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  • Chapter 13 Seated Mobility: Sitting but Not Sitting Still—Fitting and Propelling a Wheelchair 320

  • Chapter 14 Navigating the Challenges of Ambulating 370


Getting from one place to another, or locomotion, is an important aspect of daily living. In the following chapters we explore different ways of moving forward—with wheels and with assistive gait devices—and the principles that make these activities safe and effective.

To be effective, mobility must be controlled. (Falling and rolling unstoppably down a hill in a wheelchair are both forward motions, but they are far from desirable activities.) Controlled mobility is predicated on a patient's capacity for mobility and on static stability (see diagram below).

Locomotion is accomplished by some people while standing and by others while sitting, but in either case applying some simple motor learning, communication, and biomechanical guidelines will facilitate the process (see Part 4, Box 1). The human body is designed to function most efficiently when its parts are working together, doing what they were designed to—the pattern we call “normal” or “typical” movement. But all of us have conditions or habits that can cause us to move less than optimally. If those conditions are extreme enough, we may need assistive devices and equipment to help us achieve our mobility goals.

Box 1 General Terminology

  • Locomotion is “the act of getting from one place to another.”1

  • Gait is “a particular way of moving on foot”2 (e.g., walking, jogging, running) that is “specified by the goal and nature of the task.”1

  • Walking is a form of gait in which one foot is in contact with a surface at all times and in which there is a period of double-support.

  • Running is a form of gait characterized by a “float period,” a time when neither foot is in contact with the ground surface.

  • Ambulation is a term commonly used in rehabilitation to denote walking with or without an assistive device and with or without physical assistance from another person.

In many cases, the use of an assistive device and skilled training can enable a patient to walk. In other situations, ambulation either is not possible or is not the best method for achieving a meaningful goal. When a patient is unable to walk or lacks the endurance necessary to ambulate functional distances, a wheelchair can increase a patient's functional ability. If, for example, a person is able to walk only 15 ft at a time using a walker but needs to cover greater distances more quickly as a courtroom lawyer, a wheelchair may provide that person with higher levels of participation and a better quality of life.

imageBecause the person, the task, and the environment are interrelated, a change ...

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