Gait poles are sticks that the child holds near his body to maintain balance. They provide a straighter posture compared to crutches.
Do not use standard walkers in children with CP except if there is severe extensor spasticity. The reverse walker is the primary choice because it provides an energy saving gait pattern and prevents hip and knee flexion.
Supine frames
Supine.standers.support.the.child.from.the.back.[F.on.previous. page].. Lateral. supports,. knee. pads. abduction-adduction. hip. supports.and.head.rests.help.maintain.standing..Supine.standers. are.better.for.children.who.do.not.have.head.control.and.who. need.to.work.on.upper.extremity.skills..Prefer.to.use.them.when. there.is.extensor.muscle.spasticity..Supine.standers.are.easier.to. use.in.large.children..Begin.to.use.standers.as.early.as.possible. to.adapt.the.child.to.erect.posture..Encourage.the.nonambulatory. child.to.spend.some.of.the.day.in.the.standing.frame.and.work. on.upper.extremity.function.in.the.meantime..Gradually.increase. the.time.in.the.frame.from.15.minutes.to.a.couple.of.hours.at. different.hours.during.the.day..The.child.with.walking.potential. learns.to.stand.in.the.stander.and.then.gradually.progresses.to. training.in.parallel.bars.. Gait trainer The.gait.trainer.is.a.metal.frame.with.metal.uprights.that.support. the.trunk.and.arms..Slings.or.bicycle.type.seats.are.attached.to.keep. the.child.erect..It.provides.significant.trunk.and.pelvis.support.and. can.help.teach.the.child.a.reciprocal.gait.pattern..Consider.using. the.gait.trainer.to.prepare.the.child.for.walking..As.the.child.gets. used.to.walking.in.a.reciprocal.manner.in.the.trainer,.he.progresses. to.walking.with.a.simpler.assistive.device.such.as.a.walker.or. crutches..The.gait.trainer.is.also.useful.in.to.provide.therapeutic. ambulation.at.home.in.total.body.involved.children. Gait aids Walkers
All. children’s. walkers. should. be. built. from. ultralight. durable. aluminium. and. supplied. with. wheels. to. minimise. energy. expenditure.. Swivel. wheels,. forearm. attachments,. hip. guides,. hand. brakes,. baskets. and. seats. are. added. to. the. walkers. if. necessary.. Walkers. provide. the. greatest. support. during. gait. but.they.pose.certain.difficulties.during.stair.climbing,.among. crowds.and.within.narrow.corridors.
There.are.two.types.of.walkers.for.pediatric.use..The.anterior. open. (reverse). [A,. B]. walker. is. also. called. a. postural. control. walker..Use.the.reverse.wheeled.walker.in.the.majority.of.children.. It.provides.the.best.gait.pattern.and.is.less.energy.consuming.[A. on.next.page]..Standard.forward.walkers.lead.to.increased.weight. bearing.on.the.walker.and.increased.hip.flexion.during.gait..Choose. them.only.in.cases.where.extensor.spasticity.predominates.[C].. Canes, crutches and gait poles
Walking.aids.are.usually.prescribed.for.balance.problems..Slowly. push.the.standing.child.from.the.side.and.then.from.the.front.and. back..Watch.for.signs.of.disturbed.balance..Canes.or.gait.poles. are.necessary.if.the.child.does.not.have.sufficient.lateral.balance.. Quadriped.canes.are.the.next.usual.step.as.the.balance.improves. following.walker.use..Instruct.the.child.to.use.the.quadriped.canes. lateral. to. the. body. rather. than. out. in. front..Try. to. switch. from. posterior.walker.to.forearm.crutches.in.adolescents..Gait.poles.[D]. or.sticks.provide.sensory.input.for.gait.and.facilitate.a.normal.gait. pattern,.but.sometimes.are.not.cosmetically.acceptable.to.patients.. Avoid.forearm.crutches,.as.children.tend.to.lean.forward.into.these. and. develop. hip. flexion. contracture. [E].. Forearm. crutches. also. lead.to.the.child.to.bear.the.body.weight.on.the.upper.extremities,. leading.to.a.pattern.of.walking.on.all.fours..Use.forearm.crutches. only.in.children.who.need.an.assistive.device.for.weight.bearing.as.
well.as.balance.. Courtesy of M. Sussman
Courtesy of M. Sussman
The child using crutches tends to go into a flexion pattern which increases the energy consumption of walking.
56 Mobility Aids & Assistive Devices
Collapsible and lightweight manual wheelchairs can be used outdoors for mobility.
Wheelchairs
Encourage. wheeled. mobility. in. all. children. who. have. poor. potential.for.walking..Strollers.and.wheelchairs.are.options.for. wheeled.mobility..Use.strollers,.wheelchairs.which.tilt.backwards,. or.wheelchairs.with.reclining.backs.in.children.who.are.totally. dependent.and.do.have.any.potential.for.independent.mobility.. They.provide.caregiver.relief.in.transport.and.ease.of.care..
A. wheelchair. is. a. mobility. as. well. as. a. seating. device. (positioning.device).in.children.with.severe.motor.dysfunction,. poor. sitting. balance. and. no. functional. ambulation. [B].. Independent. mobility.can. be. achieved.with. manual. or. power. wheelchairs. in. children. who. have. adequate. cognitive. and. motor. function.. Independent. wheeled. mobility. allows. the. child. to. explore. his. surroundings,. contributes. to. his. mental. improvement,.socialization.and.self.esteem..
Prefer.motorized.wheelchairs.in.severely.involved.children. who. have. upper. extremity. dysfunction. [C].. Motorized. wheelchairs. have. a. great. positive. impact. on. the. life. of. the. severely. impaired. child. and. his. family.. Consider. prescribing. them.as.early.as.four-five.years.of.age.and.enable.the.child.to. move.around.independently.to.explore.his.surroundings.and.to. take.part.in.family.life.without.spending.too.much.energy..
Some. severely. involved. spastic. and. athetoid. children. spend.excessive.energy.while.trying.to.walk.with.walkers.and. crutches..Motorized.wheelchairs.preserve.energy.and.improve. the.level.of.social.and.educational.function..Even.though.there. is.an.argument.that.early.use.of.the.motorized.wheelchair.causes. laziness.and.decreases.cardiovascular.capacity.it.is.obvious.that. the. beneficial. effects. of. early. independent. mobilization. with. less.energy.expenditure.far.outweigh.the.risks.
Choose. an. age-appropriate. mobilization. device. and. teach. the.child.how.to.use.it.[D]..
Wheelchair use in terms of function Independent Independent in sit-
ting and rising from a wheelchair.
Manual or power wheel- chair
Needs help
in transfers Somebody is neces-sary to help to sit in and rise from a wheelchair.
Manual or power wheel- chair
Dependent The child is carried when sitting in and standing up from a wheelchair.
Strollers, wheelchairs which tilt backwards, or wheel- chairs with reclining backs
Children with spastic diplegia have prob- lems with posterior balance and tend to fall backwards. In this case, prescribe a walker. The child who walks very slowly in high guard position and falls backwards after a few steps benefits from a reverse walker as an aid to improve his balance.
Most total body involved children prefer to use power wheelchairs because involvement of the up- per extremities makes them un- able to use manual wheelchairs.
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