Upper Extremity Joint Dynamics During Walker Assisted Gait: A Quantitative Approach Towards Rehabilitative Intervention

Background Many children with spastic diplegic cerebral palsy (CP) use anterior or posterior walkers to aid ambulation. Prolonged use may lead to upper extremity (UE) pathology later in life, including arthritis and joint contractures. Purpose This study analyzes the dynamics (kinematics and kinetics) of the shoulder (glenohumeral), elbow, and wrist joints during anterior and posterior walker use. It also examines the dynamic effects of adjusting handle height and grip rotation. Methods Ten children with CP underwent motion analysis with upper and lower extremity marker sets and six-degree-of-freedom instrumented walker handles, while using both anterior and posterior walkers. One child underwent the same analysis, with added trials for wrist derotation (adjusted axial grip rotation) and wrist plus elbow derotation (adjusted handle height). A validated kinematic and kinetic model was applied to calculate UE joint angles, joint reaction forces (JRFs), and joint reaction moments (JRMs). Results Surprisingly, no statistically significant differences in UE angles, JRFs, or JRMs were observed between anterior and posterior walkers. Wrist derotation, however, decreased the flexion JRM seen at the wrist, and elbow derotation decreased the flexion JRM seen at the elbow. Conclusion Anterior and posterior walkers produce similar UE motion and peak loading values. Wrist and elbow joint derotation alters the dynamic effects experienced by the UEs. UE motion analysis during aided gait can be useful for optimizing UE loading conditions to limit pathology later in life