Pacer Prompt Reduction
Concepts for Skill Building
by Lori Potts, PT
Each child is unique.
Active participation of each child, at any level possible, should be encouraged. In order to challenge the child both physically and mentally, this participation should occur with the least amount of support possible. Learning, recovery, and compensation are all facilitated through challenging and novel tasks.
Strength-gains and motor-skills learning are best achieved when a child is given just enough support to stimulate weight bearing and movement control. As the child gains skills, the supports or prompts should be systematically reduced or removed, encouraging greater independence. Configure the prompts of the Pacer to meet the individual’s requirements, providing only as much support as needed.
Appropriate prompt positioning is very important for children who are unable to bear full weight through their lower extremities, and for children who need positioning for alignment.
Weight-bearing assist occurs:
- Through the forearms with the Arm Prompts.
- At the chest with the Chest Prompt.
- At the pelvis with the Hip Positioner.
With the Arm Prompts horizontal (positioning the elbows below the shoulders) weight is shared through the shoulder girdle and arms, freeing the legs to move. Leaning into the front portion of the forward-tilted Chest Prompt also offers weight-bearing support. The seat of the Hip Positioner provides “lift” under the child’s seat to help with weight-bearing. This is achieved by raising the height of the Handhold posts and tightening the straps.
Alignment can be improved while the child is supported, by adding and adjusting prompts as necessary.
Positioning the child for alignment occurs:
- At the trunk with the Chest Prompt.
- At the pelvis with the Hip Positioner.
- At the thighs with the Thigh Prompts.
- At the ankles with the Ankle Prompts.
Angling the Arm Prompts upward assists with head and upper trunk control. Efficient placement of the four straps of the Hip Positioner, along with utilizing the Chest Prompt tilt, enables purposeful positioning of the pelvis in relation to the shoulders. Thigh Prompts and Ankle Prompts provide leg abduction and guide placement and length of steps.
Children who have difficulty initiating forward movement may have more success in a forward-leaning position. The key to providing the appropriate amount of forward-lean is the placement and angle of the Hip Positioner, Chest Prompt, and Arm Prompts. To increase forward-lean, the Hip Positioner can be moved back by fastening the front straps of the Hip Positioner to the supporting bars of the Chest Prompt. When both the Hip Positioner and Chest Prompt are used in conjunction with the Arm Prompts, the Arm Prompts can be moved forward onto the front bar of the Pacer. The Chest Prompt tilt is adjusted for maximal comfort. The amount of forward-lean can be decreased as mobility skills improve.
Utilizing the Pacer's full range of possibilities will help you to meet your child’s goals for mobility and activity. Movement while upright, weight bearing while standing, and the ability to participate more fully in activity, are very beneficial for every child, regardless of whether complete independence from prompt support is ever achieved.
Through using only the prompts that a child needs, and gradually reducing and eventually eliminating this support, many children will demonstrate increasing independence in mobility.
Following are examples of the many options available for prompt use and reduction. Depending on the ability demonstrated by each child, other variations can be considered.
- Remove the Hip Positioner for a child who quickly develops improved weight-bearing ability, so that the seat is utilized no longer than necessary.
- Loosen and lower the Chest Prompt to permit more weight-shifting for a child who is gaining trunk control.
- Remove the Chest Prompt while the Arm Prompts and leg control prompts are still in use, for a child who needs help with leg placement and positioning, but who has good trunk control and balance.
- Use the Ankle Prompts (without the Thigh Prompts) to help limit stride length for a child who needs help with movement control. The spacing of the Ankle Prompt spring adjusters can be increased over time as the child’s walking ability improves.
- The Casters also assist movement control. The variable wheel drag individually slows each Caster, to decelerate a fast mover, promote leg strengthening, or to help a user who veers toward one side during gait. Engage the swivel lock on the two rear Casters for easier steering. The one-way ratchet control permits forward movement only. Lock the Casters for standing practice.
- Remove Arm Prompts for children who function best when their arms are not restricted. Children with extreme spasticity may utilize their ATNR reflex to promote step-taking, and may walk with less effort when their arms are free.
- Use just Arm Prompts with the Pacer positioned either in front of the child or placed behind the child (in a reverse walker position). When the Arm Prompts are the last prompt to be removed, the child has maximal opportunity to develop control of the trunk, pelvis, hips and legs for independent walking. When using the Arm Prompts only, do not place them at extreme positions toward either the front or back of the Pacer. The Handholds can be used in place of the Arm Prompts as the child progresses toward independent walking.
Activity is important, regardless of the quality of movement or how much support is required. A child’s gait may not be beautiful, but there are significant benefits to active limb use and independent movement.
The Pacer is more than a gait trainer: it is a device that allows children to participate more fully in life. The supportive prompts of the Pacer enable active participation and promote valuable motor learning, strength gains, and mobility. Prompt reduction can occur as a child gains skills, improves function and achieves greater independence.
Please note: This article does not replace the direct personal advice of a medical professional. Appropriate use of the Rifton Pacer requires the prior approval and ongoing guidance of a qualified therapist.
Read more…
Prompt Reduction Sample Sequence
Guidelines for Functional Use of the Pacer
