Canada lacks a national data source on individuals with limb loss and limb difference (LLD), which limits understanding of incidence, prevalence, risk factors, etiology, and healthcare outcomes. In the absence of standardized data collection, the provision of LLD healthcare services in Canada remains inconsistent. The objective of this study was to gather key interest groups’ perspectives on the development of a Canadian LLD registry. Invitees were identified through professional networks and snowball recruitment techniques. A two-round modified Delphi approach was utilized to identify key LLD registry domains via a pre-meeting survey followed by a virtual workshop on February 14, 2024. Of 96 invitees, 53 completed the survey, and 64 attended the workshop (63 from Canada and 1 from the United States). Five key LLD registry domains were identified: representation, standardization, practice-based evidence, research and innovation, and policy and funding. Inclusivity of diverse populations, national outcome measures adoption, and integration of psychosocial and clinical data was emphasized. Foreseen challenges included privacy concerns, necessary infrastructure, and resources to ensure long-term sustainability. Despite these challenges, a Canadian LLD registry could support advocacy, strengthen practice-based evidence, enhance research collaboration, improve clinical care, and inform population-level policies. Efforts to develop the registry are ongoing. Layman's Abstract Canada currently lacks a national registry of individuals with limb loss and limb difference (LLD), which limits our understanding of how many Canadians have limb loss or limb difference, and the effectiveness of healthcare services. Without consistent national data collection, it is impossible to understand regional differences in care, including prosthetic interventions and rehabilitation. This initiative gathered insights from representatives of the LLD community on establishing a Canadian LLD registry to improve research, healthcare delivery, and advocacy. Ninety-six LLD experts and professionals were identified to participate in a two-stage process that included a survey and virtual workshop. Fifty-three individuals (55%) completed the survey. On February 14, 2024, 64 (67%) individuals (63 Canadian and 1 American) attended the virtual workshop. The workshop included presentations on the development of the American Limb Loss and Preservation registry and the Canadian Rick Hansen Spinal Cord Injury registry, and measuring Canadian LLD outcomes. The meeting explored the feasibility, vision, and strategies for creating a Canadian LLD registry. Findings from the survey and workshop showed strong support for the registry, and workshop attendees discussed a number of critical areas for its development and sustainability. While some challenges regarding privacy, infrastructure, and sustainability still need to be addressed, there was agreement among meeting attendees on a strategy to start planning a registry. A Canadian registry would support advocacy efforts, enhance clinical care, encourage collaborative research, and provide essential data about care nationwide to ensure that the health and social care needs of the LLD community are met. Work is continuing to create and fund a Canadian LLD registry. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/46909/34865 How To Cite: Mayo A.L, Hitzig S.L, Zidarov D, MacKay C, Kaufman K.R, Noonan V.K, et al. A national strategy for a Canadian limb loss and limb difference registry. Canadian Prosthetics & Orthotics Journal. 2026; Volume 9, Issue 1, No. 3. https://doi.org/10.33137/cpoj.v9i1.46909 Corresponding Author: Dr. Amanda L. Mayo, MD, MHSc, FRCPC, Affiliations: 1) St. John’s Rehab, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 2) St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 3) Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. E-Mail: amanda.mayo@sunnybrook.ca ORCID ID: https://orcid.org/0000-0001-7061-2529

BackgroundPrecise upper limb movements required for daily activities rely on feedback and feedforward control mechanisms. In children with cerebral palsy (CP), damage to white matter tracts impairs motor execution and sensorimotor control. Most studies in CP have focused on motor execution deficits, whereas the relationship between feedforward control alterations and white matter microstructure features has received less attention.MethodThis study compared feedforward control during a grasp and lift task in 9 children with CP (diagnosis of hemiplegic CP with mild to moderate upper limb deficits) to 40 typically developing (TD) children aged 8 to 17 years. A secondary objective was to examine associations between feedforward control and the microstructural measures of corticocerebellar and other motor-planning related tracts. All participants completed 13 trials of the grasp and lift task. The CP group also underwent diffusion magnetic resonance imaging (MRI) using a 3-Tesla system to acquire anatomical and diffusion MRI.ResultsResults showed feedforward control deficits in the non-dominant hand of children with CP, reflected by reduced peak force rates before sensory feedback was available and a lack of adaptation across trials. Strong correlations were observed between feedforward control and microstructural measures of the corticospinal tract and superior longitudinal fasciculus, but not with the corticocerebellar tracts.ConclusionThese findings suggest that broader sensorimotor processes, beyond feedforward control alone, contribute to force control deficits observed in children with CP.

