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Comparison of anterior and posterior walkers with respect to parameters and energy expenditure of children with spastic diplegic cerebral palsy

Authors:
  • Yonsei University Severance Hospital

Abstract

The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.
... Two authors (Abd El-Hakiem Abd El-Nabie and Abd El-Aziz) extracted the following items from the included articles: (a) the author and year of publication; (b) information on the population, describing numbers of included children by diagnosis, age, and sex; (c) study design; (d) methodology, including the type of intervention or assessment, technique of its application, and its duration; (e) measured outcomes as explained by their authors; and (f) results. The extracted data are grouped into two tables: Table 1 related to articles that evaluated the effect of orthosis on energy expenditure [14][15][16][17][18][19][20][21][22][23], whereas articles investigating the effect of assisted walking aids, for example, a Walk Aide foot drop stimulator, walkers, sticks, a robotic-assisted gait trainer, and a flexible derotator, on energy expenditure [24][25][26][27][28][29][30][31], were presented in Table 2. ...
... The included articles had a variety of study designs. There were 12 studies with cross-sectional design [4,14,17,[19][20][21][22][23]27,28,30,31], two pre-post experimental studies [15,16], one RCT [24], one clinical trial [25], one case-series study [29], and two retrospective studies [2,18], as shown in Tables 1 and 2. ...
... All studies in the current systematic review examined the effect of different types of lower limb orthoses (different configurations of AFO [4,[14][15][16][18][19][20][21][22][23], plastic and metallic knee-AFO [17] or the effect of assisted walking aids (anterior and posterior walkers [27,28,30,31], walking sticks [29], robotic-assisted gait training [25], flexible derotator [26] and Walk Aide foot drop stimulator [24]) on energy expenditure in children with CP. All included studies can be classified into the following types: (a) studies that investigated the immediate effect of lower limb orthoses [14,17,18,20,22,23] or assisted walking aids [28,30,31] on energy expenditure, in which energy expenditure was assessed during the wearing of orthotic devices or during the usage of assisted With the posterior walker use, there was a reduction in anterior torso tilt and the shoulder extension and elbow flexion were increased Sex: 7 female and 3 male ...
... In studies since 2008, participants were given 1 month-time to acclimate walkers before measurements and at least 3 acceptable gait cycles were obtained by researchers. Before 2008, Mattsson and Andersson (1997) collected data when patients walking a 70-m circle for 4 min or more, yet Park et al. (2001) did not indicate it. Sequence of walker utility was illustrated in Table 2. Unlike the first 2 studies (Mattsson and Andersson 1997;Park et al. 2001), in which patients randomly used the walkers, the posterior walker was the priority in other studies. ...
... Before 2008, Mattsson and Andersson (1997) collected data when patients walking a 70-m circle for 4 min or more, yet Park et al. (2001) did not indicate it. Sequence of walker utility was illustrated in Table 2. Unlike the first 2 studies (Mattsson and Andersson 1997;Park et al. 2001), in which patients randomly used the walkers, the posterior walker was the priority in other studies. Subjects in 1 (Mattsson and Andersson 1997) and 2 (Konop et al. 2009a, b) of the studies had 1 and 5 trails respectively, while it was not mentioned in the rest of articles. ...
... Outcomes were finally compared mainly in 2 aspects: variables of gait/UE and energy consumption. Gait analysis was shown in 6 studies of which 4 mentioned UE parameters (Strifling et al. 2008;Konop et al. a, b;Konop et al. 2011) while 4 mentioned energy cost (Mattsson and Andersson 1997;Park et al. 2001;Strifling et al. 2008;Konop et al. 2009b). Konop et al. (2011) conducted the research (with ATPW, which is height-adjusted and handle rotated) in a different way. ...
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Systematically review the comparison of anterior and posterior framed walker in terms of biomechanical analysis and energy expenditure and to discuss the implications for clinical practice. A systematic literature search was performed to identify studies that evaluated the gait pattern, upper extremity (UE) kinetics and kinematics and energy consumption. Outcome measures and treatment results for them were identified. 6 studies met the criteria and were included in this systematic review. Gait analysis, UE kinetics and kinematics and energy consumption were all assessed in 4 different papers. Gait parameters were comparable between walkers but declined torso tilt was found in the posterior walker group. In UE joints, two groups showed no significant difference but adaptive therapeutic posterior walker helped decrease UE burden. Most of papers prefer posterior walkers because of low oxygen cost. For better gait pattern, less UE burden and energy consumption, the adaptive therapeutic posterior walker is relatively the proper choice among all. For future studies, crossover studies or randomized controlled trails (RCTs) with larger sample size and more accurate measurement equipment may provide more persuasive evidence. Long term effects of walker users can also be investigated.
... This walker was designed as a posterior walker, and data for other studies indicate the preference that users and parents have for a posterior walker [7]. This review suggests that the posterior walker can offer more stability than anterior devices [24]. ...
... This is because other research referring to fatigue has been recognized by clinicians as a barrier to participation [25]. In this way, it has been demonstrated that a posterior walker, such as the walker developed by "Padrino Tecnológico", promotes less oxygen cost [24]. Another physical benefit that emerged from the analysis was the improvement in muscle strength of the users' lower limbs. ...
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Children with Cerebral Palsy (CP) participate less regularly in physical and social activities. Support walkers allow mobility for infants who need aid. The aim of this study is to explore the benefits of a low-cost walking device in children with CP. A qualitative study using semi-structured, face-to-face interviews was conducted. Eight participants (two parents, two educational professionals, and four physical therapists) who live or work with children with CP that use a low-cost walking device were questioned to examine the benefits of the practice. Thematic analysis denoted three key factors about the benefits: emotional welfare, physical wellbeing, and social enjoyment. To conclude, the use of a support walker in children with CP makes them feel happier, improves their self-confidence and autonomy, and promotes participation.
... As children develop adequate balance to stand and step, a walker may still be necessary to prevent falling. Posterior walkers allow for greater hip and trunk extension and improve energy conservation when compared to anterior walkers (Park, Park, & Kim, 2001); however, a therapist should always individualize treatment to the specific child. Along with walking strategies, toddlers must learn the sensation of falling and the strategies to recover balance in order to become independent ambulators. ...
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Preprint
Full-text available
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