Clinical Considerations Related to Tilt
Forward tilt will decrease seat height
A child with extraneous movements during ambulation and extensor posturing of the pelvis, benefits from a Custom Extended Seat, Dynamic Pelvic Wrap at the pelvis and custom sized Extended Lateral Hip Pads to assist with pelvic/leg alignment.
Clinical situations were tested and answered by Chris Wright-Ott, OTR/L, MPA and Rick Escobar, ATP, Co-Developers of the KidWalk
Minimize forward tilt
Extraneous leg movements
A child with excessive movement including both adduction (crossing of legs) and abduction or wide placement of the legs and feet may benefit from an Extended Seat and Extended Lateral Hip Pads. This assists in guiding leg movements.
Upper Body Soft Support Wrap
The soft support wrap can be used if the child has enough core strength to hold themselves upright.
Clinical Consideration Related to Dynamic Leg Wraps
Learning Strategy
Children who have no experience in a standing mobility device may benefit from having an adult “motor” or push them along to encourage stepping.
This technique is similar to using a tread mill for stepping, but it is “over the ground” and motivating for children.
Please check the section of the website to learn how to properly adjust equipment and what the proper fit for the best functionality.
Feet turn outward
If feet turn outward, the seat height may be too low.
Raise the seat height incrementally by squeezing the double handle on the mast, and the feet may align forward.
Clinical Considerations for Adjusting the Auto Centering Pelvic Guide
Forward Tilt -Precautions
The upward spring motion is one of the three components needed for a more natural gait. Depending on several factors involving the child's ability to ambulate freely. Observe the feet as they take a step to be sure the spring is not set too soft so the stepping is blocked.
Clinical Consideration Related to Wheel Type
Rearward Tilt - Ancillary Effects
Head Position: Tilting the mast rearwards may benefit children who have difficulty keeping their head upright or are hypotonic or weak. It often reduces the effort needed to keep the head and trunk upright against gravity.
Seat to Floor Height: Rearward tilt of the mast angle will increase the seat to floor height. After angle adjustment, lower seat as necessary.
Ambulation Speed: Rearward tilt may decrease the speed of the child's ambulation.
Does the kid need the upper body chest support?
Children who can sit independently and have upper body control and balance (cerebral palsy with diplegia or hemiplegia) may not need the Upper Body Support System. They can depend on just the Pelvic Support Unit, but may benefit from placing the Pelvic Support Unit up higher on the pelvis or use the Upper Body Dynamic Support Wrap initially.
Clinical Considerations Related to the Headrest
Child has difficulty maintaining the head upright
Move the headrest backwards and lower to allow more room to position the head upright. Tilt the mast rearwards slightly (you may need to lower the seat height after tilting).
Clinical Consideration Related to Leg Length Discrepancy
Some children have a leg length discrepancy or a shorter leg which will make ambulation more difficult if the shorter leg cannot adequately reach the ground. Many times this goes undiscovered, but may be obvious if one foot is rotated outward and one foot is not.
A lift on the shoe of the shorter leg may be appropriate, but check with the therapy team.
Weak or Hypotonic Children
Rearward tilt may reduce the effort needed to keep the head and trunk upright which may benefit children who are hypotonic or weak.
Forward tilt is difficult for children who are weak or hypotonic.
It is very important to adjust the pelvic guide properly for best functionality of the KidWalk. There handle that tightens or loosens the self centering apparatus is very important. The side/lateral pads should be tight so the child's pelvis does not rotate within the unit. The Anterior Pelvic Pads should also be tight so the child's back is against the Sacral Pad. The height should be so the anterior pads are against the ASIS and not the child's stomach.
Clinical Situations Related to Upper Body Chest Support
Clinical Consideration Related to the Vertical Spring
Adduction or Scissoring
If the feet cross even when an extended, wider seat is utilized, then a custom seat extending below the knees or the use of Ankle Glides may be beneficial.
Clinical Considerations
Minimizing leg adduction (crossing of the legs & feet)
An extended seat, rather than a standard seat, can assist in maintaining leg alignment.
An extended, wider seat may also reduce the muscle tone or stiffness in the legs and pelvis making it easier for the child to take steps.
