Critical reflection on walking devices for children with cerebral palsy (CP) and introducing an innovative walking aid providing alignment and enabling individually adjusted support.

Cuppers Ria
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Pediatric physiotherapist and BAP at the university of Antwerp

Introduction: Walking aids are widely used by children with cerebral palsy (CP). Unfortunately, this often comes at the cost of poor alignment which can increase the risk for musculoskeletal deformities and even loss of walking in the long term. An optimal walking device should maintain a balance between body structure and function on the one hand and activity and participation on the other. A multidisciplinary team developed a new walking device based on the clinical need for better alignment, proper muscle activity, weight bearing (i.e no saddle) and walking handsfree.

Patients and Methods: Next to developing a new walking device, PubMed and parallel databases were searched for 'walking aids' and 'cerebral palsy' including related terms. This resulted in 1815 articles of which 27 were selected based on inclusion criteria and the Oxford levels of evidence.

Results: Walking devices can be classified into handheld-walkers, gait trainers, and robotic devices. These differ regarding the degree of support provided to body segments, the quantity of weight-bearing, and self-initiated or actuated movements. No clear evidence-based recommendations regarding the use of walking devices in CP are currently available. Based on clinical experience, the innovative walking device might provide better alignment by having an individually adjustable amount of support and the possibility to walk hands-free.

Conclusion: Selecting an appropriate walking aid for the individual child may not only affect the child's activity and participation but also the body structure and function. The developed device might strike a better balance to address this issue, but further research is necessary.

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