Gait Trainer

When pediatric patients do not have the postural control to learn to walk independently by age 12-24 months, we may consider a gait trainer. Independent mobility drives the development of cognition and learning. In children who may have global developmental delays, speeding up the onset of independent ambulation may be crucial. Gait trainers offer varied levels of trunk, head, pelvis, and leg control to allow some children to learn to take steps.

Many children who are not walking independently by age 2 will benefit from the strengthening and cardiopulmonary conditioning that upright mobility offers. The best way to strengthen the muscles needed for walking in a minimally involved child may, in fact, be walking. Upright mobility may also be important in spatial awareness, exploration of the environment, peer interaction, and communication.

Most of the models of gait trainers available in the United States are made of many supports or components that easily come off and on. This system makes it easy for the therapist to provide each patient with just the right amount of support. The key is to make the patient comfortable and functional, but not to provide so much support that the patient does not move or exercise.

Children with severe gross motor dysfunction who are not expected to walk until age 5 or later, if at all, could benefit from using a gait trainer as early as 9-12 months of age. Very young, severely involved children learn to take some of their body weight through their legs as a precursor to assisting with stand pivot transfers, toileting, and perhaps assisted ambulation in later years.

For older children who have never been exposed to a gait trainer, begin by placing them upright and make sure that they can tolerate this. If the team has any concerns, a medical consultation should be obtained. If the child has any musculoskeletal deformities (back, hips, knees, and ankles), the orthopedist should be consulted before beginning the program. Once the child has medical clearance and can tolerate being upright for 5-10 minutes, then we begin to teach the child to take steps. This is accomplished by getting on the floor and moving the child’s feet (gently) with your hands. Some people believe that children should begin this process in the upright (vertical) position. Forward leaning is another option.

In the forward-leaning position, children are able to place most of their body weight on the balls of their feet. This may stimulate some basic reflexes that assist in the performance of stepping reflexes. When normal infants are tipped forward, they take steps. This is called the stepping reflex. Many children with severe gross motor dysfunction still have this reflex and it may be useful for this initial stage of learning.

Forward leaning may also produce a stretch on the hip flexors and help them to activate. The shortened position of the hip flexors and hamstrings may help very weak muscles to be able to begin to produce enough muscle force to move. Forward leaning also allows the user to be positioned so that some weight is taken through the forearms. This lessens the load taken through the trunk support and ensures that weight bearing does not occur between the legs (not a traditional place to weight bear). Weight bearing through the forearms may increase sensory input to the neck, arms, and spine, and should result in improved motor control.

The long-term goal of gait training can vary from reducing flexion contractures and increasing alertness and head control to achieving independent ambulation. By choosing an appropriate gait trainer and teaching the skill of walking, independent functional ambulation can become a reality for many people.

Some gait trainer models come with an electric lift option. A power lift gait trainer allows you to wheel up to a person sitting in a wheelchair or on a mat table or bed and get him upright without having to lift him. If you are dealing with a large person, this is a great back-saving option.

Following are some tips on using gait trainers:

• People should never hang, especially from the armpits. This can put pressure on the brachial plexus and occlude the artery. Alleviate all pressure areas.
• Avoid crouch gait (walking with bent knees). Hips and knees should be maximally extended at the proper times during the gait cycle. Facilitate a gait pattern that is as close to normal as possible.
• Do not block the pelvis. The pelvis should be free to move independently of the spine. A mild posterior or neutral tilt may work best in the initial skill-acquisition phase.
• Do not park the kids. There is little benefit to placing a child in a gait trainer and leaving her to figure it out on her own. With supervision, teach standing and weight shifts with the seat or sling removed.