.4 was used to construct the database, and SPSS version 15 for the statistical analysis. RESULTS: The odds-ratio was used to measure the association between independent walking and clinical characteristics, adopting a level of significance of 5% for the analysis. Results: 69 patients were included. Of these, 43.5% were classified as OI type I; 37.7% as type III and 18.8% as type IV. 76.8% presented long bone deformities. A negative association was observed between hypotonia, number of fractures, and independent walking. A positive association was observed between independent walking and OI type I. CONCLUSIONS: physical therapy, as a complementary approach to orthopedics, and the administration of medications of the biophosphonates class, are of fundamental importance for the rehabilitation of motor capacity of individuals with OI. Level of Evidence, cross sectional.

This article describes developmental changes in gait velocity and relates these changes to gait parameters that index postural stability (step width and lateral acceleration) and two components of velocity (cadence and step length). Five children were observed longitudinally over a 2-year period after onset of independent walking. Their range of speed increased threefold in the first 6 months of independent walking and then remained constant. In contrast, step width decreased approximately twofold. Whereas in adults, cadence and step length contribute approximately equally to speed, when infants first begin to walk independently, increase in velocity is due mostly to increased step length. After 5 months of independent walking, the pattern reverses, and increase in velocity is due primarily to increased cadence. The pattern remains constant over the next 18 months. From a developmental point of view, the data lead us to interpret early walking (the first 5 months) as a process of integration of postural constraints into the dynamic necessities of gait movement. A second phase, beginning after 4 to 5 months of independent walking, is considered to be a tuning phase characterized by a more precise adjustment of the gait parameters.

The development of efficient and independent walking is an important therapeutic goal for many children with cerebral palsy (CP). Consequently, there has been growing interest in determining the effects of treadmill training programs for these children.A systematic review of the literature was conducted to evaluate the effectiveness of treadmill training for children with CP. Relevant trials were identified by searching electronic databases and by citation tracking.Of 125 papers initially identified, five met the criteria for review. Results showed that treadmill training is safe and feasible for children with CP across a wide range of ages and functional abilities. Children with more severely affected walking ability significantly increased their walking speed (d = 1.48, 95% CI: 0.49-2.40) and gross motor performance (d = 1.5, 95% CI: 0.50-2.50) after training. However, the results also suggested that treadmill speed and length of training sessions might need to be set to specifically match desired intervention goals such as increasing walking speed or endurance.The review suggests that treadmill training is safe and feasible for children with CP and indicates that there may be some positive benefits in walking speed over short distances and in general gross motor skills. The provision of PBWS may be particularly beneficial for children with more severe walking disability (GMFCS III and IV). Further research is necessary before it can be concluded that treadmill training is beneficial for children with CP.

