Table 2.

Current clinical guidelines for mobility

Age group	Guidelines		Evidence
0–11 months	1.	Assess neurologic and motor level using standardized assessment tools so there is a baseline to monitor for neurologic changes.	Clinical consensus
	2.	Assess multi-domain developmental milestone progress using standardized tools.	Clinical consensus
	3.	Refer to early intervention programs and implement physical and occupational therapy programs to optimize skill attainment in fine motor and gross motor domains.	Clinical consensus
	4.	Maximize motor development using good body alignment with an emphasis on trunk control as a first key goal.	Clinical consensus [15, 16]
	5.	Use the “Back to Sleep, Prone to Play” model that emphasizes postural control acquisition as the foundation of movement. Focus on antigravity muscle activity that engages the trunk extensors before the trunk flexors. Lack of prone positioning is linked to developmental delays in typical infants and therefore has an impact on children with disabilities.	Clinical consensus [17]
	6.	Provide a family-centered approach and, in conjunction with the family, develop strategies to incorporate mobility within the home environment and daily routine.	Clinical consensus
	7.	Use casting, splinting, and orthoses to support and maintain alignment and movement. Monitor skin according to recommended guidelines.	Clinical consensus, See guidelines for Skin and integument
	8.	Collaborate with orthopedic specialists to monitor for age specific musculoskeletal problems.	Clinical consensus and the Orthopedics guidelines
	9.	Encourage weight-bearing activities daily to promote bone health.	Clinical consensus
1–5 years $+$ 11 months	1.	Assess neurologic level and strength changes using standardized assessment tools at each clinic visit. Monitor for changes in gait, sensation, bowel and bladder function, and musculoskeletal changes.	Clinical consensus [18]
	2.	If the child is not pulling to stand, consider using a standing frame or mobility device to get him or her upright and weight bearing.	Clinical consensus
	3.	Emphasize mobility options for all children including ambulation and wheelchairs. Make sure parents are aware that all children who have the potential to walk may have some delay in achieving this milestone.	Clinical consensus [19]
	4.	Use appropriate bracing to assist weak muscles and protect the lower limbs from torque and shear forces.	Clinical consensus [20]
	5.	Ensure proper wheelchair fit, posture, and technique in children who use wheelchairs, in order to reduce energy expenditure and promote long-term function.	Clinical consensus
	6.	Have an understanding of options for durable medical equipment (DME) and consider current and future DME needs.	Clinical consensus
	7.	Encourage weight-bearing activities daily to promote bone health.
	8.	Collaborate with orthopedic specialists to monitor for age specific musculoskeletal problems.	Clinical consensus and the Orthopedic guidelines
6–12 years $+$ 11 months	1.	Assess neurologic level and strength changes using standardized assessment tools at each clinic visit. Monitor for changes in gait, sensation, bowel and bladder function, and musculoskeletal changes.	Clinical consensus [18]
	2.	Discuss with families the benefits of the different types of mobility devices including ambulation aides and wheelchairs based on predicted mobility potential.	Clinical consensus [21]
	3.	Monitor walking or wheeling ability with standardized outcome measures. Consider gait studies if ambulation is changing or information is needed on optimizing bracing.	Clinical consensus [22]
	4.	Continue flexibility, range of motion (ROM) and strengthening exercises to maintain mobility goals, whether using ambulation devices or a wheelchair.	Clinical consensus [23]
	5.	Teach independence in putting on and taking off orthoses.	Clinical consensus
	6.	Educate child about the importance of physical activity to maintain flexibility, strength and health, especially during growth years and explore adapted physical education opportunities or recreational sports options with the family.	Physical Activity Guidelines [24]
	7.	Start teaching children to be involved in their own care by educating them to watch for signs and symptoms of pressure injuries, fracture, and neurologic changes.	Clinical consensus, Self-Management and Independence Guidelines
	8.	Ensure proper wheelchair fit, posture, and technique in children who use wheelchairs, in order to reduce energy expenditure and promote long-term function.	Clinical consensus [25]
	9.	Encourage weight-bearing activities daily to promote bone health.	Clinical consensus
	Collaborate with orthopedic specialists to monitor for age-specific musculoskeletal problems.		Orthopedic Guidelines