Gait training can mean multiple things depending upon who is asked for their definition. Gait training is seen by some as a way to increase independence in all aspects of mobility with the ultimate goal to be independent without adaptive equipment or the least restrictive equipment. Others define gait training as a means for mobility exploration and aerobic exercise with the goal being overall health and increased independence with transfers. Both of these are accurate descriptions which define gait training for children with different long-term potential for independence. Now the question is, how does one know which group describes a child. The answer can best be found through discussions with the physicians and therapists that are familiar with the child’s diagnosis.

In addition to this, there is a great tool that is available to help guide and predict relatively accurately a child’s potential for independent mobility throughout their childhood and adolescence. I must mention that this tool is only a predictor for children with Cerebral Palsy. It is not designed to be used as an assessment or predictor of function in any other diagnostic category. That being said, this great tool is referred to as the Gross Motor Function Classification System (GMFCS). The GMFCS has determined through extensive research that there are 5 levels that categorize mobility aptitude in children with cerebral palsy. The levels range from level I: a child is independent with mobility and requires no assistive devices to a level IV: a child is dependent upon manual mobility unless they can master independent mobility using a power wheelchair. In order to learn where a child falls within the levels, an evaluation must be completed and scored by a trained professional, most likely the child’s therapist. More information about the GMFCS levels can be found at http://motorgrowth.canchild.ca/en/GMFCS/resources/GMFCS-ER.pdf. Regardless of the diagnosis, certain factors can adversely affect mobility. These include muscle tone, tonal movement patterns, and orthopedic concerns (i.e. brittle bones, dislocated/subluxated hips, etc.). The abovementioned can best be managed with appropriate positioning and adaptive equipment combined with the efforts and knowledge of physicians and therapists.     

Why is mobility important? Mobility has many benefits ranging from physical to cognitive and social development. For this next section, all forms of mobility will be explored. First, gait training, ambulation, or mobility using an adaptive device (i.e. crutch, walker, and gait trainer) provides the opportunity for aerobic exercise. Exercise has been determined to be essential for cardiac and respiratory health as well as bone density and weight management. Mobility, that is self-directed by the child, whether through ambulation or with a powered wheelchair, is crucial to developing cognitive and social skills. A child that is provided the opportunity to explore their environment can interact with others by seeking out a communication partner, learn about their environment, and begin to learn how to navigate including safety and directional concepts. Mobility in a young child is a naturally occurring developmental step that greatly increases a child’s cognitive and social skills. During the exploration phase a typical child will learn about textures, be able to self-explore items that they are interested in, learn about and see more of their surroundings as well as “find” mom/dad or a caregiver to seek social interaction as desired. A child with special needs may not be able to reach this independent exploration phase that is critical to development without adaptive equipment. Research has shown that power mobility is just as effective as ambulation for maximizing this growth. That being said, not every child is appropriate to have their own power wheelchair due to extenuating reasons, but one can be used during therapy to assist with learning cause and effect and basic switch access. (RESNA Position Paper on Application of Power Wheelchairs for Pediatric Users, 2009), (Ginny Paleg, June 2008).

Power mobility use is a tool that must be completed with a therapist and is beyond the realm for the purpose of this article. It was mentioned only as an alternative for those children that gait training may not be appropriate. For the rest of the article, let’s focus on the types of assistive ambulation devices and their function. Adaptive walking products can be divided into the following 3 categories: gait trainers, walkers and forearm crutches.  Gait trainers offer the most postural support followed by walkers and then with forearm crutches providing the least. For this reason, children who require the most postural support, have less functional use of their arms, and/or are in the early phases of mobility, may benefit most from gait trainers.

Gait trainers offer a multitude of positioning options and prompts to encourage mobility. These include pelvic harnesses, forearm prompts/pads, trunk supports, ankle prompts and additional pads and prompts for support. These devices can provide positioning supports to facilitate a walking position (i.e. forward lean) while supporting the weight of the child. The gait trainer is responsible for “doing most of the work” as it offers postural support, weight bearing support, and facilitation prompts. The child is still required to move their legs for movement while being supported as much as needed. The gait trainers best serve the emerging mobility users or those that require more postural support. Gait trainers can be modified to meet a child’s needs as their skill level increases by removing the prompts and postural supports.

Walkers are the next level of assistive devices. Walkers require a child to complete more work. The child is responsible for supporting more of their weight and fewer postural supports and prompts are available. A walker can provide support from the front (anterior) or the back (posterior). Posterior walkers allow the child to approach surfaces from the front and allow the best access to tables/counters. They also promote proper alignment. These walkers are best used by children with the ability to utilize their arms for postural support with sufficient upper body control and strength. While anterior walkers are better for children that may not have the strength or upper body control to manage the walker. These walkers have a slightly wider base and stable frame to better accept the tonal influences related to certain neuromuscular disorders.

The last category includes the forearm crutches. These crutches require the most amount of postural control by the child to be able to use. The forearm crutches require sufficient upper extremity support as well as the ability to tolerate weight bearing through the legs. With crutches a child must possess adequate muscle coordination to be able to coordinate an arm swing type of movement with steps. The crutches require the child to do the majority of the work.

As mentioned, mobility plays an important role in a child’s overall development. It not only impacts the child physically but also socially and cognitively. In order to achieve the benefits of mobility, the act must be self-directed by the child. There are multiple ways for a child to explore mobility regardless of their diagnosis and level of physical involvement. Please consult the child’s therapists and physicians prior to beginning any mobility program.

If at any time, it becomes too confusing or difficult to navigate through the world of walking products or any other piece of equipment, please do not hesitate to contact us here at Tadpole Adaptive. We are always willing to provide unbiased and informed guidance.