Mulholland Positioning Systems: Products Designed for the Development of Functional Skills

What 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 had five times the number of pressure sores and twice the number of fractures as walkers with the same disability ⁽²⁾. In 1959 Phelps published on 100 children with CP who had not borne weight before the age of 4 years, and compared them to 100 normal and CP children who had. He found that about 25% of the children in the non-weight bearing group had coax-valga, compared to 3-4% in the weight- bearing group. He concluded that acquired dislocations of the hip in CP appeared to result from coax-valga due to late weight bearing along with spasticity and contracture ⁽³⁾.

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, which will eventually lead to irreversible degenerative changes in the joint cartilage ⁽⁴⁾.

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⁾

References:

(1) Steinberg, F.U.: The Immobilized Patient: Functional Pathology and Management pp17-21 (1980)

(2) Mazur et al: Bone & Joint Journal 71A, 56-61

(3) Phelps, Wm: Journal of Bone & Joint Surgery (Am). 1959; 41:440-448

(4) Enneking, W.F. and Horowitz, M.: Journal of Bone & Joint Surgery 54A:973 (1972)

(5) Karen E. Chad, PhD et al: Journal of Pediatrics; 1999; 135-115-7