The ambulatory status of 76 children and adolescents with spinal cord
injuries was studied to delineate the natural history of ambulation an
d to identify factors predictive of successful ambulation. The type of
orthotic used and the degree and duration of ambulation depended on a
ge, completeness and level of the neurologic deficit, and lower extrem
ity contractures. Younger age, L3 or better neurologic levels, incompl
ete lesions with motor preservation, and absence of lower extremity co
ntractures were associated with functional walking. The psychological
advantages of ambulation must be weighed against the cost of orthotics
and associated training and the nonfunctional nature of ambulation in
the vast majority of individuals with spinal cord injuries. In additi
on, the developmental aspects of pediatric spinal cord injuries requir
e changing therapeutic goals at different developmental stages.