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Der NF-Walker in der Rehabilitation von Kindern mit einer ausgeprägten Bewegungsstörung

Christel Kannegießer-Leitner

Der NF-Walker verhilft auch mehrfachbehinderten Kindern, die ohne dieses Gerät eine starke Führung bzw. Unterstützung durch einen Helfer benötigen würden, zum Gehen.

Dieses geführte Gehen ohne Gehhilfe kann für Eltern und Kind sehr anstrengend sein, nicht nur abhängig von der motorischen Stabilität des Kindes, sondern auch von dessen Größe. Mit dem NF-Walker dagegen können gut auch längere Strecken zurückgelegt werden, wodurch das Gehen intensiviert und der Ablauf des Gehens so leichter automatisiert werden kann. Durch dieses intensive Gehen wird die Muskelkraft gestärkt - sowohl der Beinmuskulatur als auch der Oberkörpermuskulatur. Hinzukommt die positive Wirkung auf die Hüftreifung, da diese Steh- und Gehreize benötigt. Bedingt durch das flexible System des NF-Walkers kann die Unterstützung genau an die Bedürfnisse des Kindes angepasst werden. Die Umgebung nimmt diese Kinder eher als eigenständige Persönlichkeiten wahr, da sie ja gehen und sich auf „Augenhöhe“ befinden. Ja und die Kinder selbst genießen dieses Gefühl und sind einfach stolz darauf, im NF-Walker auf eigenen Fü.en zu stehen und zu gehen.

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.

Ist frühe Hilfsmittelversorgung sinnvoll?Am Beispiel des NF-Walkers

S. Schneiders

Einige Kinder habe ich, nachdem ich sie mit circa zwölf Monaten in den Stehständer mobilisiert habe, mit ungefähr 18 Monaten mit dem NF Walker versorgt, zunächst drei Monate zur Probe.

Folgende Dinge konnte ich beobachten:

  • sie können wechseln zwischen aktivem und passivem Stehen und dadurch ihre Muskulatur kräftigen und ein Muskelungleichgewicht verhindern
  • sie bekommen durch den Wechsel von aktivem und passivem Stand propriozeptive Reize, dieses verändert die Wahrnehmung (die Beine gehören zu mir) und trägt zur Ausreifung der Hüften bei
  • die Gelenke der unteren Extremität können aktiv in einer Ebene frei bewegt werden
  • durch die Aufrichtung können sie den Raum und sich selber anders wahrnehmen
  • sie werden durch andere, vor allem andere Kinder besser wahrgenommen und werden oftmals in ihr Spiel integriert
  • das Gesichtsfeld vergrößert sich, da der Kopf besser im Raum bewegt werden kann
  • die Lungen werden tiefer belüftet
  • die Durchblutung des Körpers ändert sich
  • die Diaphragmakette wird stimmuliert und gestärkt entwickeln mehr Kraft zum Abhusten
  • das Becken wird stabiler, dadurch auch die gesamte Aufrichtung und die Kinder
  • durch die Aufrichtung wird auch die Perspektive auf das Kind geändert, es hat die Möglichkeit die „Babyrolle“zu verlassen und signalisiert somit unbewusst andere Bedürfnisse

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.

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.

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.




Literature review on walking aids for children with CP. Development of walking aid for better lumbo-pelvic postural control

Presented: "Physiotherapy 2019 UK", Birmingham

When choosing the best walking aid, therapists should carefully consider all individually influencing factors of a child and his environment. The Hibbot is a new walking aid, classified as gait trainer, that might facilitate proper muscle activity and alignment during walking, but further research is necessary to prove evidence.



Positive effects of assisted walking movement with the motorised device Innowalk in patients with neuromuscular disorders

Presented: EACD 2019, Paris

Raw data from 9 case studies with totally 31 patients were pooled into this meta-analysis. 94% of patients (aged 10 [2 – 58] years; 58% male; 67% non-ambulatory, 86% CP) used the Innowalk in a home based or day-care setting. Improvements was recorded for walking or weight-bearing transfer, control/strength of the trunk or head, joint mobility, sleep, muscle strength, vital function, bowel function and attention/orientation.



Differences in exercise effects from static versus dynamic standing in non-ambulatory children with cerebral palsy

Presented: EACD 2019, Paris

Eighteen non-ambulatory children with cerebral palsy participated in an exercise intervention study with a cross-over design, comparing four months of static standing to four months of dynamic standing. A highly statically significant difference was found in the metabolic adaptation, described as oxygen consumption, carbon dioxide production, and ventilation, to static standing versus dynamic standing. Static standing and dynamic standing represents different exercise modalities. Dynamic standing through robotic walking offers new possibilities to design different exercise regimes to non-ambulatory children with cerebral palsy.



Effects on the passive range of motion and spasticity after dynamic standing among non-ambulatory children with cerebral palsy in the lower extremities.

Presented: EACD 2019, Paris

Twenty children were included to this exercise intervention study with a cross-over design. The children with CP, GMFCS-E&R level IV and V, were aged 5-17 years. 30 min of dynamic standing increases PROM and lowers the spasticity in the muscles around the joints in the lower extremities. 30 min of static standing does not alter this.



Static compared to dynamic supported standing for non-ambulatory children with cerebral palsy - a pilot study

Presented: EACD 2018, Tbilisi-Georgia

The pilot study showed the design was feasible and the measurements were widely accepted by the children and their parents. Static and dynamic supported standing gives different physiological response.



Effect of a motion therapy device on the hip joints of children with CP, GMFCS IV and V

Presented: 30th International Seating Symposium, Vancouver, Canada

The study show that the motion therapy device(Innowalk) have direct effect on the hip joint of children with CP. Effects on the range of motion and mucle tone was documented. Duration of the intervention (3 months) was a determining factor.



Improving gait and gastrointestinal function following Innowalk trial

Presented: 28th International Seating Symposium Vancouver, Canada

Evaluation on gait and gastrointestinal function in a 13 year old child with CP GMFCS III. Improvements was seen in range of motion on the hip, gastrointestinal function, resistance against rapid passive stretch, and walking function.



Assisted Movement, Project in Vestfold Country, Norway

Presented: European Seating Symposium

Effect of assisted movement in a standing position on children with former disabilities over a period of one year. To provide assisted movement the helping aid Innowalk was used. 13 children was involved in the project. All children were tested before they started up with the helping aid, after 4 weeks, 4 months and 12 months of use.