Posterior Versus Anterior Walkers for Children with Cerebral Palsy-Biomechanical Analysis and Energy Consumption: a Syst
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Posterior Versus Anterior Walkers for Children with Cerebral Palsy-Biomechanical Analysis and Energy Consumption: a Systematic Review Ran Tao 1 & Li Feng 1 & Zhen Xiao 1 & Bei-hua Zhang 1,2 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Systematically review the comparison of anterior and posterior framed walker in terms of biomechanical analysis and energy expenditure and to discuss the implications for clinical practice. A systematic literature search was performed to identify studies that evaluated the gait pattern, upper extremity (UE) kinetics and kinematics and energy consumption. Outcome measures and treatment results for them were identified. 6 studies met the criteria and were included in this systematic review. Gait analysis, UE kinetics and kinematics and energy consumption were all assessed in 4 different papers. Gait parameters were comparable between walkers but declined torso tilt was found in the posterior walker group. In UE joints, two groups showed no significant difference but adaptive therapeutic posterior walker helped decrease UE burden. Most of papers prefer posterior walkers because of low oxygen cost. For better gait pattern, less UE burden and energy consumption, the adaptive therapeutic posterior walker is relatively the proper choice among all. For future studies, crossover studies or randomized controlled trails (RCTs) with larger sample size and more accurate measurement equipment may provide more persuasive evidence. Long term effects of walker users can also be investigated. Keywords Cerebral palsy . Children . Walkers . Kinematics . Gait . Energy
Cerebral palsy (CP) is currently considered as a clinically defined symptom complex applied to individuals with a static, nonprogressive motor impairment. (Chen 2017). About 1/500 neonates were affected worldwide (Graham et al. 2016). The syndrome of CP comprises a large group of childhood movement and posture disorders (Colver et al.
* Bei-hua Zhang [email protected]
1
Department of Pediatric Rehabilitation, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
2
Department of Rehabilitation Sciences, School of Medicine, Tongji University, Shanghai, China
Journal of Developmental and Physical Disabilities
2014). Patients often present with impairments in muscles and sensory functions of the limbs. These impairments result in restrictions in activities of daily living, particularly walking. They often show deviated walking patterns which result in slower walking speed and higher energy cost or even disability of walking. Most CP children (70%) had sufficient motor control for walking (ACPR 2016; Koop 2009). Those in GMFCS Level I (35%) or II (24%) can walk without devices, and children at Level III (11%) can walk with a handheld mobility device (ACPR 2016). Sticks or crutches are convenient and cost effective but hard for children to handle if children have strongly restricted mobility or poor trunk control. Whilst
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