Health Column: A Move Toward Independence

For some of the youngest patients, one of the first questions that parents often ask the pediatric physical therapists at Blount Memorial’s pediatric rehabilitation clinic is when their child will roll, crawl or walk, which all are components of mobility.

The answer never is simple for us because every child develops differently, and there might be neurological, orthopedic, environmental or other factors that hinder the child’s development. The end result, though, for all patients is to try to achieve the highest level of independence possible, which could mean increasing one’s ability to move around and about.

There are several ways to aid in increasing mobility. Strengthening exercises, transitional activities, motor planning and repetition of movement patterns all are effective treatment plans. A key to successful mobility is increasing the number of repetitions for a particular movement or movement pattern, and a pediatric therapist might use the treadmill, just to name one example, to increase the number of repetitions for steps taken in a certain amount of time.

Treadmill training can be used with a wide variety of patients. It can be performed with the patient full-weight-bearing using just the treadmill, or partial-weight-bearing using a harness system for those patients who cannot tolerate all their weight in an upright position or who have the strength or coordination to take independent steps.

At Blount Memorial’s pediatric rehabilitation clinic that’s located in Alcoa, the staff uses a Lite Gait system, which was developed by Mobility Research. This system allows varying amounts of weight bearing, depending on what amount the patient can tolerate, and it can be used over a treadmill to increase the number of steps. For instance, someone walking for eight minutes at 0.8 miles per hour will go more than 500 feet. The patient also can use the harness system to walk over ground in a supported position, working on increasing stride length, strength and endurance through increasing the number of repetition of steps.

Taking steps is not the only way someone can be independent with their mobility, though. If someone is unable to walk and is wheelchair-bound, one goal might be to become independent with wheelchair mobility. The therapist teaches wheelchair-bound patients how to propel themselves in a manual wheelchair and how to use a power wheelchair. In both instances, the number of repetitions must be increased for a patient who has limited mobility to become independent.

The goal of many patients and their families -- as well as their physical therapist -- is to achieve the highest level of independence or mobility. Increasing the number of repetitions can help with this goal, whether it is rolling, crawling, walking or using a wheelchair.

The capacity for being moved or moving is by definition mobility, and the more someone can move, the more independence they will achieve.

Tom Schlitt is a pediatric physical therapist with Blount Memorial’s outpatient rehabilitation. He is board-certified by the American Physical Therapy Association as a pediatric clinical specialist, one of 630 nationwide and the only one in Blount County.