A growing trend in the use of reciprocal walking orthoses for infant paraplegic patients, and their application for control of the lower limbs in very young total body involved cerebral palsy patients, has created a need for smaller components. A prototype design of a hip joint has been produced which provides the following features: adjustable range of flexion/extension control; override on stops to permit sitting; high lateral rigidity; no lateral bearing play; very high rigidity in the sagittal plane; low friction bearings; high resistance to torque about the vertical axis. In addition a size envelope which is more in keeping with the dimensions of infant patients was an important objective. Comparisons were made of the computed structural properties of the prototype joint and existing routinely available standard orthotic hip joints. In each plane of loading the prototype joint had the highest identified structural property. The hinge-bearing material was tested in a representative joint with 200,000 cycles of typical loading. It was also field tested on adult orthoses over a minimum of a 12-month period with the most vigorous of walkers. In neither test did excessive play develop. The mechanical properties of the joint were established using tests advocated in the British Standard on testing lower limb orthosis knee joints. These showed the joint had structurally equivalent performance to a successful reciprocal walking orthosis hip joint, and that the mode of failure was essentially ductile in nature. Production development of the joint is now being undertaken.

Swivel walkers are being increasingly used for muscular dystrophy patients in order to prolong the period of their ambulation. Existing designs did not address the special problems of accommodating such patients comfortably and providing the easier and more assured ambulation which their weakened condition requires. The ORLAU VCG (variable centre of gravity) swivel walker has been developed so that the walking mechanics can be adjusted independently of patient posture. Additional patient support features permit the patient to be secured in their chosen position of comfort prior to setting the ambulation mechanics. Patients using the device, which is now approved for supply by the Department of Health in England and Wales, have improved their walking performance and extended their period of walking.

Swivel walkers were commonly prescribed for children with complete thoracic lesion myelomeningocele in the 1970s and 80s, when the incidence of spina bifida in the UK was of the order of 3 per 100,000 live births. The advent of reciprocal walking orthoses provided a more suitable alternative for those with good upper limb and trunk function, and swivel walkers were then used primarily for very young or more severely disabled patients. Pre-natal screening has dramatically reduced the incidence of spina bifida in the UK and subsequently swivel walkers have been used in a wider range of pathology, including spinal muscular atrophy, multiple sclerosis, muscular dystrophy and other neurological conditions that lead to lower limb dysfunction. The detail design of these devices has been adapted to accommodate the specific problems encountered in these conditions. In particular the designs have been updated to: enable very young patients to be more readily fitted at the age of 1 year; allow the walking mechanisms to be conveniently adjusted for easier ambulation when weakness or lack of confidence inhibits performance; permit simple adjustment to a standing frame mode to enhance stability in situations of increased risk; promote manual handling practice that is compatible with the National Health Service (NHS) policy of compliance with relevant regulations. To underpin appropriate prescription and safe supply the NHS Procurement Agency have encouraged the development of a common course for all types of swivel walker.