Background:Physical activity supports the health and well-being of individuals with physical disabilities. Despite the significance of engaging in physical activity, barriers faced by individuals with disabilities, such as limited access to adapted facilities and lack of transportation, can restrict their participation. Community organizations play a role in addressing these challenges, but virtual reality (VR) also offers a way to diversify adapted activities. In some situations, VR can help overcome the resource limitations of organizations by providing accessible, engaging, and highly personalized options for physical activity. Objective:The aim of this study was to explore the needs and expectations of individuals with physical disabilities and their interventionists for the use of a VR physical activity platform in a community organization. Methods:A descriptive qualitative study was conducted using semistructured interviews with individuals with physical disabilities and their interventionists, all associated with a nonprofit organization promoting physical activity among people with disabilities. Data were analyzed using an inductive thematic approach. Results:In total, 15 participants, including 8 people with physical disabilities and 7 interventionists, were interviewed. Through this discussion, we gained insights into the everyday challenges faced by individuals with disabilities and identified priorities for community organizations. Subsequently, we discussed key considerations for using VR, including adapting activities, the possibility of fostering a more positive perception of physical activity, and harnessing the potential of VR to improve access to physical activity. We also discussed the importance of supporting personal goals and creating inclusive experiences while recognizing challenges such as technical difficulties and connectivity issues. Conclusions:By exploring the needs and expectations regarding VR technology from individuals with physical disabilities and their interventionists, this study provided essential insights for integrating immersive and nonimmersive VR into community organizations, informing next steps for the design of adapted physical activities in VR.

Older adults face ergonomic barriers in virtual reality (VR), particularly with head-mounted displays (HMDs), which are heavy and poorly suited for fragile musculoskeletal systems. This poster introduces a 3D-printed support system that alleviates the weight of the headset by redistributing it to an external frame. This solution promotes accessibility by allowing passive, seated VR experiences, enabling better comfort and extending the use of VR for seniors in health, leisure, and telepresence contexts.

AIM:Adapted paddleboard provides an outdoor leisure-time physical activities (LTPA) opportunity with many health benefits (e.g., physical activity, reduced stress, social engagement). However, nearly 50% of individuals with disabilities do not participate in any LTPA. Quality of LTPA participation influences sustainable adherence, while optimizing participant experiences. An adapted paddleboard program is offered in Quebec City, for adults with physical disabilities, but little is known about how participants perceive their quality of participation. This study aimed to describe individuals with disabilities' perceived quality of participation in the adapted paddleboard program, and to explore their suggestions of strategies to support meaningful engagement in the program. METHODS:An ethnographic mixed-methods design was conducted, consisting of participant observations during the 13-week program and semi-structured interviews based on the Quality Parasport Participation Framework (QPPF). Measure of Experiential Aspects of Participation (MeEAP) questionnaire were collected. A mixed approach of data analysis was used for qualitative data and descriptive statistics were conducted for quantitative data. RESULTS:Nine participants (8F) with various disabilities (42±15 years old) participated in the study. Emergent dimensions of quality of participation included belongingness and autonomy. Facilitators to participation were identified, such as autonomy support through volunteers and provision of adaptive equipment. Barriers to participation included water access and level of individual challenge. Suggested strategies to improve engagement included water access closer to parking and multiple groups for variable skill levels. CONCLUSIONS:Participants expressed high-quality of participation in adapted paddleboarding. The study allows the development of knowledge about conditions that enhance the experience of participating in outdoor LTPA.

Objective: To answer the following questions: (1) Do physical activity (PA) and exercise improve fitness, mobility, and functional capacity among adults with lower limb amputation (LLA) and (2) What is the type and minimum dose of PA (frequency, intensity and duration) needed? Design: Systematic review. Setting: Outpatient intervention, outside of the prosthetic rehabilitation phase. Participants: Adults with lower limb amputation living in the community. Intervention: Any physical activity or exercise intervention. Outcomes and Measures: Any fitness, mobility, or functional capacity indicators and measurements. Results: Twenty-three studies were included, totaling 408 adults with LLA. Studies evaluated the effect of structured PA sessions on fitness, mobility, and functional capacity. The highest evidence is for mixed exercise programs, that is, programs combining aerobic exercise with strengthening or balance exercise. There is moderate confidence that 1-3 sessions of 20-60 minutes of exercise per week improves balance, walking speed, walking endurance, and transfer ability in adults with LLA above the ankle. As for flexibility, cardiorespiratory health, lower -limb muscles strength, and functional capacity, there was low confidence that exercise improves these fitness components because of the lack of studies. Conclusion: Exercise 1-3 times per week may improve balance, walking speed, walking endurance, and transfer ability in adults with LLA, especially when combining aerobic exercises with lower limb strengthening or balance exercises. There is a need for most robust studies focusing on the effect of PA on cardiorespiratory health, muscles strength, flexibility, and functional status. Archives of Physical Medicine and Rehabilitation 2024;105:1194-211 (c) 2023 by the American Congress of Rehabilitation Medicine.

