The Upper Extremity Load of Children with Spastic Diplegic Cerebral Palsy Using Posterior Walkers at Different Heights

Objectives:Walkers are the most prevalent assistive device used to help children with cerebral palsy. However, objective and quantitative criteria for the walker prescription are still lacking, and only a few studies in the literature have been directed at children with cerebral palsy. In addition, there is disagreement in terms of results with respect to the sagittal load of the upper extremities during walker-assisted ambulation. Furthermore, the transverse load of the upper extremities has never been discussed. Therefore, the purpose of this study was to determine the effects of posterior walker settings at different heights on the horizontal push (transverse) and vertical downward (sagittal) force applied to the walker by children with spastic diplegic cerebral palsy. Methods: The dataset was collected with the help of four children with spastic diplegic cerebral palsy who used an instrumented walker under five different conditions. These were standard walker height (at the level of the subject’s greater trochanter), 1 inch and 2 inches above the standard high and 1 inch and 2 inches below the standard height. The horizontal push (transverse) and vertical downward (sagittal) force produced by the upper extremities were measured for both left and right sides by means of force transducers. Results: In children with spastic diplegic cerebral palsy, using the walker at different heights resulted in different upper extremity loads, although no linear correlation was found between any pairs of them. Conclusion: Since no consideration of trunk and the upper extremity muscle tone has been made in this study, which relates to the heterogeneity of the individuals studied here, the common standard for walker height setting, namely the level of the user’s greater trochanter, may not be appropriate for all users. Our study provides clinical workers with some background information and suggestions that may help when planning therapeutic intervention. When prescribing a walker for children with cerebral palsy, multidimensional considerations should be taken into account in order to meet the demands of each individual, to fit with the different purposes the child may require and to aid in the choice between the various available therapeutic options.