OBJETIVO: Determinar as idades cronológica e corrigida de aquisição das habilidades motoras até a marcha independente em prematuros de muito baixo peso e avaliar até quando é necessário o uso da idade corrigida. MÉTODOS: Estudo longitudinal de prematuros < 1.500 g e com idade gestacional < 34 semanas, sem alterações neurossensoriais, selecionados no ambulatório de seguimento de recém-nascidos de alto risco do Hospital das Clinicas da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu (SP), no período de 1998 a 2003, e avaliados a cada 2 meses até a aquisição da marcha independente. RESULTADOS: Dos 155 prematuros incluídos, 9% foram excluídos, sendo estudados 143 pacientes. A idade gestacional média foi 30±2 semanas, o peso ao nascimento, 1.130±222 g, 59% foram do sexo feminino e 44%, pequenos para idade gestacional. Os prematuros controlaram a cabeça no 2º mês, sentaram sem apoio aos 7 meses e andaram com 12,8 meses de idade corrigida, correspondendo respectivamente ao 4o, ao 9o e ao 15o mês de idade cronológica. Para todas as habilidades motoras houve diferença significativa entre idade cronológica e corrigida. Prematuros pequenos para idade gestacional adquiriram suas habilidades mais tardiamente, porém dentro do limite esperado. CONCLUSÕES: Prematuros de muito baixo peso, sem alterações neurossensoriais, adquirem as habilidades motoras dentro do prazo previsto para a idade corrigida. A correção da idade deve ser feita até a aquisição da marcha independente. OBJECTIVE: To determine chronological and corrected ages at acquisition of motor abilities up to unaided walking in very low weight preterms and to determine up to what point it is necessary to use corrected age. METHODS: This was a longitudinal study of preterms with birth weight < 1,500 g and gestational age < 34 weeks, free from neurosensory sequelae, selected at the high-risk infants follow-up clinic at the Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP) in Botucatu, Brazil, between 1998 to 2003, and assessed every 2 months until acquisition of unaided walking. RESULTS: Nine percent of the 155 preterms recruited were excluded from the study, leaving a total of 143 patients. The mean gestational age was 30±2 weeks, birth weight was 1,130±222 g, 59% were female and 44% were small for gestational age. Preterms achieved head control in their second month, could sit unaided at 7 months and walked at 12.8 months' corrected age, corresponding to the 4th, 9th and 15th months of chronological age. There were significant differences between chronological age and corrected age for all motor abilities. Preterms who were small for their gestational age acquired motor abilities later, but still within expected limits. CONCLUSIONS: Very low weight preterms, free from neurosensory disorders, acquired their motor abilities within the ranges expected for their corrected ages. Corrected age should be used until unaided walking is achieved.

This study examined the effect of the frequency of physical therapy on the outcome of infants referred for delayed motor development due to joint hypermobility and benign hypotonia. The study groups comprised 29 infants (8-12 months) who were randomly placed into a monthly and weekly treatment groups. No difference was found between the 2 study group scores on the different tests at all assessment points. However, assessment of walking at the age of 15 months revealed a clear advantage of the infants who were treated weekly. Our study demonstrated a minor benefit of weekly treatment protocol only in the achievement of independent walking in children with joint hypermobility and benign hypotonia. It did not prove an advantage of weekly physical therapy. It seems that monthly physical therapy combined with a home treatment protocol implemented by the primary caregivers is sufficient to achieve motor catch-up.

It is possible for the visually impaired to walk their known area independently by using a white cane. However, in their unknown area, they cannot walk without help of others even if they can use a white cane very well. In such cases, not only a visually impaired person but he/she who assists them receives many stress in dairy activity. Therefore, many types of independent walking assist system for the visually impaired are developing. Our objective of this study is the development of an auto navigation system for the visually impaired which assists independent walking of them. This system measures the position of a visually impaired person (a user) by using GPS (Global Positioning System) and navigates him/her to the destination like as a car navigation system. In our system, a location data is stored in the map database and a position of user are analyzed and optimal route for a user to the destination is calculated. Our system guides a user to the destination along this route, and notifies the user of this route and some information for the safety walking by artificial voice. Three normal subjects were tested with our navigation system. All subjects were blind folded by an eye mask and equipped a navigation system. As a result, our system worked well and all subjects were able to walk to the destination following guidance voice. So, we are developing a new navigation system which is installed on a cellular phone. In Japan, there are some cellular phones that include GPS. And most of application programs for cellular phone are written by JAVA. Therefore, GPS included in a cellular phone will be used and every functions of the navigation system will be written by JAVA. In this paper, we also reports about this new navigation system.

This study is part of a research program that aims at a better understanding of the influence of individual morphological differences and physical growth on development of independent walking in toddlers. As morphometric and segment inertial parameters for toddlers aged between 15 and 36 months are indispensable for the mechanical analyses inherent to this purpose, parameter data were collected. The provided dataset of morphological and segment inertial parameters is a valuable tool for locomotor biomechanical modelling. Analysis of the parameter data showed that there are substantial changes of most segment inertial parameters across body length and body mass. In addition, a classification system was developed to categorize toddlers on the basis of morphometry, reflecting the segment inertial constitution of the child. A principal components analysis (PCA) was applied to define the variance in physique between the children. PCA resulted in three newly composed variables: the 'Axis of chubbiness', the 'Axis of allometric growth' and the 'Axis of relative limb length'. The three axes are plotted against each other, resulting in eight morphological classes. With this classification the morphotype of toddlers between 15 and 36 months can be specified and used for further research on their walking patterns.

