The effect of different walking devices on body functions, activity and participation in children with cerebral palsy; a systematic literature review

Lebeer Jo
Author e-mail
University of Antwerp

Introduction: Walking aids are widely used in children with cerebral palsy (CP), but carry a risk for musculoskeletal deformities. The aim of the study is to determine the effect of walking aids on gait kinematics, trunk and pelvic control, hand function, activities, and participation.

Patients and Methods: Electronic databases (PubMed, Web of Science) were searched using pre-defined terms, excluding meta-analyses, systematic reviews, and comments. Risk of bias was evaluated using ‘Cochrane risk of bias tool’, ‘QUADAS-2’ and ‘QUIPS’. Quality of evidence was assessed using EBRO.

Results: 30 studies were included, covering 1360 children. Motor function and participation improved after training with Lokomat, robotic-assisted training with task-oriented physiotherapy, multi-positional walking sticks, and hands-free mobility devices. Effects are small. Posterior are better than anterior walkers as regards stride length, stability, and alignment. Most studies have low evidence level because of heterogeneity, low numbers, and lack of control groups. Negative effects include wrist deviations in anterior and posterior walkers; daily life activities may be disrupted when using adaptive equipment. Pooled data analysis was not possible due to heterogeneity.

Conclusion: Robotic walking aids are promising as to improving body functions (lower extremity kinematics), but are limited to therapy rooms. Rare is the literature comparing different walking aids between each other. With supported pelvis, there is better trunk control and synergy with lower extremities. Results on activities and participation are scarcely researched. There is a need for innovation in developing walking aids, facilitating a functionally useful gait pattern, proper trunk control, activities and participation yet without hindering hand function.

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