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Gait TrainersWhat are the benefits of walking? They can be broken down into three different categories: physiological, psychological, and motor developmental. The physiological benefits of standing are more pronounced with walking. The benefits to the 4 B's (blood, breathing, bone, and bowel) are enhanced due to movement and exercise made possible by gait trainers. The bones and joints may be the most affected; weight bearing and movement are necessary for their proper development. The Medical Need for Walkabouts for Non-Ambulatory CP Children: All newborns have cartilaginous skeletons. Their bones mineralize with stress, and grow in the direction of stress. In a newborn the femoral shaft is straight without an angled neck connecting the ball end. The acetabulum and the offset angle of the neck of the femur to the shaft do not occur until there is weight bearing. The acetabulum does not fully form until there is weight bearing throughout the full range of motion of the femur. Children with CP have damaged central nervous systems that effect motor
control, often causing immobility. Steinberg states that immobilization
has dramatic effects on the musculoskeletal system. It has been demonstrated
that the immobilization of muscles and lack of weight bearing on bone
causes bone demineralization and a true osteoporosis (1). Mazur et al
showed that non-walkers Enneking & Horowitz state that: "Muscles that are immobilized
and remain in a shortened position or fixed position, become contracted.
Eventually much of the muscle tissue is replaced by fibrous components
and normal function cannot be restored. Many neuromuscular diseases predispose
the patient to muscular contractures, including: CP, poliomyelitis, Duchenne's
Muscular Dystrophy, and chronic degenerative diseases of the spinal cord.
Prolonged muscular immobilization may have a direct effect on joints.
Contractures of the joint capsule and surrounding muscle can cause a restriction
in the range of motion of the joint. The lack of movement in the joint
results in a lack of synovial fluid flow, Karen Chad of the University of Saskatchewan concludes in her paper on
"The effects of a weight-bearing physical activity program on bone
density in children with spastic CP" that "It should be the
therapeutic goal of health professionals to promote active standing and
other forms of weight-bearing activity to decrease skeletal fragility
and susceptibility to fracture in these groups." (5) Adjusting a Walkabout or Gait Master for Optimun Performance These systems have many adjustable parameters and positioning accessories to help a user achieve a functional walking posture: It is important to first assess the client's dominant reflexes, and postural
support needs. If he/she has a dominant STNR the column tilt must be adjusted
to attempt to neutralize the tendency to either strong extension or flexion.
A forward tilt of 2-4 degrees generally works. The pelvis needs to be
well secured so that forward thrust is limited. In most cases the shoulders
need to be slightly ahead of the hips. If the child's upper truck is posturally secure a "C" model
having a double sling support will suffice. If it is weak a "D"
model with an adjustable ring angled up to support the sternum will give
shoulder girdle support making head control easier. Although tilting the column can help breakup strong adduction at the hips you may need addition help. We have found that abduction cuffs and straps build strong adductors, and inhibit gait. We build an abduction seat that consists of a tapered seat with a heavily padded top and a bottom extension (skirt) that come down almost to the knees. In most cases it has worked very well. They are individually made, so accurate specs are important. Head control: the Walkabouts are about the only device available with
head arrays to support abnormal head posture. Many sizes and types of
supports are available.
Mulholland Positioning Systems, Inc. |
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