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As a pediatric physical therapist, it is important to understand the biomechanical and social benefits associated with the use of walkers in children.
Walkers provide an effective therapeutic tool to improve children's mobility and emotional well-being, as well as promote their social inclusion.
Here, we will explore in detail the general biomechanical benefits of walkers, anterior walker and posterior walker benefits, as well as their positive impact on children's emotional and social development.
General biomechanical benefits of children's walkers
Improved Muscle Strength : Using weight-bearing walkers contributes to the development of muscle strength throughout the child's body. By leaning on the walker and performing lifting and pushing movements, various muscle groups are activated, leading to an improvement in overall body strength. * 1
Developing Righting Reactions and Balance : Walkers provide a safe environment for children to practice their righting and balance reactions. By interacting with the walker, children experience postural corrective movements and develop balance skills, enabling them to better cope with the challenges of walking.
Anterior infant walker
These walkers are placed in front of the child and allow him/her to lean forward by flexing the shoulders, trunk and hips, shifting the centre of gravity forward; these walkers offer a series of important biomechanical advantages.
These include:
Support and Stability: By placing the walker in front of the child, a solid support point is provided, which helps maintain an upright and balanced posture while walking.
This configuration is especially beneficial for those individuals who require significant support from the walker, those who cannot bear weight on one leg, those who have extensor hypertonia , upper body weakness, or those who need to lean forward to move forward .
Weight Distribution : By shifting your weight forward on the walker using your outstretched arms, you achieve a more even distribution of body weight. This helps improve balance control and reduces the load on your lower extremities.
Facilitating Walking : By lifting or pushing the walker forward while walking, it allows for a more efficient and fluid movement. The anterior walker provides a stable and secure point of support, allowing the child to focus on leg coordination and facilitating a more natural walking pattern.
Posterior infant Walker
These walkers, also known as reverse walkers, are placed behind the child with their handles on the sides, facilitating the shifting of the center of gravity toward the base of support and promoting alignment; these walkers offer a number of important biomechanical advantages.
These include:
1. Improved Posture: Scientific evidence has shown that walking with a posterior walker promotes improved posture, with elongation (extension) of the neck, tucked chin, depression of the shoulders, and extension of the trunk and hip. These characteristics align with an upright, healthy posture both while standing and walking * 2
2. Increased Stability : Children with spastic cerebral palsy with a flexor pattern or with a diplegia, who tend to walk slowly with their arms in a high guard position and can easily lose balance backwards without a walker, are therefore likely to benefit from a posterior walker. *3
3. This type of device also improves oxygen consumption , increases stride length, cadence and speed while walking . * 4
Mixed infant Walker
These are devices that can be configured in both anterior and posterior mode, and in some cases, offer dynamic options that allow adjustment to changes in the child's motor development.
This ability to adapt to specific postural control and stability needs at different stages of development makes mixed walkers a highly valued option for pediatric physiotherapists.
Social and Emotional Benefits of Using Walkers
Increased moments of happiness and social interaction: Evidence supports that children who use walkers are happier and feel more satisfaction, which allows them to socialize more with their environment. By having the ability to stand and walk, children can actively participate in social activities and experience greater interaction with their peers. *5
Positive Impact on Parents and Families: The use of walkers also provides an emotional benefit for parents and family members of children. Seeing their children standing and walking, achieving motor skills appropriate to their age, generates great happiness and joy. This contrasts with previous moments when they only saw them moving around on the ground, which strengthens the emotional bond and generates a sense of shared achievement. This is perhaps one of the greatest reasons why we should encourage children who cannot walk independently to use a walker as soon as possible . *5
Promoting Independence and Inclusion: The use of walkers improves children's mobility and independence by allowing them to move from one place to another without assistance. This increased mobility facilitates their participation in educational and social activities that require travel, thus promoting their inclusion in the community. *5
Clinical Considerations of Infant Walkers
When selecting the most appropriate type of walker for a child, it is essential to consider several clinical variables. Some important considerations include:
👉🏼 Individualized Evaluation : Each child must undergo a thorough evaluation to determine which type of walker is most appropriate for their specific needs.
👉🏼 Specific needs of the child: It is essential to take into account the motor skills and level of support required by the child when choosing a front or rear walker.
👉🏼 Adaptability and Accessories: Some walkers are versatile and can be configured for both types of orientations. Additionally, walkers can offer a wide variety of accessories to ensure customized support that meets the unique needs of the user.
Resources on infant walkers
Blog about the different types of walker brands on the market, their advantages and disadvantages:
References
*1 Butler EE, et al. Experiences of physical therapists who use gait trainers in pediatric practice. Pediatr Phys Ther. 2017;29(2
*2Greiner BM, Czerniecki JM, Deitz JC. Gait parameters of children with spastic diplegia: a comparison of effects of posterior and anterior walkers. Arch Phys Med Rehabil. 1993 Apr;74(4):381-5. PMID: 8466419.
*3 Logan L, Byers-Hinkley K, Ciccone CD. Anterior versus posterior walkers: a gait analysis study. Dev Med Child Neurol. 1990 Dec;32(12):1044-8. doi: 10.1111/j.1469-8749.1990.tb08521.x. PMID: 2149558.
*4 Tao, R., Feng, L., Xiao, Z. et al. Posterior Versus Anterior Walkers for Children with Cerebral Palsy-Biomechanical Analysis and Energy Consumption: a Systematic Review. J Dev Phys Disabil 32, 877–892 (2020). https://doi.org/10.1007/s10882-020-09731-3
*5 Rodríguez-Costa, I.;Dela Cruz-López, I.; Fernández-Zárate, I.; Maldonado-Bascón, S.; Lafuente-Arroyo, S.; Nunez-Nagy, S. Benefits of a Low-Cost Walking Device in Children with Cerebral Palsy: A Qualitative Study. Int. J. Environ. Res. Public Health 2021, 18 , 2808. https://doi.org/10.3390/ ijerph18062808
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