Background: Proprioceptive position sense (PPS), which provides the awareness of the positions of one's limbs in space, is compromised in children with unilateral spastic cerebral palsy (USCP). Relationships between decreased PPS, skill acquisition, and performance are not well understood partly due to differences between measurement modalities of PPS. During assessments, individual joints are often constrained to a single plane of movement. We introduce ways to estimate PPS, simultaneously from multiple upper limb joints during unconstrained pose matching tasks, using 3D kinematics. Methods: Nineteen children with USCP, 14 age-matched typically developing children (TDC) and, 16 typically developed adults (TDA) were recruited. Participants performed contralateral upper limb pose matching tasks while blindfolded. Using 3D kinematic data extracted by a VICON Nexus motion-capture system, three ways of measuring matching performance were calculated: joint angle symmetry, joint distance symmetry, and orientation symmetry. Mann-Whitney U tests were used to statistically compare scores between groups. Spearman's rank correlation was used to investigate relationships between PPS symmetry measures and hand function in children with USCP. Results: Children with USCP presented significantly lower angle, distance, and orientation symmetries compared to TDC. TDA scores were not statistically significantly different compared to TDC. In children with USCP, orientation symmetry measures strongly correlated with several clinical hand function scores such as the box and blocks test. Conclusions:We introduced a new way to conveniently measure multi-joint PPS. Children with USCP presented lower PPS estimates compared to TDC. We also observed that orientation symmetry (limb coordination) strongly correlates with hand function. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The BRANY IRB responsible for ethical oversight of clinical research at Burke Neurological Institute gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Background: The company Ethnocare has developed the Overlay, a new pneumatic solution for managing volumetric variations (VVs) of the residual limb (RL) in transtibial amputees (TTAs), which improves socket fitting. However, the impact of the Overlay during functional tasks and on the comfort and pain felt in the RL is unknown. Methods: 8 TTAs participated in two evaluations, separated by two weeks. We measured compensatory strategies (CS) using spatio-temporal parameters and three-dimensional lower limb kinematics and kinetics during gait and sit-to-stand (STS) tasks. During each visit, the participant carried out our protocol while wearing the Overlay and prosthetic folds (PFs), the most common solution to VV. Between each task, comfort and pain felt were assessed using visual analog scales. Results: While walking, the cadence with the Overlay was 105 steps/min, while it was 101 steps/min with PFs (p = 0.021). During 35% and 55% of the STS cycle, less hip flexion was observed while wearing the Overlay compared to PFs (p = 0.004). We found asymmetry coefficients of 13.9% with the Overlay and 17% with PFs during the STS (p = 0.016) task. Pain (p = 0.031), comfort (p = 0.017), and satisfaction (p = 0.041) were better with the Overlay during the second visit. Conclusion: The Overlay’s impact is similar to PFs’ but provides less pain and better comfort.

We investigated the effect of age on predictive and reactive grip force control. We compared the coupling between the grip and load force when participants tapped the object (i.e., self-TAP condition) held in their contralateral hand or when the experimenter tapped the object (i.e., external-TAP condition). Participants held the object either with their dominant or their non-dominant hands. Neurophysiological changes occur in the brain throughout childhood, so we hypothesized that these changes would make motor prediction less reliable in adolescents than adults. We compared adolescents’ predictive and reactive grip force control (n = 19) to adults (n = 19). We quantified the coupling between grip and load forces using cross-correlation. The lags determined whether peak grip force occurred before (predictive control) or after (reactive control) peak load force. In the self-TAP condition, the change in grip force occurred significantly earlier in adults compared to adolescents by 24 ms for the dominant and 12 ms for the non-dominant hands. During the external-TAP condition, the peak grip force lagged the peak load force for both groups, but the lags were shorter for adolescents than adults for both hands. Smaller finger sizes with larger neural afferent density could enhance the cutaneous reflex responses caused by the sudden change in loading. For the self-TAP condition, results confirmed less efficient motor prediction in adolescents. Morphological and neurophysiological changes unfold in the developing brain during childhood; they can introduce variability into the neural circuits responsible for refining motor prediction.