Background It is not uncommon for post stroke patients or their caregivers to ask the attending physiotherapist when the patient would regain ability to walk. This is often difficult to predict as many clinical and non-clinical factors influence when this function is accomplished. Objective To investigate the influence of some clinical and psychosocial factors on the time post stroke individuals commence independent walking. Methods The one-group, pre-experimental study carried out in a teaching hospital facility involved 27 (14 males and 13 females) fully conscious, unilateral, first-episode stroke patients admitted to the facility and referred for physiotherapy over 5 months. A daily, structured physiotherapy care including Bobath technique was administered on the patients for 12 weeks. Ages, marital status, years of formal education, occupation, personality type (Eysenck classification), level of disability, co-morbid factors and admission-referral interval were obtained. Main outcome measure was time taken to attain ability to walk a continuous, level floor 10m distance unaided. Results The mean time independent walking was attained was 7.4 ± 2.6 weeks. Participants with mild disability level at baseline commenced independent walking significantly earlier (4.00 ± 0.01 weeks) than those with moderate disability (7.72 ± 2.53 weeks). Independent walking attainment time showed no significant difference (p>0.05) across the psychosocial factors. A significant relationship were found between age (r = - 0.57), functional independence measure (r = - 0.55) and commencement of independent walking. Conclusion Age and the initial level of disability had significant influence on commencement of independent walking by the participants. Introduction Il n\'est pas inhabituel pour les patients victimes d\'un accident vasculaire cerebral (AVC) et pour leur soignants, de demander aux reeducateurs fonctionnels le delais permettant la reprise de la marche. Ce delai est souvent difficile a prevoir compte tenu des facteurs multiples, a la fois cliniques et non cliniques intervenant dans cette fonction motrice. Objectif L\'objectif est de definir quelques facteurs cliniques et psychologiques influencant la duree de recuperation post-AVC permettant l\'autonomie de la marche. Methodes Un groupe preliminaire a ete etudie dans un centre hospitalier universitaire et concernaient 27 patients (17 mâles et 13 de sexe feminin) conscients, presentant un deficit unilateral apres un premier episode d\'accident vasculaire. Il ont ete suivis dans un centre de physiotherapie durant cinq mois. Une prise en charge quotidienne incluant la technique de Bobath a ete instituee pendant douze semaines. Les parametres suivants ont ete etudies : âge, statut marital, niveau de formation et d\'education, profession, personnalite (classification d\'Eysenck), degre d\'invalidite, facteurs de co-morbidite, et de delai de prise en charge. La principale mesure attestant de la capacite a marcher de maniere continue a ete une marche continue, sur distance plane de 10 metres, sans aide. Resultats Le temps moyen de reprise de la marche sans aide etait de 7.4 ± 2.6 semaines. Les patients avec un handicap moyen ont eu une recuperation plus precoce modere (4.00 ±0.01 semaines) que ceux qui avaient un handicap (7.72 ± 2.53 semaines). Les facteurs psychosociaux n\'etaient pas significatifs (p>0.05). Une relation a ete objectivee entre l\'âge (r = - 0.57), le degre d\'independance (r = - 0.55), et le debut de la marche de maniere autonome. Conclusion L\'âge et le degre d\'invalidite avaient une influence significative sur le delai de reprise d\'une marche autonome. Keywords : Africa, Independent Walking, Psychosocial, Stroke African Journal of Neurological Sciences Vol. 25 (1) 2006: pp. 59-66

