Many children with cerebral palsy (CP) require walkers to achieve functional ambulation, yet little scientific study has been done to understand the mechanics of usage. Objective: To provide a quantitative comparison of ambulation with anterior and posterior walkers in children with CP using measures of temporal-spatial gait parameters, Gross Motor Function Measure (GMFM), energy expenditure (EEI), and upper extremity joint positioning and loading. Method: With informed consent, data were collected for nine children with spastic diplegic CP who were community ambulators and who routinely used posterior walkers. Participants were initially evaluated while using their posterior walkers and then were trained and evaluated in the use of an anterior walker.

Results of the study showed increased double-limb support time (24.3% to 30.7%) with anterior walker use. Walking speed increased (16.7% to 21.4%) for ambulation with the posterior walker. An increase of 4.7% in dynamic functional stability (GMFM score E) was noted with use of a posterior walker. Significant changes in trunk flexion, standing functional stability (GMFM score D), and EEI, however, were not noted. The shoulder was more extended (32% to 45%) with posterior walker use and a net demand on the shoulder flexors (0.15 Nm/kg) was documented, while a net shoulder extensor demand (Ð0.04 Nm/kg) was recorded with use of the anterior walker (0.19 Nm/kg, 0.07 Nm/kg) compared with the use of the posterior walker (0.06 Nm/kg).

The methodology of this study provides insight into the effect of upper extremity muscular demands in addition to the traditional lower extremity gait analysis, clinical evaluation, and energy expenditure assessment. Potential rehabilitation applications which could benefit from this technology may include the optimization of pediatric walker-assisted gait.

Childhood Disability Update 2005 - Conference Abstracts.Pediatric Oncall [serial online] 2006 [cited 15 January 2006(Supplement 1)];3. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
anterior_versus_posterior_walkers.asp