Quantitative study of walker-assisted gait in children with cerebral palsy: anterior versus posterior walkers

Many children with cerebral palsy require walkers to achieve functional ambulation, yet little scientific study has been done to understand the mechanics of usage. The objective of this work was to provide a quantitative pilot comparison of ambulation with anterior and posterior walkers in children with cerebral palsy using temporal-spatial gait parameters and an upper extremity joint kinetics. Following informed consent, data were collected for nine children with spastic, diplegic cerebral palsy who were community ambulators and who routinely used posterior walkers. Results of the study showed increased double limb support time (24.3%-30.7%) with the anterior walker, increased walking speed (16.7%-21.4%) with the posterior walker. Elbow extensor and wrist flexor demands were greater with the anterior walker (-0.19 Nm/kg, 0.07 Nm/kg) than with the posterior walker (-0.06 Nm/kg, 0.02 Nm/kg). The methodology developed in this study appears to provide improved insight into the effect of upper extremity muscular demands in addition to the traditional lower extremity gait analysis, clinical evaluation, and energy expenditure assessment.