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Maximizing Participation During Walking in Children With Disabilities

Is Response to Unpredictability Important?

Gosselin, Dora, PT, DPT, PCS; Wright, Alexis, PT, PhD, DPT, OCS, FAAOMPT; Sole, Gisela, PT, MSc(Med) Exercise Science, PhD; Girolami, Gay, PT, PhD; Taylor, Jeffrey, PT, PhD, DPT, OCS, SCS, CSCS; Baxter, G. David, PT, TD, BSc(Hons), PhD, MBA

doi: 10.1097/PEP.0000000000000575

Walking ability is one of the primary components of human motor function, and interventions aimed at improving walking ability are common in physical therapy, particularly in children. One element encountered in a participatory, or natural, environment is unpredictability, defined as the presence of an unexpected obstacle, stimulus, or alteration of the environmental conditions. Little research has assessed the influence of unpredictability on biomechanical adaptations to walking in children who are developing typically or children with motor disabilities. A variety of impairments may result in an inadequate response to unpredictability, and we propose that there may be a relationship between response to an unpredictable visual cue and mobility-based participation.

We believe that a child's ability to respond to unpredictable circumstances while walking may provide additional information regarding participation limitations that have yet to be captured in existing clinical gait tools.

High Point University (Drs Gosselin, Wright, and Taylor), High Point, North Carolina; University of Otago (Drs Sole and Baxter), Dunedin, New Zealand; University of Illinois at Chicago (Dr Girolami), Chicago, Illinois.

Correspondence: Dora Gosselin, PT, DPT, PCS, High Point University, One University Pkwy, High Point, NC 27268 (

Grant Support: This work was supported by a grant from High Point University Research and Sponsored Programs, High Point, North Carolina. Additional support was provided by an APTA Academy of Pediatrics Mentored Grant and a NTDA Mini-Research Grant.

The authors declare no conflicts of interest.

Copyright © 2019 Academy of Pediatric Physical Therapy of the American Physical Therapy Association