AIMS:To describe the nature of custom and non-custom virtual reality and active video game (VR/AVG) implementation within a Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention program for children with hemiplegia.METHODS:Six children aged 8-11 years participated in a 10-day HABIT-ILE intervention (65 h; 6.5 planned VR/AVG hours). VR/AVG implementation details were recorded daily and summarized with descriptive statistics; active motor engagement was quantified as minutes of active game participation. Post-intervention interviews with interventionists were analyzed with qualitative content analysis.RESULTS:On average, participants received 79% of the planned VR/AVG dosage (314/400 planned minutes, range 214-400 min), of which the per-session active motor engagement average was 68% (27 min, SD 12 min). Participation involved equivalent amounts of custom (49%) and non-custom (51%) VR/AVG system use. Material and verbal adaptations facilitated alignment with HABIT-ILE principles. Interventionists identified type of task (gross versus fine motor), children's perceived motivation, and VR/AVG attributes as factors influencing active motor engagement and alignment with HABIT-ILE principles.CONCLUSIONS:Describing individual and technological challenges of VR/AVG integration within HABIT-ILE can advance knowledge about VR/AVG use in intensive interventions and identify directions for subsequent research.

BACKGROUND: Work-related musculoskeletal disorders (WRMSDs) remain a challenge despite research aimed at improving their prevention and treatment. Extrinsic feedback has been suggested for the prevention and rehabilitation of WRMSDs to improve sensorimotor control, and ultimately to reduce pain and disability. However, there are few systematic reviews on the effectiveness of extrinsic feedback for WRMSDs. OBJECTIVE: To perform a systematic review investigating the effect of extrinsic feedback for the prevention and rehabilitation of WRMSDs. METHODS: Five databases (CINAHL, Embase, Ergonomics Abstract, PsycInfo, PubMed) were searched. Studies of various designs assessing the effects of extrinsic feedback during work tasks on three outcomes (function, symptoms, sensorimotor control) in the context of prevention and rehabilitation of WRMSDs were included. RESULTS: Forty-nine studies were included, for a total sample of 3387 participants (including 925 injured) who performed work-related tasks in the workplace (27 studies) or in controlled environments (22 studies). The use of extrinsic feedback was shown to be effective in controlled environments for short-term prevention of functional limitations and sensorimotor alterations (very limited to moderate evidence) and for improving, in injured participants, function, symptoms and sensorimotor control (moderate evidence). In the workplace, it was shown to be effective for short-term prevention of functional limitations (limited evidence). There was conflicting evidence regarding its effect for WRMSD rehabilitation in the workplace. CONCLUSION: Extrinsic feedback is an interesting complementary tool for the prevention and rehabilitation of WRMSDs in controlled environments. More evidence is needed regarding its effect for the prevention and rehabilitation of WRMSDs in the workplace.

Introduction: Achieving our daily tasks depends on the speed-accuracy conflict. Physical activity plays a role in the development of our motor skills. However, the relationship between physical activity level (PAL) and fine motor skills remains largely unexplored. Aim: Our aim was to examine the relationship between the amount of daily physical activity and the performance of healthy adults in a reciprocal aiming task. Materials and methods: Eighty-seven healthy adults completed a reciprocal aiming task using a digital tablet. Four difficulty levels (3-6, determined by target width) and 50 scores for each level were performed using both hands. Movement time, error rate, and performance index were analyzed. PAL was measured using the Global Physical Activity Questionnaire. Spearman correlations and nparLD analysis were used in R Studio to explore the influence of physical activity level, difficulty index on individuals’ performances. Results: Apart from a correlation between PAL and motor performance at the easiest level (r=0.23, p=0.002), there was no correlation between PAL and fine motor performance. Conclusions: The results of our study did not indicate any significant major correlations between daily PAL and fine motor performance except when the constraints of a reciprocal aiming task are the lowest. Further work is needed to consider the use of the reciprocal Fitts task in a clinical setting.