Objective To evaluate whether very early treatment in our patients would result in better clinical outcomes and to compare these data with other infantile-onset Pompe disease (IOPD) cohort studies. Methods In this nationwide program, 669 797 newborns were screened for Pompe disease. We diagnosed IOPD in 14 of these newborns, and all were treated and followed in our hospital. Results After 2010, the mean age at first enzyme-replacement therapy (ERT) was 11.92 days. Our patients had better biological, physical, and developmental outcomes and lower anti-rh acid α-glucosidase antibodies after 2 years of treatment, even compared with one group that began ERT just 10 days later than our cohort. No patient had a hearing disorder or abnormal vision. The mean age for independent walking was 11.6 ± 1.3 months, the same age as normal children. Conclusions ERT for patients with IOPD should be initiated as early as possible before irreversible damage occurs. Our results indicate that early identification of patients with IOPD allows for the very early initiation of ERT. Starting ERT even a few days earlier may lead to better patient outcomes.

Background It has been reported that only half of the non-ambulatory stroke patients admitted to inpatient rehabilitation in Australia learn to walk again 1. Treadmill walking with partial weight support via an overhead harness is a relatively new intervention that is designed to train walking. The main objective of this randomised controlled trail is to determine whether treadmill walking with partial weight support via an overhead harness is effective at establishing independent walking (i) more often, (ii) earlier and (iii) with a better quality of walking, than current physiotherapy intervention for non-ambulatory stroke patients. Methods A prospective, randomised controlled trial of inpatient intervention with a 6 month follow-up with blinded assessment will be conducted. 130 stroke patients who are unable to walk independently early after stroke will be recruited and randomly allocated to a control group or an experimental group. The control group will undertake 30 min of routine assisted overground walking while the experimental group will undertake 30 min of treadmill walking with partial weight support via an overhead harness per day. The proportion of participants achieving independent walking, the quality of walking, and community participation will be measured. The study has obtained ethical approval from the Human Research Ethics Committees of each of the sites involved in the study. Discussion Given that the Australian population is ageing and people after stroke can expect to live for longer, attainment of safe, independent walking is more likely to be associated with long-term health and well being. In its National Research Priorities, the Government has recognised that it will be important to promote healthy ageing and that this endeavour will be underpinned by research. The results of this study will clearly identify effective intervention to establish early quality walking, thereby promoting an increase in community participation in the longer term. Trial Registration The protocol for this study is registered with US NIH Clinical trials registry (NCT00167531)

We describe new Fourier- and shape-based methods for quantifying variation in phase-portraits, and re-analyze previously-published ontogenetic and adult data [Clark, J. E., & Phillips, S. J. (1993). A longitudinal study of intralimb coordination in the first year of independent walking: A dynamical systems approach. Child Development, 64, 1143–1157]. Results show considerable variation between individuals and through development, but after 6 months of walking some gait patterns stabilize.

Insight into neuromuscular control of movement is gained through an understanding of the mechanical causes of movement. Data on new walkers' net joint moments is scarce, however, although those moments can be considered the direct cause of movement. The authors' goal in this research project was to characterize net joint moments in toddlers (N = 10) during the first 5 months of independent walking and to discuss their role in mechanical control of walking. The authors modeled leg segments as oscillating pendulums fixed at the proximal joint and investigated the relationship between force and movement. Their investigation revealed that at the onset of independent gait, walking was primarily hip driven. Furthermore, the toddlers seemed to experience problems in uncoupling active and passive control around the joints. Changes in mechanical control of walking were observed after 3 to 4 months of independent walking. The changes were more obvious at the hip and the knee joint than at the ankle.

