A rear support walking frame for severely disabled children with cerebral palsy: initial development

Ambulation for patients with total body involved cerebral palsy poses greater problems than those encountered in providing reciprocal walking for thoracic lesion paraplegic subjects. Experience with a prototype system showed that an orthosis which controls the movement of the lower limbs, in combination with a walking frame giving anterior support, enables such patients to walk. Despite shortcomings which restricted the use of the system to an indoor environment it provided a sound basis on which to examine walking frames to address the problems which had been identified. A review of these devices showed that the most effective means of achieving this aim is the use of a wheeled walking frame which provides vertical support and truncal alignment via a sprung pantograph mounted to the rear of the patient (rear support walking frames). Trials were conducted with two existing rear support walking frames. These indicated their potential for severely disabled patients, but also identified the need for higher stiffness in the structure and more sensitive control of vertical support to be achieved if effective ambulation in a wider range of environments was to be made possible for the target group. Prototypes based on an existing frame, which took account of the specification requirements, were produced for four new total body involved cerebral palsy patients with the same degree of walking dysfunction. Three of the patients were able to walk in a much wider variety of environments than any patient in the original system. A number of other issues related to transfer and steering were identified as requiring further development.