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SMART Device Provides New-Found Freedom
By Mendal Slack, BSc, CO
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A youngster enjoys the freedom and mobility provided by the SMART Walker™ |
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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; www.smartwalker.com. 
Table Of Contents - May 2003
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