Physical rehabilitation of children with spinal cord pathology remains one of the most complicated and advanced methods in medical and social rehabilitation providing extensive use of orthoses systems. Objective: To determine the effectiveness of the orthosis with reciprocal mechanism for the recovery of walking function in children with consequences of vertebral and spinal cord injuries, disease and congenital abnormalities of the spinal cord. Methods: A five-year comparative analysis of the results of a clinical, radiological and physiological study in 31 children with the consequences of vertebral-spinal trauma, disease and congenital abnormalities of the spinal cord was carried out. Pa­tients of the main group (17 children) rehabilitated with reciprocal orthosis according to the developed program of rehabilitation. Children in the control group (14) used the conventional locking orthosis systems. Results: greater efficiency of using of the orthosis with the reciprocal mechanism for the rehabilitation of children with pathology of the spinal cord was established comparing to conventional locking orthosis systems. Reciprocal walking in orthoses with reciprocal mechanism facilitated decreasing an abnormal muscle tone, increasing strength of preserved muscula­ture, the compensation level of the motor deficits, general motor activity and independence of the patients from the assistance which has led to the recovery of the functions of self-walking in reciprocal orthosis in 76.5 % of children. In the control group an independent walking has not been mastered by none of the patients. Conclusion: The efficiency of reciprocal orthosis in rehabilitation of patients with lack of walking function due to pathology of the spinal cord allows you to recommend the pro­posed system of rehabilitation and these orthoses for increasing the effectiveness of rehabilitation measures.

An increasing number of studies have examined the development of walking in preterm infants; however, the results concerning those who had no major neonatal disease were inconclusive. This study was therefore aimed to examine the age of onset, the quality of early walking movement, and the sensitivity to resonant period of the force-driven harmonic oscillator (FDHO) model in preterm infants who had no major neonatal disease and normal term infants. Twenty-nine preterm infants and 29 term infants were prospectively examined for their age of onset of independent walking and were subsequently assessed the qualitative features of walking at 18 months of corrected age using kinematic analysis. Kinematic variables examined included spatio-temporal organization, inter-joint coordination, and inter-limb coordination. The anthropometric data were used to calculate the resonant period. The results demonstrated that the preterm infants attained independent walking at significantly older ages than the term infants when corrected for prematurity. The preterm infants manifested similar walking characteristics, except for shorter stride lengths, at 18 months of corrected age compared with the term infants. Furthermore, the stride periods of both groups were accurately predicted by the resonant period of the FDHO model. We conclude that preterm birth without accompanied major neonatal disease may affect infants' age of onset and spatial organization but not their sensitivity to resonance during the early stage of walking development.

To review what predictors are of positive or negative value in the rehabilitation procedure following hip fractures.Reviewing a doctorial thesis on prognosis and rehabilitation of elderly with a hip fracture from 1980 and then review the literature on this subject for the following quarter of a century.In the Western world the short-term prognosis for early return home after sustaining a hip fracture depends on the success of the operation allowing independent walking and basic activities of daily life, no debilitating disease and having someone at home. The one-year prognosis for having returned and remained at home requires a reasonable good health irrespective of living alone and a somewhat deteriorated hip function.It is difficult to make comparisons with studies of other populations and other time periods. Different predictors of the rehabilitation are used and the definitions of these are not always the same. They are of varying weight, can change with time and may be interdependent of each other. For example, general medical condition and age are strongly interrelated predictors but age alone is less important than concomitant disease for the success of the rehabilitation. Nevertheless, already on admission of a patient with a fresh hip fracture a reliable prognosis can be done. However, such a prediction must be guided by ethical, social and scientific concerns.

The transition from sitting to walking is a major motor milestone for the developing postural system. This study examined whether this transition to walking impacts the previously established posture (i.e., sitting). Nine infants were examined monthly from sitting onset until 9 months post-walking. Infants sat on a saddle-shape chair either independently or with their right hand touching a stationary contact surface. Postural sway was measured by sway amplitude, variability, area, and velocity of the center of pressure trajectory. The results showed that for all the postural measures in the no-touch condition, a peak before or at walk onset was observed in all the infants. At the transition age, when peak sway occurred, infants' postural sway measures were significantly greater than at any other age. Further, infants' postural sway was attenuated by touch only at this transition. We suggest that this transient disruption in sitting posture results from a process involving re-calibration of an internal model for the sensorimotor control of posture so as to accommodate the newly emerging bipedal behavior of independent walking.

