The potential for ambulation by severely handicapped cerebral palsy patients

Whereas walking for paraplegic patients is now a routine clinical option, ambulation for heavily handicapped cerebral palsy patients is less well established. There are good reasons for supposing that therapeutic benefits similar to that achieved with paraplegic patients are possible for this group. However, the biomechanical problems which must be overcome are different and in many ways more difficult to address. The most important factors are identified as appropriate truncal support, control of abduction/adduction, rotation and flexion range at the hip, and of knee flexion. A means of applying these controls is described as being a combination of a walking frame and orthosis. The special walking frame provides adjustable support at thoracic, abdominal and sacral levels and incorporates castor steering and upper limb support. Controls on lower limb movements are applied through a special orthosis which has a readily available variation of specification to accommodate the wide range of conditions met in cerebral palsy. Practical application of a prototype system has shown that it can enable patients to walk unaided. However, in most cases it was used indoors only. Evaluation of the experience in applying the system has enabled the fundamental principles to permit more practical applications to be defined.