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Tommy

Tommy, aged 3, achieves encouraging gait progress with R82’s Mustang

Tommy, an inquisitive 3-year-old from Immingham, Humberside has recently started using R82’s Mustang gait trainer that allows proper positioning and support for children while they learn the skills of stepping and walking.

Tommy and Frances

Tommy lives with Tuberous Sclerosis Complex which has caused the growth of benign tumours, particularly in his brain and affects movement and abilities. Tommy has high tone in his lower legs and requires a lot of support to facilitate walking and to progress developmentally.

Tommy recently started attending Humberston Park Special School, Grimsby, where Frances George, Specialist Physiotherapist, MSc, BSc, HPC, MCSP has introduced “walking and stepping” focus groups to assess the walking patterns of children with different abilities. Frances explains: “To encourage a child to walk, it is important to understand the 3 gait phases of a normal walking pattern – the heel strike, stance phase and toe off which happen reciprocally. If a child makes a heel strike with the right foot, then a stance phase will be happening on the left – creating stability and placing the hip and knee in a neutral position. A step forward into toe off extends the hip and knee before allowing the knee to flex and the leg to swing through. This is then followed by the knee extending and the foot dorsi-flexing to create a heel strike. During this process, weight is transferred from the back to the front foot which creates sway or a “lateral shift”. This entire process allows propulsion forwards and is the walking pattern we want to achieve when we place a child in a walker.”

Humberston Park started using R82’s Mustang 18 months ago. An older child was struggling to find the correct position in the walker they were using and their feet were becoming wider apart. School staff explored options for other walkers and decided on the Mustang which led to dramatic improvements. 

The Mustang is designed to assist gait in a wide range of abilities and currently there are five children at Humberston Park, aged between 3½ to 16 years, benefitting from regularly using the walker in integrated therapy and education sessions. The anterior position is ideal for users unable to fully weight bear on their feet, or if motor skills are reduced and the user needs support around the trunk and pelvis. The posterior position can be used for those children who have improved gait development, more advanced trunk stability and who are capable of bearing their full weight.

Humberston Park School assess children in the Mustang over the course of several therapy sessions, allowing time for them to adjust and for staff to see if the equipment is suitable. After monitoring Tommy’s gait for a few weeks whilst he settled at the new school, Frances felt the Mustang could help re-educate his walking pattern. Tommy has a scissor gait which means he often steps on his own feet and also uses a learned walking “hopping” pattern. Frances ideally would like Tommy’s left and right legs to work in isolation and the muscles to be worked through the full range to achieve a more reciprocal walking pattern. Frances elaborates: “If a child has issues with muscle strength, tightness and tone there are often typical patterns that emerge – such as the bottom sticking out, flexion in the hips and knees and the legs start to scissor. The child struggles to step forwards, as is the case with Tommy. With other walkers, a child who has issues with walking or stepping not only has to move their body against gravity but also has to move the piece of equipment as well. So they have to move their body weight, the walker and overcome inertia. However, the Mustang allows prone which shifts the centre of gravity forwards of the base of support. This assists the child in overcoming inertia, enabling them to make that crucial first step.”

In order to help Tommy achieve a normal walking pattern, a seat saddle has been attached to the Mustang. The seat saddle provides a firm support so Tommy’s hips and legs can be fixed in a set position. The saddle can be set at a height which supports his body weight whilst staff focus on reeducating his gait and working the correct muscles to allow hip and knee extension. Once the correct pattern is achieved the saddle can be lowered and gravity can be reintroduced.

Frances explains: “To develop early stepping, the child needs to be in a standing position – so a correct starting position is crucial. The trunk, shoulders, hips and feet should be in line, with weight bearing as central as possible. This ability to fix the Mustang’s seat firmly in different positions allows us to monitor Tommy’s situation really well and provides us with crucial feedback as to how we can progress. So, for example, if we need flexion or we want him to extend, we can adjust the seat accordingly.”

Tommy does not have issues with tightness in his hamstrings and can achieve a good alignment in With other walkers...a child has to move the piece of equipment as well. However, the Mustang allows prone which shifts the centre of gravity forwards of the base of support....enabling them to make that crucial first step. hip and knee positioning, which the school are keen to promote. To correct his scissoring, the Mustang has an attachable leg divider, which keeps his feet apart and prevents one treading on the other. It can also reduce Tommy’s tendency to hop by encouraging a reciprocal pattern from the left foot to the right, accompanied by an ideal weight shift – instead of both feet being placed together and pushed through to a hop forwards.

As the Mustang has different wheel configurations, all four wheels can be fixed so that Tommy can walk in a straight line, concentrating on achieving forward momentum and obtaining the correct gait pattern. This will also help develop his trunk control and promote balance in stepping. Following on from this, the front wheels can be unfixed so that Tommy can go forwards or backwards and in the future, all four wheels can be unfixed giving him complete control over his walker and the pace he is using whilst stepping. Although this is much more challenging for the trunk, the Mustang supplies essential chest support in the form of an adjustable moulded trunk support. It provides a firm and snug fit to aid trunk stability which allows for greater mobility and coordination of the lower body.

For Frances, the Mustang walker is a superior piece of equipment crucially because of the firm support of the adjustable saddle, the essential chest support and the prone positioning. Simultaneously, they allow crucial alignment to be maintained, creating the hip and knee extension necessary for a step forwards.

Whilst still in the early stages of developing a correct gait, Tommy has shown encouraging progress in the short time he has spent with the Mustang. He still has a tendency to hop but can already place one foot in front of the other. Tommy loves social interaction and is keen to explore. Frances believes this self- motivation, coupled with the Mustang’s capabilities, will ensure Tommy can achieve long range progression in his standing and walking abilities.

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