Evidence Based Practice

Evidence Update

Perspectives on Selecting Gait Trainer Features

September 23, 2016 by Elena Noble, MPT

A therapist assists a young girl smiling as she practices gait training Once again Ginny Paleg, DScPT, MPT and Roslyn Livingstone, MSc have delivered a valuable literature review, this one on the all-important topic of gait training. In the therapy community we’re well aware of the importance of mobility for the developing mind and body. Because children with cerebral palsy at GMFCS levels IV and V are not independently mobile, supportive gait trainers provide critical therapy opportunities. While there are many adaptive gait trainers available, each with a wide variety of features and accessories, there is a lack of information or research to guide a clinician’s decision-making process when choosing between the various models. In fact, preliminary research suggests that gait trainers are chosen either because of familiarity or availability.

To assess the available evidence, researchers Paleg and Livingstone put together a literature review containing clinically grounded articles, case studies, surveys and expert opinion pertaining to gait trainer features and selection.

Considerations for Choosing Gait Trainer Features

It is clear from their findings that current evidence pertaining to the benefit of various gait trainer features is limited, divergent in areas and depends largely on the diagnosis of the client. Though it is difficult to summarize their findings, here are a few considerations I found particularly interesting:

  • Posterior gait trainers encourage more upright posturing whereas anterior gait trainers are easier to transfer into.
  • Flexible and dynamic pelvic supports may be most helpful for kids with dystonia or hypotonia and will contribute to more movement of the pelvis and rotation of the trunk.
  • A forward-leaning position in a gait trainer contributes to stepping and moving forward whereas a more vertical position makes the device more maneuverable.
  • Hands-free walkers contribute to arm swing and trunk rotation as well as increased participation and inclusion. Parents prefer hands-free walkers because they look more “typical.” But children with spasticity tend to relax more and step better when using arm supports.

This literature review is a welcome addition to the existing body of pediatric gait training research. Thank you Drs. Paleg and Livingstone!

Reference: Paleg G, Livingstone R. Evidence-informed clinical perspectives on selecting gait trainer features for children with cerebral palsy. Int J Ther Rehabil. 2016;23(8):444-54.

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Reply by Lynn Geddes on September 28, 2016 at 4:57 PM
Why would a rifton dynamic gait pacer, be more beneficial to a person with a TBI and Stroke than a gait pacer that the patient sits in and pushes along with there legs. What is the difference.
Reply by Daniel on October 01, 2016 at 11:54 PM
Daniel has been using Rifton gait trainer since he was 6 years old. Throughout his growth, controlling his spasticity was very challenging. At time I, as his mother, felt like he was no longer able to walk in his gait trainer due to various factors from having CP. At 16, he got his first power standing wheelchair, after years of standing in a standing frame. He actually can drive on his own!!! This took us (parents) years to teach him to drive. Reason he can drive is because he has spatial awareness from being in conductive education during his earlier years and years of practice with walking in the gait trainer. Daniel was born with severe brain injury. He is now 24 years old. He is has spastic quadriplegia (GMFCS level 5),nonverbal, tube fed, received full spinal fusion at age 17. After courses of hyperbaric oxygen therapy (HBOT). We (his parents) taught him to use a DynaVox T10. This spring Daniel did a 5k run for Respect at the Gonzaga University, he drove his power wheelchair for about 2k, and he walked the last few yard without his gait trainer. To see him walk in action: www. youtube. com/ watch?v=6G0uqLYDT2A He still practice walking in his gait trainer at home 5 days a week. Saturday he walk up (with my assistant) to bowl!
Reply by Elena on October 05, 2016 at 10:58 AM
Thank you for sharing about Daniel. He walked wonderfully across that finish line. Keep it up!