The On Time Mobility Framework: Mobility Equity for Young Children with Disabilities

A toddler walks in a Rifton Pacer walker while his caregiver helps him.“ON Time Mobility” is a term coined to reflect best practices for providing daily hours of active mobility to young children with disabilities, to encourage exploration, motor development and socialization. The authors of a recent special communication, ON Time Mobility: Advocating for equity in mobilityThey maintain that mobility is a human right that begins in the first year of life.1.2 While many doctors agree with this position, the provisions for this fundamental right are woefully inadequate for the population from birth to three years of age. Research tells us that early childhood is the time of most rapid and significant development. This critical moment of plasticity of developing systems is primarily driven by movement experience and exploration.3 For young children with disabilities, taking advantage of this window of opportunity to move, learn and grow will improve their functional outcomes and reduce complications later in life. However, children with disabilities between zero and three years old are less likely to move actively. This is partly due to inadequate assistive technology for younger people, as well as access and funding issues. Passive mobility is common as small children are easily transported. There is also a lack of evidence-based research to drive interventions and inform practicing clinicians. These factors contribute to suboptimal levels of mobility and place children at risk for maladaptive neuroplasticity. So, it is up to clinicians, researchers, academics, and manufacturers to take note of this critical moment of development and provide mobility options to this population that are timely and appropriate.

The ON Time Mobility Framework

The ON Time Mobility Framework addresses five key principles: opportunity, urgency, multimodal, frequency and sociability. These principles allow therapists to examine current mobility practices in young children with disabilities, as well as advocate for and provide equitable resources.


Timing recognizes that mobility begins within the first year of life and even current “early” interventions are in fact late and therefore miss much of the critical period of development. This is compounded by hesitancy on the part of clinicians and families to explore assistive technology in younger people. The researchers and authors behind ON Time Mobility offer strategies to help inform practice. This begins with clinicians introducing mobility and assistive technology interventions that help young children with disabilities engage in play and social experiences at similar stages to their peers. This also means advocating for technology funding and addressing rules regarding age-restricted access to assisted mobility. Equipment manufacturers are also part of the picture. Small equipment for adults is no longer accepted. Young children under preschool age need assisted mobility designed and built for their specific mobility needs, which differ significantly from the needs of adults.


Urgency refers to the critical period of development and neuroplasticity in the population from birth to three years of age. This recognizes that mobility is an important driver of cognition, physical development and social well-being; and children need several hours of mobility throughout the day to obtain the best neuroplastic benefits. However, current practice accepts frequent and prolonged episodes of passive mobility in these children. This ultimately creates situations of learned helplessness and widens the functional gap with their peers. Strategies suggested by researchers to inform urgency practice are to consider “mandatory mobility” as urgently as we consider “tummy time.”2 Introduce him early and provide interventions and supportive technologies for play and exploration. This includes continued education on the positive outcomes of self-initiated movement development, both with and without the use of assistive technology. Promoting urgency means families should not have to choose between using funds for a stroller or a walking trainer. Children and families need both passive and active mobility options for optimal results.


The multimodal principle addresses the use of different types of supportive mobility in a wide variety of settings throughout the child’s day, such as ride-on strollers, gait trainers, and bodyweight harnesses. Traditional practice and technology has focused on walking as the gold standard of mobility, especially in children under five years of age.1 But mobility cannot be limited to a single motor skill. Rather, gait training should be performed in conjunction with many other mobility strategies to achieve the daily hours of activity necessary for optimal child development. This often requires access to multiple mobility devices. Strategies to help inform practice, then, focus on promoting the disparity in insurance funding for a single mobility device for children with disabilities; while their peers have access to multiple forms of mobility, from tricycles and scooters to wheeled toys and trampolines. Ideally, clinicians should provide motor skill development techniques along with assistive mobility technology, and continue to educate consumers about the supportive role of assistive technology toward mobility options, access to environments, and equity. .

Frequency in real world environments

The term frequency recognizes that young children perform high levels of mobility every day. This gives them multiple opportunities to explore their environment, try to move and fail, try again, and learn movement solutions. In fact, children who learn to walk fall more than 100 times a day and move across 46 football fields in the same period of time. Young children with disabilities need this same opportunity for self-directed exploration, trial and error of motor skills, and frequent mobility in natural environments. Strategies to inform best practices around frequency include creating opportunities for movement and use of mobility technology outside of therapy sessions, and making movement part of everyday life in natural contexts. When movement is limited, the use of mobility technology allows children to access everyday environments at home and in the community.


Enriching a child’s daily routine and environment with plenty of mobility opportunities improves participation and promotes the child’s social skills. Movement allows young children to interact with family members or meet new friends on the playground, which in turn improves communication skills and provides a context for self-directed mobility. Continued promotion of inclusion, universal design, and accessible playgrounds is an important best practice strategy. Additionally, early intervention therapists can serve as catalysts in creating motorized play groups with peers and children in their caseload, when possible. And therapists can also educate families about the important reciprocal connection between motor skills and communication development. There is not much movement in childhood.

Early childhood is a time of rapid and critical development of motor, social, and cognitive skills, driven primarily by the experience of movement. For children with disabilities, taking advantage of this window of opportunity by providing mobility throughout the day can transform their learning, boost motor and social skill acquisition, and decrease physical complications as they age. Therefore, the authors behind the ON Time Mobility framework advocate for mobility equity across all ages, stages, and disabilities. The term “On-Time Mobility” implies that until now, young children with disabilities have not received adequate mobility opportunities due to issues with access to assistive technology, lack of funding, and insufficient awareness and research related to On-Time Mobility. , its implementation and profound positive results. effect on development. The special communication Timely mobility ON It is worth reading as it describes how doctors, researchers, manufacturers and families can get involved in creating a better future for children with disabilities through timely mobility.

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