By Susan Knight, PT
Susan has worked at a children’s hospital for 17 years, and does clinical teaching alongside her caseload.
It is an important part of every child's life to be upright: this is a typical activity for any child. A child who has had an injury or an accident, or who is not developing typically, should have the opportunity to be up with their peers and to move, again, or for the first time.
Many children do not have any way to move independently until they are in some type of equipment. When a child is in equipment where they can independently move themselves, rather than in a stander, then they are using their muscles. The research literature says that stresses on the bones, such as stresses coming from muscle action, promote healthy and strong bones. When a child is in a Pacer gait trainer, even if they are at first quite dependent on the hip positioner, they are still getting some weight bearing on their lower extremities, and will be actively trying to move their legs to move the walker. In this way, they are getting muscle practice, and in time will be moving themselves.
For motor learning, the key is practice. The more opportunities for practice, the better and higher level the individual can achieve. We know that typical kids practice: an infant can crawl up to the distance of a football field daily, for example. To find opportunities for children with special needs to practice independent movement can be a challenge. Equipment can provide opportunities for children to practice skills that they wouldn't otherwise be able to.
Parents are encouraged when they see their child standing or walking in a gait trainer. Even though this isn't what they had envisioned for their child - perhaps the child was typically developing before, and then the child had an accident - it is encouraging to see their child stand in equipment, or take a few steps. It's heartening for a parent to be able to take their hands off the child for a moment, to be able to see some independence early on.
We have an inpatient rehab unit with many children who come through. We have a large oncology population, children with brain and spinal tumors, and then we have children who have suffered traumatic brain injuries such as falls or motor vehicle accidents. They are all in the early stages of recovery. We have used the Rifton Pacer for an upright position for some of these kids in the more acute stages, children who are not really moving that well yet. We use it to compliment the rest of their therapy program. It's about having them be more active during the day.
We are taking a new view of the Pacer. We now think of it as a safe and beneficial way to get these children up, get them mobile, and get them feeling a little independent earlier in their rehabilitation. Since we have so many different children at many different stages, this is of course dependent on each child's status. We are finding that the Pacer has an application in the inpatient setting for many of our children. It's wonderful.
Our therapy staff appreciates the Rifton Pacer because it is so adjustable. It adjusts quickly and easily with no tools, so it's great for a place like ours that has many therapists working with many kids.
When gait practice is a focus in therapy, and I am sure that a child will be walking independently, I do not necessarily recommend a Pacer for gait training at home. However, for those cases where a walker is needed at home, we like to try several walkers with a child, to figure out the one that works best. Our outpatient staff regularly utilizes a demo Pacer in the clinic for this purpose. The Pacer is a favorite, both because of the prompt support options, and because it rolls well. Since it moves easily, it is more sensitive to the child's forward motions.
There was one family for whom we got a Pacer at home. The family took it to school with the boy, and the school saw how well he did with it, and ordered one to have at school.
Perhaps the more common view of the Pacer is as a long-term solution for children who are not expected to walk on their own, such as a child with a developmental disability. The hip positioner may be necessary in some cases for safety, but you do not want the more able child to use it as a seat, as a substitute for their own weight-bearing. It is important to make progress where possible, by removing the prompts that are no longer needed. This is an aspect I find appealing about the Pacer.
We have used the Pacer for a young boy, using only Arm Prompts. This child has cerebral palsy and he has a lot of challenges. He could not pull to stand on his own. He has a lot of tone in his lower extremities and is unable to cruise when he is upright. His family is very involved with his therapy program: his dad walks with him in the Pacer, every single day. He has done really well and is now able to pull to stand. He has developed enough strength in his legs that he can pull to stand at home at the kitchen table and participates in looking at the computer with his family. Certainly that progress can be partly attributed to all the walking practice he has had; that gait activity has been the main thing he has practiced.
The Pacer is important to give children quality of life: for the health benefits, for motor learning, and for the opportunity to be upright and move independently in their day.
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