Focus on Gait Training

Who Can Benefit from Gait Training?

• By Laurie Watanabe
• Apr 01, 2022

The term gait training suggests learning to walk — and for some who use gait trainers, that’s exactly the goal. But gait trainers can also be beneficial even to those who will always need support while walking.

Many Clinical & Functional Benefits

Curtis Philyaw, ATP, an Etac Product Manager, explained, “The human body is designed to be in an upright position. Our body functions — our muscle development, bone structure, nervous system, even internal organs — all function ideally when you’re standing or walking.”

Philyaw said he’s often asked when a gait trainer should be introduced. “We’ve seen extremely positive results from an early introduction to gait training,” he said. “If you look at a typically developing child and when they start to stand or take steps — some children are taking steps around 12 months. A child with a physical impairment may not be able to do that independently… but every child deserves the same opportunities.”

Introducing a gait trainer when a child would typically start to stand and walk can have a huge impact on the child’s overall development, Philyaw said: “Not only cognitive development, but also the physical development of the child.

“Clinical benefits include joint and bone development. A newborn has kind of an inverted hip prior to ambulation. When the child starts to stand upright, they start to weight bear, and they stand or even take steps. Now you have rotation of the head of the femur; it’s going into the acetabulum. You’re building stability in their hip structure. They’re starting to get not only normal hip alignment, but knee alignment, foot alignment. Entire body alignment.”

When weight bearing and gait training are paired, “You’re encouraging not only that body alignment, but now you’re reducing the risk of osteoporosis,” Philyaw noted, “which comes from a lack of mineral density within the bones. Once you start to lose that density, you begin to risk osteoporosis, which ultimately leads to a higher risk of fractures. When you look at the muscle-bone relationship and the child is not moving, now they have a greater chance of contractures, with those muscles tightening and pulling those legs further in. You start to get into other issues: hamstring tightness, contractures, limited mobility.”

Assessing for a Gait Trainer

Gait training can also help children with spasticity: “Weight bearing and ambulation can reduce their levels of spasticity,” Philyaw said. “You’re building strength in the muscles and joints, you’re improving the balance of that child, you’re improving their posture. Most of all, you’re improving their endurance with that increased mobility. You’re increasing their range of motion, and ultimately, you’re increasing that child’s independence.”

Philyaw emphasizes there is no age limit for a gait trainer — “We would love to see gait training introduced as early as possible, with the appropriate child,” he said — but Etac has gait trainers with weight capacities up to 170 lbs. to accommodate kids and adults.

“The evaluation is key in the decision-making process,” he said. “Along with determining therapy goals, we dig a little deeper on the purpose of the gait trainer and this child’s life. How will this equipment be used? That will help you determine the right gait trainer. There are different levels of support needs.”

This summer, Etac plans to launch its Crocodile size 0 gait trainer: “The handle height is 11.5" from floor to handle,” Philyaw said. “It can accommodate a very small child, and the intention is to address a child as they take their first steps.

“The Crocodile can be used for a child that can ambulate short distances, but may fatigue and need assistance, or it can be used for a child who can self propel in a wheelchair, but has limited ambulation with an assisted device. Some kids only use it at school; some only use it at home. Some children use it 100 percent of the time, at home, school, or in the community. So you have to determine the purpose of the gait trainer, and determine where it’s going to be used or how often.”

Philyaw also distinguished a gait trainer from a walker: “The gait trainer has supports for a child that has a great need for balance support, stability, and weight-bearing support, whether or not it be partial weight bearing. That’s what differentiates a gait trainer, because those components and accessories can be not only added to the gait trainer, but they can be adjusted to accommodate growth in that child and still provide that same level of support. As the child becomes stronger, you can begin removing those supports as they are no longer needed. The gait trainer adapts with the child’s abilities.”

Crocodile size 0, Philyaw added, functions very much like larger Crocodile gait trainers, with a few added functions. “Very small children, when they’re first beginning to walk, hold their hands out in front of them as a counter weight to balance their bodies,” Philyaw noted. “So we redesigned the hand placement of the Crocodile 0. It will come with the standard handles, but there is an option for a hand grip that’s placed in front of the child.”

The great flexibility of gait trainers — including that there are anterior, posterior, and reversible models — means they can be used short term to build strength or rehab an injury, or longer term, while offering a range of benefits the entire time.

“There are several factors when choosing a gait trainer, and that’s why it takes a team: the clinician, the family, and most importantly, the child,” Philyaw said. “Whether the child is verbal or non-verbal, they can communicate very effectively when something is not working and they are unhappy. Then of course, the ATP and often the manufacturer’s rep, and the doctor. It’s a team approach, first of all determining the goals, and then determining what equipment can be used to achieve those goals.”

This article originally appeared in the Mar/Apr 2022 issue of Mobility Management.