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.”