Clinical Bottom Line
“How could I apply this information?”
This article provides valuable information about the current practice of experienced pediatric physical therapists related to the use of support walkers (SWs). Respondents perceived that SWs allow children with a variety of diagnoses who are unable to walk independently to achieve an upright position and increase participation with peers. Most respondents recommended 2 specific walkers and a minimum of 9 sessions for a child to learn to move the SW. In addition, respondents indicated that about 50% of children will progress to a handheld walker within 1 year. This information is helpful in responding to families about timeframes for learning to use an SW and about prognosis for a less supportive type of device. Recommendation for a particular SW depended on the child's needs, the clinical picture, and the family situation, and these parameters might direct a practitioner in developing evaluation criteria. The increased participation opportunities and perceived physiological benefits could be useful for payment purposes.
The home is the second most frequent setting for the use of an SW, but every household may not have adequate space. Therapists may be able to encourage schools and families to use the SW to attempt to meet the current physical activity recommendations for children for 60 minutes per day1 and to avoid a decreased physical exercise seen in some children with developmental impairments.2
“What should I be mindful about in applying this information?”
Readers should be mindful that the results describe current practice rather than “best practice” determined by objective outcome measures. The experience of the respondents may have influenced the perceived ease of adjustability of specific SWs. Evidence was cited as a top factor in selecting an SW, but little evidence exists for using SWs, or for specific types of SWs. Respondents cited guidelines for standing to affect bone mineral density, but children using SWs may be unable to sustain activity for a full 60 minutes. Readers must consider whether respondents were referring to documented records of clients or were basing responses on general practice perceptions. The article demonstrates the value of SWs and emphasizes the need for more research on the use of SWs and on the “dose” required to produce physiological effects.
Venita Lovelace-Chandler, PT, PhD, PCS
Texas Woman's University, Dallas, Texas
Diana Early, PT, MS, PCS
Baylor Our Children's House, Dallas, Texas
2. Brunton LK, Bartlett DJ. Description of exercise participation of adolescents with cerebral palsy across a 4-year period. Pediatr Phys Ther. 2010;22:180–188.