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Introduction

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Getting from one place to another, or locomotion, is an important aspect of daily living.1 Locomotion can be accomplished with a wheelchair or on foot. Terminology associated with pedal locomotion includes the following:

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  • Gait—the process of moving on foot (e.g., walking, jogging, or running), the characteristics of which are specified by the goal and nature of the task.1

  • Walking—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.

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

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

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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 (e.g., adequate range of motion and muscle innervation) and on static stability (the ability to maintain a still position) (see Fig. 1). Image not available.

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FIGURE 1

Controlled mobility is predicated on a patient’s capacity for mobility and on static stability.

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For some people, locomotion is accomplished in standing and for others in sitting, but in either case applying some simple motor learning, communication, and biomechanical guidelines will facilitate the process. The human body is designed to function most efficiently when its parts are working together, doing what they were designed to do—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 extensive enough, we may need assistive devices and equipment to help us achieve our mobility goals.

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In many cases, skilled training with the use of an assistive device can enable a patient with restrictions in body structures or functions 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 (4.6 m) 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.

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Locomotion can also be used as a form of exercise, but locomotion ...

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