The Effects of Posterior Walkers of Different Heights on Gait Performance among Children with Spastic Diplegic Cerebral Palsy

Abstract

Objectives: A walker is the most prevalent assistive device for children with cerebral palsy. Clinically, individualized functionality and rehabilitation goals can be achieved using different types of walker and by adjusting the parameters of the walker. However, the objective and quantitative criteria to be used when prescribing a walker are still lacking. Only few studies in the literature that have been directed at children with cerebral palsy refer to the walker's adjustable parameters. In addition, studies that explore standard measurements in relation to walker height are even less common. Therefore, the purpose of this study was to determine the effects of a posterior walker that is set at different heights on gait performance among children with spastic diplegic cerebral palsy. Methods: Data were collected from four children with spastic diplegic cerebral palsy who used an instrumented walker that had been set at five different conditions. These were standard walker height (at the level of the subject's greater trochanter) together with 1 inch above, 2 inches above, 1 inch below and 2 inches below the standard height. Gait performance was analyzed via a motion analysis system that collected gait velocity, step length, cadence, hip angles and knee angles. Results: In children with spastic diplegic cerebral palsy, using the walker at different heights resulted in different values for the gait variables as well as changes to the different hip and knee angles. However, no linear correlation was found between any of the pairs of variables. Nevertheless, each of the four subjects had his/her best functional gait performance during assisted ambulation at one specific walker height. Conclusion: Since the results show significant heterogeneity across the individuals, the commonly used standard for setting the walker height, which is the level of the user's greater trochanter, will not fit all users. Clinical Significance: To meet individual needs and various different therapeutic purposes, there needs to be multi-dimensional considerations taken into account when adjusting walker parameters after a walker has been prescribed for a child with cerebral palsy. Our study provides clinical workers with some considerations and suggestions when planning such a therapeutic intervention.