Provision of Functional Mobility
Generally, antigravity quadriceps are required for community ambulation in childhood neuromuscular disease. Short-distance ambulation may be achieved by some patients with more severe weakness using KAFO bracing, with or without a walker.
Such orthotic intervention is often provided to children with SMA type III, severe childhood autosomal recessive muscular dystrophy (SCARMD), congenital muscular dystrophy, DMD, and Becker muscular dystrophy during adulthood. Children with DMD SMA type II, congenital muscular dystrophy, congenital myopathies, some myasthenic syndromes, and more severe hereditary motor sensory neuropathies utilize power mobility devices for functional mobility. Generally, children can be taught to safely operate a power wheelchair when they are at the developmental age of approximately 2 years (139,140). The initial power wheelchair prescription needs to consider the natural history of the neuromuscular disease condition over the following five years, as some children will subsequently develop the need for a power recline system and the chair needs to be able to accommodate such a recline or be retrofit. In more severe disability, the power wheelchair electronics should be sufficiently sophisticated to incorporate alternative drive control systems, environmental control adaptations, and possibly communication systems in patients who are unable to vocalize.
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