This study aims at giving an insight into the causative forces of walking in toddlers. Therefore, joint angle, moment and power profiles of 10 toddlers with less than 6 months of walking experience are compared to the stereotype adult patterns. In general, joint moments are small, which can be explained both by the small size of toddlers and differences in walking strategy. Also mass specific powers are reduced due to the low average walking speed. Balance problems in toddlers lead to a dominance of hip and knee extending moments throughout stance. The joint moment profiles are characterized by a reduced complexity, which might suggest an immature control of movement. Another feature of toddler gait is that virtually no power is generated at the ankle joint prior to foot-off (no active push-off). We also examined the effect of walking experience on the toddler gait pattern. In general, an evolution towards a more mature gait becomes evident after 4 months of independent walking. Changes are observed in step-time parameters, ankle dorsiflexing moment and power absorption at the hip joint. (c) 2004 Published by Elsevier B.V.

To study the relationship of the parachute responses to the age of independent walking, three groups of infants were prospectively examined: a normal sitting, normal walking group; a late sitting, normal walking group; and a late sitting, late walking group. All other spheres of the neurodevelopmental examination were normal. It was found that when the parachute responses appeared by age 10 months in the late sitting infants, most of them would achieve independent walking by 15 months. A delay in the parachute reactions in these infants predicted a delay in walking.

The inverted pendulum model in which the centre of mass of the body vaults over the stance leg in an arc represents a basic mechanism of bipedal walking. Is the pendulum mechanism innate, or is it learnt through walking experience? We studied eight toddlers (about 1 year old) at their first unsupported steps, 18 older children (1.3-13 years old), and ten adults. Two infants were also tested repeatedly over a period of 4 months before the onset of independent walking. Pendulum mechanism was quantified from the kinematics of the greater trochanter, correlation between kinetic and gravitational potential energy of the centre of body mass obtained from the force plate recordings, and percentage of recovery of mechanical energy. In toddlers, these parameters deviated significantly (P, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

Electromyographic (EMG) recordings of the lower limbs were made from a girl from 3 weeks after birth until 7 years of age to determine EMG changes in the development of human bipedal locomotion. Recordings were taken from the tibialis anterior (TA), lateral gastrocnemius (LG), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), and gluteus maximus muscles. In each of three developmental stages of gait, primitive walking, supported walking, and independent walking, muscle activity progressed from excessive co-contraction of mutual antagonists to reciprocal patterns. For the stance limb, the predominant reciprocal pattern to emerge was continuous activity of the posteriorly located LG and BF as opposed to the anteriorly located TA and RF. In independent walking this preponderance of maintained activity by the LG and BF in stance phase gradually waned over the first 2 years of walking to focused bursts of activity. The developmental changes observed in this girl appear to have been attributable to changes in posture reflecting increased strength and to improvements in control of balance reflecting neuromaturation.

In order to describe foot function during the first weeks of independent walking, spatio-temporal pressure distribution patterns were measured. These data give detailed information about roll-off of the foot, by determining the course of the center of pressure, and about load bearing, by calculating relative vertical impulses under the feet. During those first weeks of independent walking, roll-off is very unstable. Although infants can occasionally perform a mature roll-off, a consistent pattern has not yet developed and there is instability. To improve stability the entire plantar surface area contributes to load bearing – first, because a larger contact area will improve stability, and second, because a forward shifting of the load allows more muscular control to compensate for minor imbalances under the foot.

s / Brain Stimulation 8 (2015) 343e359 354 neurorehabilitative protocols to modulate lower limb function in the form of enhanced movement speed, a prerequisite of independent walking function.

