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The NF-Walker in the rehabilitation of children with a pronounced movement disorder

Christel Kannegießer-Leitner

The NF-Walker also helps children with multiple disabilities who, without this device, would need strong guidance and/or support from a helper to walk. This guided walking without a walking aid can be extremely strenuous for parent and child, depending not only on the motor stability but also the size of the child. The NF-Walker, on the other hand, enables the child to cover longer dis- tances, as a result of which walking is increased and the walking sequence can more easily be automated. This intensive walking increases muscle strength in both the legs and upper body.

There is also a positive impact on hip maturation, as this requires standing and walking stimuli. The exible system of the NF-Walker means the support can be precisely tailored to the needs of the child. Other people more readily perceive children using the NF-Walker as individual personal- ities, as they are walking and are at “eye level”. And the children themselves enjoy the feeling, and are proud to be standing and walking on their own feet in the NF-Walker.

NF- Walker dynamic and mobile standing orthosis

Idoia Gandarias Mendieta

The NF-Walker offers children the possibility to experience standing independently, both still and moving. This device guarantees a correct body alignment, allowing the lower limb exor muscles to stretch and improving head control and trunk stability. It consists of a system of braces and supports which allows children to load around 80- 90% of the corporal weight on their feet whilst the remaining 10-20% is taken by the thoracic, pelvic and tibial supports. The child is slightly de- gravitated making it easier for him or her to be able to take a step.

Does early application of medical aid devices make sense? Based on the example of the NF-Walker

S. Schneiders

I have used the NF Walker with a number of children aged approximately 18 months after having mobilised them into the standing frame at approximately 12 months of age, at rst on a three- month trial basis.

I was able to make the following observations:
• Patients can alternate between active and passive standing, thus strengthening their muscles and preventing muscle imbalance
• By alternating between active and passive standing, they receive proprioceptive stimuli, which changes their perception (these legs are part of me) and contributes to the maturation of the hip joints
• The lower extremity joints can freely and actively be moved within one plane
• Because of their upright posture, they perceive space and themselves in a different way
• They are perceived more positively by others, especially by other children, and are more fre-
quently integrated into play activities
• The eld of view increases with better spatial head motion
• The lungs are ventilated in greater depth
• There is an improvement in the blood ow through the body
• The diaphragm muscles are stimulated and strengthened
• The pelvis becomes more stable, bringing about a gain in upright posture; the children also
develop more strength to help them expectorate
• A more erect posture also changes the perspective on the child; it can thus leave the role of the
“baby” and, unconsciously, signal other needs

Evaluation of the NF-Walker

Martín Gómez M., Laguna Mena C., Martín Maroto M.P., Arroyo Riaño M.O.

Cerebral palsy (CP) is the primary cause of disability in developed countries, with an incidence of 1.5-3/1000 live births. Bipedal locomotion in children with CP (especially GMFCS Levels IV or V), or other diseases which are characterised by severe psychomotor development delays, is a skill which is dif cult to achieve. The Norsk Funktion-Walking Orthosis (NF-Walker) is a standing frame system with partial suspension of body weight. It consists of a 4-wheel system, from which HKAFOs (hip- knee-ankle-foot orthoses) are hung, connected to a hip and chest belt. At the bottom of the device, special orthopaedic shoes can be tted. The suspension of body weight allows the patient to activate ambulation and initiate alternating movements.

A total of 26 patients were included. Of these, 61.5% were female and 38.5% were male, with a mean age of 10.2 years. 84.6% had CP, with spastic cerebral palsy being the most common type (50%). 73% were GMFCS Level V.

Innowalk – Beneficial effect in Spinal Muscular Atrophy

Ulrika Skjellvik Tollefsen

The case report has shown that for Martin, who has SMA, training in Innowalk has produced positive results in a short time in the form of better walking function, more energy and a genuine sense of moving more easily. It remains to be seen whether the results are lasting. Eighteen months after starting to use Innowalk, Martin is still very happy in it and continues to have better sitting balance, trunk control, arm strength, etc.

Gross motor function, joint mobility and spasticity in the lower limbs of children with CP can be affected by using the “Innowalk” motorised training and stimulation aid.

Hege M. Hansen

The text is a summary of a Master’s thesis in Manual Therapy at the University of Bergen, 2014.

The approach of the study was to investigate how gross motor function, joint mobility and spasticity in the lower limbs of a child with CP can be affected by using a motorised training and stimulation aid. As the study involved only a small number of participants (N=2), it is not possible to generalise the results. However, the study does tell us something about a potential effect
and trend after intervention for the two children who took part, and may serve as a pilot for a subsequent larger study involving more participants.

The results from GMFM-66 and measurement of joint mobility show that it is possible to achieve
a positive change in both gross motor function and joint mobility using the aid in question. Where spasticity is concerned, the present study has not demonstrated any change, although it has been shown that 30 minutes of standing activity daily could affect spasticity (Stevenson, 2010; Kheder & Nair, 2012). A child with GMFCS level 5 is at risk of developing contractures and pain, and the effect of the aid could be of great signi cance in terms of contracture prophylaxis. Good range of movement can also reduce the risk of dislocation of joints and surgical procedures as a result of the aforementioned contractures. It is likely that a child with GMFCS level 3 could achieve a certain walking function using aids. In order to optimise walking function, it is important to have good range of movement in the joints in the lower limbs, as well as muscle strength and trunk control, which will affect the child’s balance and opportunity of independent movement.

Experience with the Innowalk from two counties in Norway

Britt Tornes, Kari Borgen, Kari Bugge, Tone Mari Steinmoen, Charlotte Marie Schanke, Rikke Damkjær Moen

Experience so far has shown that Innowalk can improve or maintain endurance, stomach functioning and posture control. In addition, several users improved joint movement and for one user, Botox treatment was no longer indicated after the trial period ended.

Innowalk is a new aid designed for children with physical limitations who can bene t from increased movement. On request by government department responsible for special aids for people with disabilities in Norway, the rehabilitation services in the two counties in Norway together with EO Funktion, carried out a trial project with Innowalk.
The objective of the project was to defensibly show that it is possible to give assisted movement to children who have little or no ability to move on their own. At the same time, there was also
a desire to record changes in the child related to increased movement and activity. The trial project is designed in collaboration with rehabilitation services in the two counties.

Evaluation of the use of Innowalk by two patients, 4–6 times a week respectively

Britt-Marie Rydh Berner and Lotta Ahlborg

Our two test subjects were people with cerebral palsy GMFCS III, activity levels 1 and 2 (according to the Saltin-Grimby Physical Activity Level Scale). The most important thing for us (two registered physiotherapists) to say in summary is that this training method suited our test subjects very well. Many of our patients, particularly those with GMFCS III, have difficulty finding forms of training where they feel comfortable, which they can do independently and where the training in itself produces tangible results for them. The Innowalk achieved this.

In a short time, we were able to record measureable results and could see that our motivational talks were no longer required to get the patients to do their training. The patients found the training pleasurable and were more likely to do more than fewer sessions than had been agreed.