Why Walk? 

The ability to move independently plays a key role in a child’s physical, social, cognitive and psychological development. This self-initiated movement is a key developmental stage instigating a series of transformative changes to the infant brain. When a child starts initiating their own movements, they start to gain their own personal autonomy and begin to learn that they are agents of their own change. Without this opportunity to learn, the potential for physical and psychological growth is restricted.

What Are Some Of The Barriers To Walking Therapy?

Unfortunately, in lots of areas, walking frames are not provided as frequently as a seating system or standing frame would be for a child with additional needs. There are lots of different reasons for this:

Funding

Walking frames can sometimes be viewed as a ‘nice to have’ piece of child’s postural management equipment and can be given lower priority than some other areas.

Not Enough Space / Accessibility

Unlike seating systems and static standing frames for a child to get the benefits that come with using a walking frame, they need the space to move! This can be tricky where space is an issue and that is why having wheels that can work well both indoors and outdoors are key to enable children to use walking frames in lots of different environments.

Getting A Child In Or Out Of A Walking Frame

Children with more complex needs may be transferred into their equipment using a hoist or with the help of adults. As children grow and become bigger, transfers can become more difficult.

Children Not Stepping On Initial Assessment

There is a belief that a child needs to show some initiation to step during their walking frame assessment for the assessment to be deemed a success and the frame to be ordered. However, there is quite a big jump, in terms of physical skills, motor planning and muscle strength, when a child goes from standing to walking and some children need a bit longer to practice the skills before stepping can take place.

Differing Views About The Use Of Walking Frames

• There are ideas that encouraging a child who has spasticity to use a supportive walker will increase the tone/spasticity in their legs, and lead to complications with contractures further down the line. Recent research has concluded that spasticity is not the primary cause of contracture development in children with CP¹. In fact, impaired muscle growth mismatched to more normal increases in bone length, along with significant changes in the cellular makeup of CP muscle, are the primary determinants of static contracture development in CP.
  
  
• The provision of walking frames used to be very focussed on improving a child’s ‘body-structure and function’ (e.g. 'I use my walker to improve my muscle strength') in the hope that, by doing that, a child will be able to be more involved in their community and take part in more activities. This is known as the bottom-up approach. However, the way we view walking frames (and equipment in general) is changing. It’s starting to be more common that the equipment is there to facilitate that child’s inclusion and participation in whatever they want to do and in so, by doing that, they are automatically improving their muscle strength etc.
  
  
• Finally, there is sometimes the idea that a child must have sufficient trunk control to be able to move on to walking. Whilst this is true in typical development, for some children with more severe disabilities, they will never have sufficient trunk control to be able to achieve these milestones. However, as we’ve discussed, the numerous benefits of using a walking frame outweigh the risks. In addition to that, typically developing children don’t solely work on sitting and then move on to solely working on standing or walking, it is a constant process where they are frequently changing positions and therefore developing a few skills and working on strengthening various muscles at the same time.

1. Howard, J.J. and Herzog, W., 2021. Skeletal muscle in cerebral palsy: from belly to myofibril. Frontiers in Neurology, 12.