SMART Device Provides New-Found Freedom

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By Mendal Slack, BSc, CO
A youngster enjoys the freedom and mobility provided by the SMART Walker™
A youngster enjoys the freedom and mobility provided by the SMART Walker™

For some children with cerebral palsy, walking may be delayed for years or may never happen without proper therapeutic and orthotic intervention. These children usually present with a diagnosis of spastic quadriplegia, athetosis, or they may have more involved forms of triplegia and diplegia. They are often tried in conventional hand-held walkers and AFOs, but this may not be safe or functional due to spastic upper-extremity involvement, low-tone trunk, poor balance, weak upper extremities, or lack of lower-limb control.

The children may also be tried in one of the commonly used mobility devices. These generally consist of a four-wheeled frame with a seat or pommel in the groin area, some trunk support, and minimal or no control of the lower limbs. While the device may allow mobility, children tend to rest on the seat and "scoot" around, often with less-than-ideal posture. This is not "true" ambulation, and proper gait is not developed.

To facilitate proper ambulation, the child is better served in a gait-training orthosis, such as the SMART Walker", which provides regulated weight bearing through the lower limbs, hands-free trunk support, and lower-limb guidance. Such a device is essentially a TLSHKAFO on wheels and consists of a customized body brace component and a sturdy wheeled frame.

The body brace component provides support of the trunk and lower limbs and also prevents scissoring and reduces internal rotation and excessive plantarflexion. The body brace component is connected vertically to a weight-relieving mechanism within the wheeled base which provides the child with a regulated amount of lift support and also allows graduated weight bearing, encouraging gains in physical strength and endurance. Gait-guidance straps are also connected between the legs and the frame to help with positioning and control of the lower limbs. Other special features such as brakes, steering control, and transverse pelvic rotation allow customization of the ambulation parameters for each child.

While a gait-training orthosis can make a big difference to the child's physical and emotional well-being, a careful selection process is required to determine each child's suitability. A team approach is often the best way to determine this and to ensure a successful functional outcome.

The SMART Walker is a hybrid device, unlike most devices that orthotists have dealt with, and it requires specialized knowledge and training. It transcends the boundaries between the fields of orthotics and mobility. In a time when the profession is undergoing continued encroachment, it may allow the orthotist to gain some new ground in an increasingly competitive market.

Increasing Function, Well-Being

Properly fit, the device can provide the right conditions for ambulation to take place, allowing the therapist to teach the child how to walk with relative ease. The device enhances self-esteem and social interaction. Enabling an upright posture and mobility also helps maintain bone density, increases endurance and lung capacity, and improves bowel and bladder function.

In the long term, children with previously limited function can now experience hands-free upright mobility, attain a sense of autonomy, and explore their environment as they never could before. Children can reap all the benefits of their new-found freedom and have fun at the same time.

For more information, contact Advanced Orthotic Designs Inc., 4-3995 Sladeview Cres., Mississauga, Ontario L5L 5Y1, Canada. Phone: 905.607.4022; fax: 905.607.9099;