ORLAU Walkers and Standing Frames
The ORLAU Parawalker is a type of Reciprocal Walking Orthosis that is designed to enable paraplegic and other patients to walk. (‘Reciprocal walking’ means taking alternate steps with one foot and then the other – as in ‘normal’ walking.) The ParaWalker was first developed for spina bifida patients in the 1970s, experience in assisting patients to walk led to this device being used for other conditions.
- Spina Bifida
- traumatic paraplegia
Working in partnership with ORLAU; T&S Orthotics has manufactured this family of orthosis for the past 30 years, supplying to many NHS Trusts and orthotic companies in the UK and Germany.
The Parawalker is intended primarily for paraplegics – i.e. those patients who have no voluntary control of the muscles in the lower body because of damage to the spinal cord.
Paraplegia can result from a number of causes:
- Congenital (e.g. Spina Bifida)
- Traumatic (e.g. as a result of a road traffic or other accident)
- Disease (e.g. spinal tumour)
- Other causes (e.g. vascular trauma)
The orthosis is manufactured to individual patient dimensions so that it fits closely from just under the armpits down to the ground. It is (usually) worn outside clothing and locking knee joints keep the user’s legs straight during standing and walking. Special joints at the hips allow just enough fore-and-aft movement to permit a stepping pattern.
The knee and hip joints have quick-release mechanisms to allow the user to sit on a chair or couch – the position usually adopted when putting the device on and taking it off (though some find it easier to do this whilst lying down).
Crutches (or, for younger users, a wheeled walking frame such as a rollator) must always be used with the orthosis. This is necessary to maintain balance and to allow the use of the arms and upper body muscles to raise each foot off the ground in turn and to provide the forward propulsion forces.
The ORLAU Swivel Walker
Swivel Walker is a piece of equipment that is designed to help people – adults and children – who cannot stand and walk on their own. This kind of equipment used to be called a ‘splint’ or ‘brace’; these days we call it an ‘orthosis’. It is most often used by paraplegics – i.e. patients who have no control of the muscles in their lower body and legs because of damage to the spinal cord. Other people who have used it successfully include those with muscular dystrophy and some with cerebral palsy. It allows the user to stand and move about indoors independently and with their hands free.
The orthosis provides rigid support across the hips and knees in order to compensate for partial or complete lack of muscle control. Simple fastenings that are quick and easy to open and close are used at the feet, knees and chest. A few users can get in and out by themselves, but most will need help with this. Most will get in and out with the orthosis lying flat on the floor or leaning against a chair or couch, and nearly everyone needs help getting upright and back again. For larger children and adults this usually means that a patient hoist is needed. Not every type of hoist is suitable – there must be a big enough range of movement to lift all the way from lying into standing. Those that are mounted on ceiling tracks are best.
Once upright, the orthosis needs only to be rocked sideways a little to make the frame automatically swivel gently in turn on each footplate so that it ‘walks’ forwards. Shifting weight from side-to-side with movement of the shoulders is enough and, with a bit of practice, most people also learn how to turn corners and to move backwards. It is important to realise, though, that it is a somewhat unnatural form of walking. Most users find that it offers a useful addition to their therapy – research evidence points to the fact that a programme of standing and walking exercise helps with such things as:
- Reducing the incidence of pressure sores;
- Reducing osteoporosis;
- Improving urinary drainage and bowel function;
- Improving peripheral circulation..
The ORLAU Standing Frame is a modified version of the Swivel Walker. As the name suggests, it offers support only for standing, but many of the therapeutic benefits listed above can still be gained. It differs in two important respects from the many other standing frames on the market:
The upright section hinges on the base. This means that it can be tilted to an angle to lean on a couch or chair, or laid flat at floor level. The user can be lifted in and out, raised to the upright position and lowered again, all with the aid of a suitable patient hoist. The Manual Handling difficulties associated with the management of larger and heavier patients are thus solved.
It is assembled to the individual user’s measurements. In this way, it can be made to accommodate many of the deformities of the spine and the lower limbs that preclude the use of other types of frame. In recent years, ORLAU has had considerable success in using the Standing Frame for children with more severe problems arising from Cerebral Palsy and other neurological conditions.
All standing frames are mounted on braked castor wheels that allow them to be moved around with the user in the supported position. For the smaller size of frame (suitable for those up to about 12 years of age) ORLAU can also offer a combination of the two types of equipment described above. The Swivel Walker can quickly be immobilised by fitting an ‘outrigger’ (similar to the Standing Frame base). This can be useful in school where, in a busy classroom with a lot of activity going on, the extra stability provided by the base frame offers valuable safety to the user. Removal of the outrigger quickly converts the orthosis back into a walking device.