Rifton Evidence Update

Elena Noble, MPT | October 2011

A monthly roundup of evidence-based articles from rehabilitation journals.Because the Rifton Pacer gait trainer was featured as the support walker of choice in pediatric clinics, we were privileged to receive an advance copy of a great new survey which will be published in the upcoming issue of Pediatric Physical Therapy. Here’s a preview:

Pediatric Physical Therapists’ Use of Support Walkers for Children with Disabilities: A Nationwide Survey

Authors: Low, SA; Wetcott McCoy, S; Beling, J; Adams, J

This survey provides preliminary evidence pertaining to the use of what the authors’ call support walkers in the pediatric clinic. The questions of the survey focused on the clinical decisions and the factors that guide a therapist when recommending a support walker for a child. Five hundred and thirteen PTs responded to this survey and descriptive statistics were used to analyze the results. Below are some findings which indicate why therapists implement gait training as part of the intervention in the pediatric setting.

  1. The impairments that most often result in the recommendation of a support walker are (descending order): weakness, motor control, poor balance, posture, endurance, hypertonia, gait pattern, hypotonia, cognitive status, ROM
  2. The most important physiological consideration for support walker use was hip development.
  3. The majority of PTs indicated that at least nine therapy sessions were necessary in order to teach a child to use the walker. Subsequently nine or more sessions were indicated as the time in which a child could learn to walk independently using a support walker.
  4. The best indicators for a child’s success with a support walker are (descending order): GMFCS level, motivation to walk, and cognitive level.
  5. The most commonly used support walkers (in descending order) are: Rifton Pacer gait trainer, Kaye PWB Suspension, Litegait, Pony, Gator, Croc, Bronco, Mullholland Walkabout, Mae Walker

The authors of this study conclude that although therapists are recommending support walkers in their therapy routines, further evidence to validate the positive effects of support walkers on mobility, activities of daily living, and participation in the pediatric clinic would be of benefit. But there are many more findings—this is only a preview. Be sure to access the full text from the issue of Pediatric Physical Therapy when it comes out in later this month.

Effects of Functional Mobility Skills Training for Adults with Severe Multiple Disabilities (Education and Training in Autism and Developmental Disabilities 2011;46(3):436-53)

This study was conducted to determine the effects of a functional mobility program on non-ambulatory, wheelchair bound adults with developmental disabilities. Five adults from a non-profit day habilitation program participated in this study. Within this day habilitation program their typical intervention goals included: one-to-one attention, manipulating objects, crawling on floor, and daily wheelchair walks. For this study, the MOVE Curriculum was the independent variable.

The Mobility Opportunities Via Education (MOVE) program is activity-based and designed to teach functional skills to individuals with severe disabilities to improve their quality of life. The researchers chose standing time and walking distance (reciprocal steps) as the dependent variables. Measures were taken during baseline, intervention, and two-year maintenance phase.

The MOVE intervention resulted in increased standing time and walking for all participants which resulted in increased participation in activities and the ability to use adaptive mobility equipment. At the two-year maintenance phase, staff reported continued improvements in standing and ambulation for all five participants and a decreasing need for staff support in these activities. The authors suggest that this study is an important first step in demonstrating the benefits for adults with severe developmental disabilities to participate in mobility programs as opposed to passively receiving care.

Physical Activity Benefits of Learning to Ride a Two-Wheel Bicycle for Children with Down Syndrome: A Randomized Trial (Phys Ther 2011;91(10):1463-73)

Previous studies have shown that children with Down Syndrome (DS) lead more sedentary lives than their peers. This is indicative of the higher rates of obesity and weight issues seen within this population. The researchers of this study wanted to determine if applying a physical activity intervention (expanding motor repertoire) could change this trend. Bicycle riding was chosen as the intervention because it is a skill that children with DS almost never learn, but once learned could increase activity levels.

Sixty-one children with DS participated in the study and were divided into the experimental and control groups. Measurements of leg strength, balance, height weight, skinfold, and physical activity were taken for each child pre-intervention, seven weeks post intervention, and a year post intervention. Adaptive bicycles were used to teach the skill. Five days were allotted to learn this skill and 58% of the original experimental group succeeded. Data was recorded on this group.

Those children who learned the skill in five days reduced their time in sedentary activities per day by 75 minutes. At the one year follow up, these children also showed increasing moderate to vigorous physical activity levels and decreased BMIs and percentages of body fat. The researchers conclude that this study is a major milestone in helping to guide interventions for children with DS that promote health and participation in age-appropriate activities.

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