Gait parameters are altered and asymmetrical in individuals with transtibial amputation. The purpose of this study was to evaluate and compare the effect of four different prosthetic feet on lower-limb biomechanics during gait. A 34-year-old man with transtibial amputation performed four gait analysis sessions with four foot–ankle prostheses (Variflex, Meridium, Echelon, and Kinterra). Kinematic and kinetic parameters and gait symmetry were analyzed in different prosthetic conditions. The type of prosthesis had little effect on the participant’s spatiotemporal parameters. Throughout the stance phase, increased hip angle, reduced knee flexion and ankle dorsiflexion were observed in the amputated leg. For kinetic parameters, reduced propulsive force (SI = 0.42–0.65), reduced knee extension moment (mainly during Echelon and Kinterra conditions, SI = 0.17 and 0.32, respectively), and increased knee abduction moment (mainly during the Variflex and Meridium, SI = 5.74 and 8.93, respectively) were measured in the amputated leg. Lower support moments were observed in the amputated leg as compared to the unaffected leg, regardless of the type of prosthesis (SI = 0.61–0.80). The prostheses tested induced different lower-limb mechanical adaptations. In order to achieve the clinical goal of better gait symmetry between lower limbs, an objective gait analysis could help clinicians to prescribe prosthetic feet based on quantitative measurement indicators to optimize gait rehabilitation.

Have you ever been a victim of a sibling passing you an empty milk box while pretending it was full?When you lifted the milk box, your arms moved upwards rapidly.This trick reveals that when we interact with objects, we predict the forces required to grasp and lift the object.Before grasping an object, the brain adjusts the grip and the load forces to object shapes, weights, and frictional properties.These changes in grip and load forces usually occur before lifting the object.Although it may occasionally result in significant movement errors, predictive control is essential for skilled object manipulation.The other control strategy, reactive control, involves sensory feedback.This strategy becomes crucial when predictions are erroneous, or feedback is unavailable.To learn and maintain predictive control, the brain must learn to predict the sensory consequences of motor commands.Such learning develops during childhood.Children learn to adjust their grip and load forces to the object's properties by processing visual and haptic sensory information.The quality of the transmission and processing of fingertip haptic information might be associated with the ability to scale fingertip forces.This study assessed the age effect on sensorimotor adaptation between children, adolescents, and adults during object manipulation.We studied the transmission of haptic sensory information through the somatosensory cortices by measuring sensory evoked potentials (SEPs).We hypothesized that adolescents and adults would show symmetrical SEPs.This symmetry will be associated with effective predictive control and transfer of sensorimotor adaptation between hands.We measured the brain's electrocortical activities to verify this hypothesis (electroencephalography, 64 electrodes).To evoke tactile afferent, we applied vibrotactile stimulation (frequency 200 Hz) to both thumbs simultaneously and in succession.Then, to study predictive control and sensorimotor adaptation, we measure the changes in grip and lifting forces when lifting objects of different weights (200 and 500g) with the right and left hands.So far, we have tested 19 adolescents and 11 adults.Preliminary results revealed that participants learned to adjust their grasping and lifting forces within five trials.Further, participants transferred sensorimotor adaptation from one hand to the other.Following the recruitment of adults, we will be able to compare SEPs between and evaluate their association with the learning of predictive control and sensorimotor adaptation.

Inclusive physical education allows the development of social skills, attitudes, and awareness of peers about functional limitations and enhances the leadership skills of all children. However, the positive experience of children with functional limitations in inclusive physical education can be impacted by programs inadequate to their abilities and the limited training and knowledge of physical educators about teaching in consideration of their needs. The objective of this study was to identify the facilitators and barriers experienced by physical educators to include children with functional limitations in physical education in Quebec schools. A cross-sectional descriptive study with an online survey was conducted with physical education teachers and daycare educators. Descriptive statistics were used to analyze the data. A total of 149 participants (n = 130 physical education teachers) responded to the survey. Most respondents (79.5%) included children with functional limitations in activities with their classmates. However, 39.4% of respondents reported feeling not informed and not equipped to facilitate inclusion. This study identified the facilitators and barriers to physical education for children with functional limitations from the perspectives of physical educators, in Quebec schools, and the role of the latter to encourage inclusion.

