A Narrative Review of Energy Expenditure and the Shift from Effective Ambulation to Effective Mobility in the Rehabilitation of Children with Motor Disabilities.

Background: In the management of pediatric developmental motor disabilities,the attainment of independent walking is often prioritized as the primary indicatorof rehabilitative success. However, recent evidence suggests that this “gait-centric”approach may ignore the significant metabolic cost of movement, the long-termrisk, and adult trajectories. This narrative review evaluates energy expenditurepatterns in children with motor disabilities. Longitudinal studies of such childrenthrough their adulthood suggest a need fora paradigm shift of focus from “EffectiveAmbulation” to “Effective Mobility”—a framework that prioritizes energy-efficient,timely movement to facilitate social participation and preserve physiologicalreserves over the lifespan. Clinical recommendations and emerging scientificevidence emphasize early introduction of assistive technology and the adoptionof the ICF framework to ensure that mobility serves as a tool for autonomy ratherthan a source of physical exhaustion.