Spina bifida is a birth condition affecting the spine’s development, which often impacts muscle control and strength in the legs. This can challenge independent movement. To aid mobility, many children use adaptive equipment like walkers. These tools provide the support to help them stand, move, and explore their surroundings.
The Purpose of Walkers for Spina Bifida
Walkers and gait trainers aid physical development by enabling weight-bearing. Standing and moving upright places pressure on the long bones of the legs, signaling the body to build and maintain bone mineral density. This dynamic loading during assisted walking is more effective for bone development than static standing. This helps reduce the risk of fractures and osteoporosis later in life.
Using a walker also encourages better posture and strengthens core muscles. The external support allows a child to position their pelvis forward and extend their spine. This upright alignment helps stretch tight hip and knee muscles, preventing contractures, which are permanent shortenings of muscles or joints. Pushing a walker and taking steps strengthens trunk and leg muscles, improving stability and motor control.
Beyond physical benefits, these mobility aids offer social and cognitive advantages. Independent movement allows children to explore their environment, which supports spatial cognitive development. Being upright and at eye level with peers fosters more natural social interaction and participation. This independence can boost confidence and reduce the fear of falling, encouraging a child to engage more fully in daily life.
Common Types of Walkers and Gait Trainers
A variety of walkers and gait trainers offer different levels of support. One common type is the posterior walker, also known as a reverse walker. Positioned behind the user, it is pulled along as they step. This design encourages an upright posture and a natural walking pattern by promoting trunk extension.
Another option is the anterior walker, the traditional design that is placed in front of the body and pushed forward. While these provide a high degree of stability, they can sometimes promote a forward-leaning posture. The choice between walker types depends on the individual’s specific postural needs and gait pattern.
For children needing more comprehensive support, a gait trainer is often suitable. Gait trainers are highly supportive walkers with features like a saddle for pelvic support, trunk harnesses, and ankle guides to ensure proper alignment. These devices are for individuals who have difficulty bearing their full weight or maintaining balance with a standard walker. They provide a secure framework for safely practicing walking movements.
Choosing the Right Walker
Selecting the right walker or gait trainer requires a professional evaluation by a physical or occupational therapist. A therapist will assess a child’s physical abilities, considering factors like trunk control, leg strength, and weight-bearing ability. The goal is to match the equipment to the child’s current skills and support their developmental progress.
Proper fitting and adjustment of the device are necessary for both safety and effectiveness. A therapist will ensure the walker is the correct height, allowing for a slight bend in the elbows when the child is standing inside the frame. Components on a gait trainer, such as chest prompts or pelvic supports, must be individually adjusted for optimal alignment. An ill-fitting device can be unsafe and may hinder the development of a functional gait pattern.
The selection process also considers the environments where the child will use the walker. A lightweight, foldable walker might be ideal for school and home, while a more robust gait trainer might be used during therapy sessions. Customizations like forearm supports for children who cannot grip with their hands, or pelvic stabilizers for extra support, can be added to meet specific needs.
Mobility Progression Beyond the Walker
A walker is often one step in a longer journey of mobility, serving as a tool for building strength and balance. As a child grows and develops greater motor control through consistent therapy and practice, their mobility needs may change. They might progress from a highly supportive gait trainer to a posterior walker, and eventually to a less restrictive device.
A common next step after a walker is the use of forearm crutches, often called Lofstrand or Canadian crutches. These crutches provide support through a cuff that encircles the forearm, allowing the hands to be free for activities without dropping the crutch. This transition occurs when a child has developed sufficient upper body and core strength to support their body weight and can maintain balance with less external aid.
It is important to view the wheelchair as a functional and efficient mobility tool, not as a failure or a step backward. For navigating long distances, participating in sports, or conserving energy, a wheelchair is often the most practical choice. Many people use a combination of mobility aids—crutches for short distances and a wheelchair for community outings. This flexible approach allows for full participation in life while managing energy levels.