Cerebral palsy (CP), a neuromotor disorder characterized by prenatal brain lesions, leads to white matter alterations and sensorimotor deficits. However, the CP-related diffusion neuroimaging literature lacks rigorous and consensual methodology for preprocessing and analyzing data due to methodological challenges caused by the lesion extent. Advanced methods are available to reconstruct diffusion signals and can update current advances in CP. Our study demonstrates the feasibility of analyzing diffusion CP data using a standardized and open-source pipeline. Eight children with CP (8–12 years old) underwent a single diffusion magnetic resonance imaging (MRI) session on a 3T scanner (Achieva 3.0T (TX), Philips Healthcare Medical Systems, Best, The Netherlands). Exclusion criteria were contraindication to MRI and claustrophobia. Anatomical and diffusion images were acquired. Data were corrected and analyzed using Tractoflow 2.3.0 version, an open-source and robust tool. The tracts were extracted with customized procedures based on existing atlases and freely accessed standardized libraries (ANTs, Scilpy). DTI, CSD, and NODDI metrics were computed for each tract. Despite lesion heterogeneity and size, we successfully reconstructed major pathways, except for a participant with a larger lesion. Our results highlight the feasibility of identifying and quantifying subtle white matter pathways. Ultimately, this will increase our understanding of the clinical symptoms to provide precision medicine and optimize rehabilitation.

Background: Most individuals with physical disabilities do not meet physical activity recommendations, which may negatively impact quality of life. Physical literacy is a concept that considers the key elements necessary to support lifelong physical activity. Limited attention has been directed towards physical literacy for individuals with physical disabilities. Objectives: To obtain expert consensus on strategic priorities to delineate the next steps on physical literacy for individuals with physical disabilities. Methods: The Collaborative Prioritized Planning Process was followed during a two-day online consensus meeting with experts in disability and physical activity. This systematic four-step process involved: 1) knowledge synthesis before the meeting, 2) challenge identification and prioritization, 3) solution identification, consolidation and prioritization, and 4) action planning. Results: Thirty-one experts participated in the meeting. Five challenges related to physical literacy for individuals with physical disabilities were prioritized. The following solutions were suggested: developing a massive online open course, creating a physical literacy measurement toolkit, developing a physical literacy resource portal, creating a national database of physical literacy outcomes, and redefining an existing international consensus statement for physical literacy to be more inclusive. Conclusions: Collaborations between experts are needed to advance the research in physical literacy for people with disabilities through education and measurement.

Approximately 22% of Canadian children with physical disabilities meet the daily physical activity recommendations. Physical activity is attributed to physical literacy, a conceptualization of the domains required to be physically active throughout life. In Canada, pediatric rehabilitation professionals’ and coaches’ roles are essential for developing physical literacy. The aim of the study was to explore knowledge of physical literacy and strategies for developing physical literacy for children with physical disabilities among pediatric rehabilitation professionals, students, and coaches in Quebec. Semi-structured interviews were conducted with pediatric rehabilitation professionals, students and coaches and thematically analyzed using NVivo. Twenty professionals and students reported having variable knowledge about physical literacy, but suggested that adaptation, play and interdisciplinarity were essential in the development of physical literacy for children with physical disabilities. Participants highlighted the need to redefine fundamental movement skills for children with physical disabilities. Despite perceiving varied knowledge of the physical literacy concept, pediatric rehabilitation professionals and coaches described essential domains to foster physical literacy in children with disabilities. Pediatric rehabilitation professionals and coaches play a vital role in fostering physical literacy. Therefore, it is essential to support the development of knowledge that may support professionals, such as through training programs and continuing education.

Clinical gait analysis on uneven surfaces contributes to the ecological assessment of gait deviations of children with spastic cerebral palsy (CP). Walking on uneven surfaces requires specific motor strategies, which can be assessed by lower-limb kinematic and inter-joint coordination analyses. This study aimed to assess and compare kinematics and inter-joint coordination between children with CP and their typically developing (TD) peers when walking on even and two levels of uneven surfaces (medium and high). A total of 17 children with CP and 17 TD children (11.5 ± 3.5 and 10.4 ± 4.5 years old, respectively) were asked to complete 6–8 gait trials on a 4-m walkway of each surface (n = 3) in randomized blocks while fit with retro-reflective markers on their lower-limbs. Children with CP showed proximal gait adaptations (i.e., hip and knee) on uneven surfaces. Compared with the TD group, the CP group showed decreased hip extension during late stance (49–63%, d = 0.549, p < 0.001), and a more in-phase knee-hip coordination strategy during swing phase (75–84% of gait cycle, d = 1.035, p = 0.029 and 92–100%, d = 1.091, p = 0.030) when walking on an uneven (high), compared to even surface. This study provides a better understanding of kinematic strategies employed by children with spastic CP when facing typical daily life gait challenges. Further studies are needed to evaluate the benefits of integrating uneven surfaces in rehabilitation care.