Use of Overground Supported-Stepping Devices for Non-Ambulant Children, Adolescents, and Adults with Cerebral Palsy: A Scoping Review

Abstract

Individuals with cerebral palsy functioning at Gross Motor Function Classification System (GMFCS) levels IV and V are unable to use hand-held walkers and require supported-stepping devices with trunk and pelvic support to allow overground stepping in natural environments. This scoping review explored what is known about the use of supported-stepping devices with individuals functioning at GMFCS IV or V. Comprehensive database and hand searches were completed in December 2022. Of 225 unique citations, 68 met the inclusion criteria: 10 syntheses and 58 primary studies including randomized, non-randomized, qualitative, observational and case study designs. Primary studies included 705 unique individuals functioning at GMFCS IV or V, aged 9 months to 47.7 years, while surveys and qualitative studies included 632 therapists. No new experimental studies have been published since previous reviews, however, lived experience and descriptive data suggest that upright positioning and mobility in supported-stepping devices have psycho-social significance with positive impacts on individual self-esteem and autonomy, as well as influencing the perception of others. Improved head and trunk control, use of hands, stepping and independent mobility may promote fitness, functioning, fun, friends, family and future, although environmental and physical challenges may limit use in adolescence and adulthood. Further research on all aspects of supported-stepping device use with individuals at GMFCS IV/V is warranted.

Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus

“…Group experimental, observational and qualitative study evidence was mainly moderate or high quality, other than research on hip stability, which is still limited, as indicated in Section 3. This manuscript is not a scoping or systematic review, and readers are directed to the two original review publications [21,22] for details regardevidence level, quality and risk of bias analyses. Two different theoretical frameworks were used in the analysis of this evidence to create an integrated model, which is open to discussion.…”

“…Supported standing and stepping devices can promote functioning, fitness and overall health, emotional development, inclusion and participation in home and school settings for children with non-ambulant CP [ 21 , 22 ]. Development of independent standing or stepping without the devices is not an expectation, and power mobility is the focus for efficient functional mobility for children at GMFCS levels IV/V, especially in community settings [ 3 , 22 , 23 ].…”

“…Ref. [ 22 ] summarized and critiqued results from eight systematic or scoping reviews, two clinical guidelines and 59 primary studies. Fifteen of the included 59 primary studies were experimental designs and four were qualitative or mixed-methods, with the remainder being primarily observational or descriptive studies culminating in data from 705 individuals (ages 9 months to 47.7 years) and 632 therapists.…”

“…Although these recent scoping reviews examined what is known about the use of supported standing [ 21 ] and supported stepping [ 22 ] devices, no studies have compared or contrasted the evidence, outcomes and benefits of these two types of devices, with support for clinical reasoning lacking. Both reviews confirmed the influence of environmental factors, particularly the device (assistive technology) and the influence of others (social and attitudinal environment) in the use of supported standing and stepping devices.…”

Identifying and Evaluating Young Children with Developmental Central Hypotonia: An Overview of Systematic Reviews and Tools

“…Children who are 50% delayed in motor skills, or with a HINE score <40 [70], are highrisk of functioning at Gross Motor Function Classification System (GMFCS) IV and V [121] and may fit the profile of severe hypotonia. Recommendations for children with CP, GMFCS IV, and V should be implemented, including early introduction of adaptive seating [122,123], supported standing [124], stepping [125], and power mobility devices [126][127][128], to promote ON-Time positioning and mobility experiences [129]. Consideration should also be given to monitoring hip health and inclusion in surveillance programs, since non-ambulant children with hypotonia are also at high risk for hip displacement [130,131].…”