Legs are in front of pelvis so child cannot move forward
A gap between the back and Sacral Pad contributes to legs being in front of pelvis
The pelvis has slipped forward on the seat because the Anterior Pelvic Pads are too loose or too high, causing the pelvis to slide forward on the seat causing the feet to be in front of the pelvis. Re-position the pelvis upright against the back Sacral Pad and slide the Anterior Pelvic Pads inwards to fit snugly. Tighten the knobs
Minimizing a Wide Based Gait: (Legs outwardly move in abduction)
Optional extended lateral hip pads provide pelvic/leg alignment to minimize a wide based gait.
Slight Tilt May Assist Forward Movement
Tilting the mast forward in small increments may also assist in positioning the feet under or slightly behind the pelvis, if the pelvis has been re-positioned snugly against the Sacral Pad and the feet are re-positioned behind the pelvis.
Clinical Considerations Related to the Seat
Upper Body Support Width
If the Upper Body Support is too wide, too low or has loosened, the child will not be aligned and may lean forward or to one side.
Be certain to frequently tighten the adjustment knobs in back of the Upper Body Support and underneath the lateral side supports.
Excessive forward tilt may increase speed of movement
Adjust the mast to a more vertical position to decrease speed, if tilting the mast forward encourages the child to move too quickly and uncontrollably.
The anti-roll backs may be helpful if the child is traveling long distances and leans backwards to rest. However, the Anti-rollbacks “force” a forward only direction of movement on the child who will never be able to maneuver the KidWalk independently, or back up after getting close to an object or person. This will limit functional mobility since moving backwards is required for functional movement.
NOTE: If the child only moves backwards, try repositioning the pelvis, make sure the anterior pelvic pads are snug and use the Dynamic Leg Wraps before trying anti-rollbacks. If positioned properly, most children can learn to move forwards without the need for anti-rollbacks, which will limit independent mobility and exploration.
Clinical Consideration Related to Anti-Rollbacks
A spoke wheel with spoke guard is more efficient for very young children and those with weakness or hyptonia due to its lighter weight.
The KidWalk comes standard with a mag wheel. Mag wheels are ideal for kids with Spina Bifida and other children who use the wheels to help move and maneuver around.
Ankle Prompts, Extended Seat or Dynamic Leg Wraps?
If a child’s legs are scissoring, crossing or interfering with ambulation, it is therapeutically more desirable to provide proximal alignment at the pelvis by trying a long or extended seat and Dynamic Leg Wraps. If these options do not work, then distal support can be provided with Ankle Prompts.
If forward tilting the KidWalk
- Relocate the large wheels to the front axle holes and slide the brake forward.
- Slide the anti-tips forward. See how to move brakes forward
KidWalk Accessories
Forward tilt will decrease seat to floor height encouraging more flexion of the hips and knees. If you tilt the mast forward, you will need to raise the seat height by squeezing the double handles on the mast.
Apply tilt sparingly, a few degrees at a time.
The more a child is tilted forward, the more difficult it is to maintain an upright head position and forward stability will be lessened.
Forward Stability: An upright posture of the child is preferred. However, if forward tilt is necessary, check stability of the KidWalk by gently lifting the back handle upwards. If the KidWalk tips forward easily, the unit needs more stability by reducing the degree of tilt or:
•Move the wheels to the forward axle and re-position brakes.
•Move the anti tips forward, which will increase the length of the base.
Child is too tight in the anterior pelvic pads
Anterior pelvic pads may be ordered with a 10 degree angle instead of standard straight or flat. Angled anterior pelvic pads may provide better contact for children who have fullness in the tummy/pelvic area.
NOTE: GI Feeding Tube Buttons:
Take care to position the anterior pads away from the GI feeding “button”. If swinging up the anterior pads will interfere with the button, slide the pads away from the body by loosening the knob on the outside of the hip pad, before rotating the anterior pelvic pads upwards for transfers.
Dynamic Leg Wraps increase hip extension and pelvic leg alignment
Dynamic Leg Wraps (A black stretchy strap that wraps around each leg and attached to the vertical mast) are a option designed to assist in maintaining leg alignment, provide sensory feedback for leg position and minimize hip flexion, from long periods of sitting.
The Leg Wraps provide proprioceptive and sensory feedback so the user is more aware of the position of the legs to reduce stepping too far in front of the pelvis.
Function: Place a Leg Wrap around each leg, preferably above the knee, while the child is aligned standing. Secure the wrap around the posts of the mast. The Leg Wraps can be adjusted for fit to reduce overstepping, while the child moves, by loosening or tightening the Velcro closure.
Child leans or gets head caught under headrest.
Upper Body Support is too low or too wide so child leans and her head gets caught under the headrest.
Raise Upper Body Support and check width for proper fit.