Page 28 - Mobility Management, July 2017

ATP Series
Best Picks 2017
Ginny Paleg: On Abduction & Early Intervention
The evidence that abduction can help reduce hip subluxation remains “Yellow: Measure outcomes,” but is approaching “Green light, go!”, according to a recent systematic review. This has enabled three manufacturers to offer standing systems that abduct 15-30° in each leg or 30-60° total. Because we do not yet know what the optimal amount of abduction is, therapists must continue to measure and palpate the hip to determine the appropriate degree of abduction on each side for each child. Spine, hip and knee alignment should always trump abduction. Children with cerebral palsy are at highest risk for subluxation between ages 2 and 3, so we need these devices to be very small.
Prime Engineering
(800) 827-8263 primeengineering.com
The choices for abduction are Prime Engineering HLT SuperStand Straddle (prone/supine/upright); EasyStand Zing (prone/supine/upright); and R82 Gazelle (prone/ supine/upright).
KidWalk
The SuperStand and Zing are available with fun fabric covers. The SuperStand HLT Early Intervention (EI) can accommodate the smallest child and can be modified with an abduction system to begin abduction at 9 to 12 months of age.
Early Intervention for Cerebral Palsy
We can tell with 90 to 98 percent accuracy which 2- to 5-month-old infant has a brain injury (cerebral palsy), and we can use the Hammersmith Infant Neurological Exam (HINE) to predict the Gross Motor Function Classification System (GMFCS) level in infants, as well.
We also know that the motor and sensory pathways reach maximal plasticity at age 2 and that the spinal circuitry is laid down by 6 to 12 months.
All of this means we know which child will need assistive devices to explore their world, and we know how important it is to begin this intervention as early as possible, possibly at 9 to 12 months of age.
Mustang
R82 Convaid
(844) US MOBILITY r82.com
Rifton Equipment
(800) 571-8198 rifton.com
Gazelle
Three gait trainers can fit infants: Prime Engineering KidWalk Early Intervention (EI); Rifton mini Pacer; and R82 Mustang. All three can accommodate a 6" inseam, with the Rifton able to go even shorter by reversing the trunk support to be below the frame. The KidWalk is now available with fun fabric covers. The KidWalk is dynamic in all three planes of motion and may be indicated for children with dystonia. In a published study comparing these three models, the KidWalk and Pacer were the easiest to move on tile, and the KidWalk was the easiest to move on carpet. With all this great evidence, early intervention providers should consider using these products more often.
Pacer
— Ginny Paleg, PT, DScPT, MPT
26 JULY 2017 | MOBILITY MANAGEMENT MobilityMgmt.com