Few guidelines promoting good health in children are available.1 Investigations into the development of standing and walking in infants who used babywalkers (wheeled seats that allow infants to move around with their feet on the floor) obtained conflicting results. Crouchman (64 infants) and Siegel and Burton (109 infants) found that the use of babywalkers was associated with delay in crawling. 2 3 In contrast, no significant differences in achieving independent walking were seen by Crouchman or by Kauffmann and Ridenour (6 sets of twins) in infants who used babywalkers compared with non-users. 2 4 Siegel and Burton, however, found that babywalker users achieve independent walking at a later age than non-users.3 We compared the …

Introduction: Prematurity may act negatively in the course of some motor slill, such as the independent walking acquisition. Objective: It is about an identify the independent walking acquisition age in premature infants of different gestational ages, distinguish the period of independent walking acquisition among the lower economic classes and compare the independent walking acquisition with data in the literature. Method: This research is characterized as a developmental study. The sample is 21 premature infants of both sexes. Assessments and individual data collection were carried out monthly and at the end of the study, at the largest child´s living environment, and that every month the parents / caregivers previously received orientation and demonstration regarding the procedure for applying the stimulation protocol, presented in an illustrative and demonstrative primer. The instrument used for the monthly assessment was the Alberta Infant Motor Scale (AIMS) and the questionnaire of the Brazilian Association of Business and Research (ABEP), to get the socioeconomic status of the children´s family. The results were analyzed using the Shapiro-Wilk test. Analyzed the age of ability to walk due to the low socioeconomic level through the Kruskal-Wallis test (C1, C2 and D). Results: When comparing the independent walking acquisition age and gestational age, the group with less than 33 weeks of gestational age acquired independent walking later than the group with gestational age between 33-37 weeks. However, it was found that the children average age of independent walking in the study was 14 ± 2 months. Comparing independent walking acquisition age and low economic levels (C1, C2 and D), the group with higher socioeconomic status (C1) acquired independent walking two months before the group with the lowest economic level. Conclusion: influenced positively the motor performance of premature infants in the acquisition of independent walking.

Data on independent walking age of 60 children aged 0-12 months living in the city of Sao Paulo were cross-analysed with some aspects of the physical and psychological organizationof the home enviromnent: presence/absence of physical and of mother-controlled conditions favouring the child’s exploratory behaviour. An analysis scheme is proposed in which the concepts of attachment and autonomy, relative to the mother-child relationship, are linked to the concepts of “place” and “space”, relative to the organization of the home environment; and both these dimensions are understood as the expression of a “developmental system” including the basicpsycho-biological organization of the mother-child dyad and its susceptibility to the belief systems and the concrete living conditions within which development takes place. A comparison with the child-rearing practices and environmental organization in a hunter-gatherer society (the Kalahari !Kungs) is used to highlight the concept of developmental system.

1. We held infants (aged 4-12 months) over a treadmill to study how they co-ordinated the two limbs during stepping. We disturbed one limb during the stance or swing phase and recorded the responses (muscle activity and movement) from both lower limbs. Manual disturbances were applied during the stance phase by sliding the foot backward, forcing the limb into the swing phase. Disturbances were also applied in the swing phase by manually extending the hip, interfering with the forward motion of the limb. Additional disturbances were applied to see if both limbs could perform the stance and swing phase synchronously. 2. When the limb was forced to initiate the swing phase on one side, the contralateral limb either prolonged its contact with the ground or quickly established ground contact. When the forward motion of the limb was interrupted in the swing phase, the swing phase was prolonged on the disturbed side and the stance phase prolonged on the contralateral side. In most cases, one leg maintained ground contact. Moreover, it was easy to elicit bilateral, simultaneous stance phase, whereas it was difficult to elicit simultaneous swing phase. In cases where swing phase in the two limbs was initiated close in time, rhythmic alternate stepping was immediately restored in the following step. 3. We conclude that human infants can generate co-ordinated motor responses bilaterally in response to unilateral perturbations, well before the onset of independent walking.