Mobility is a large part of quality of life, and plays a pivotal role in social development and psychological function of the child. Mobility also improves the general cardiovascular and bone health. Physical impairment is a real problem to the patient and the family. But also on a societal level, there are significant direct and indirect economic costs associated with it. Unfortunately, for most conditions there is currently no cure and supportive treatments are limited to non-invasive therapies such as physiotherapies, orthotics, postural management and medications. Children who are ambulant (up to 80% of all CP children) commonly use anterior and posterior posture walkers to improve their walking. These paediatric walkers include gait trainers that provide these children with trunk and pelvic support. There is good evidence that such gait trainers help the users improve their motor function and can also be used as part of their therapy to develop independent walking. Recent systematic review of the use of gait trainers in a total of 182 children demonstrated descriptive evidence of positive motor outcomes, especially in improving their stepping as well as walking distance.
There is also evidence that gait trainers may have a positive impact on body structure and function, activity and participation outcomes including increased levels of overall independence, mobility, transfers and self-care abilities. It is recommended that the gait trainers should be introduced early around 9 to 12 months of age when upright positioning and mobility can potentially impact the children’s motor, sensory, visual and social development. One of the practical challenges in engaging these children in physiotherapy and gait training with a walker is that they tire easily. It has been shown that children and adolescents with CP have elevated energy expenditure when standing. During therapy, children with CP need to take frequent breaks to rest. To do so, they have to leave their walker to sit down. Furthermore, getting up from rest and entering the walker again is also very tiring and requires assistance due to their baseline muscular weakness and body posture. The resting periods disrupt training and cumulatively lead to further patient exhaustion and reduced intervention time. The problem of fatigue and need for frequent transfers to rest also reduces the effectiveness of gait trainers as an assistive device to enhance the children’s mobility and participation in daily activities.