Walking requires flat floors and sidewalks with no steps, curbs, thresholds or any other irregularities below the knees. Although capable of "walking," the reality is that they tend to just shuffle along.

For the person, the need to walk is incessant. They will often want to walk even when caregivers have activities which they want them to do like toileting, eating, drinking and resting. Try using lower level information to capture their attention like weighted blankets or a weighted doll or pet.

Sustained walking is often a problem when they do not experience being tired or connect being tired with a need to rest. They can answer questions about their experiences: "Are you tired?" "Would you like to sit down?" And they can follow simple commands, one action at a time:

• "Come with me," wait for eye contact and then beckon with a gesture,
• "You need to lie down," wait for them to look at the bed and point when they can see the gesture.

When they lie down, they may go to sleep. When they sit down, they are apt to get up again within a few minutes.

They will respond to a simple question or direction in about 10 to 15 seconds. When they respond, you can expect them to look at you and give you eye contact.

The internal cue seems to be to continue walking until they are tired. Toddlers sit down on the floor wherever they are and a few people functioning within ACL 2.4 will drop to the floor too. Most people will sit on a nearby chair. There are people who do not seem to experience feeling tired and they need regular assistance to sit down and rest.

The person has the ability to walk with balance but their direction when walking is undefined and resembles a poorly defined arc.

When you watch them walking around, a pathway or line of direction is not apparent. The route resembles a poorly defined arc.

If they are unable to weight bear, they should be able to do 5 bilateral upper extremity range of motion exercises, after stretching their hands and joints.

To Verify

A daily schedule for each person needs to accommodate their sense of fatigue. Upper and lower extremity range of motion exercises can be done while seated, with about 5 repetitions and rest periods in a 30 to 45-minute session, twice a day.

Without other physical impairments, the person can walk without assistance, but they do not have a sense of direction. Their attention is focused on independent walking, but the heel toe rise of their feet barely leaves the floor and must be limited to absolutely flat surfaces.

Sitting may be extended for one to two hours in a regular chair with arms, but they still need to be doing something to prevent slumping and sliding out of their chair. The preferred method for sustaining their attention is apt to be hand-over-hand assistance to apply tactile cues to different parts of their hands and face.

Upper Extremity Range of Motion Exercises

ROM exercises can be done as described for ACL 2.0, with knee supports.

Going for a walk can be very refreshing and enjoyable both for the caregiver and the disabled person. The movement in a regular wheelchair will help satisfy the urge to move forward if the person is unable to walk on their own.

They need to get out of their bedroom and the building. Going outside can reduce the constant yelling, especially when there is a daily schedule of providing movement stimuli.

A clear space is required for the person to wander around in. A few large sturdy chairs are required in this space for them to flop into when they are tired.