Weekly Innowalk Pro use shows promise in outpatient settings

Jack Torbett, a paediatric physiotherapist from the Great North Children’s Hospital conducted a small in-service project looking at the feasibility of improving walking speed in his paediatric community patients, with some interesting results. Here we look at the results and how they can be interpreted.

The project included 4 children diagnosed with CP (GMFCS III-IV) and 1 diagnosed with Duchenne Muscular Dystrophy, all participants were aged between 5-9 years old. The outcome measures used were:

• Timed up and go test
• Evaluation questionnaire – one for participants, one for their parents/carers. 

The aim of the project was to answer the question: Can a single weekly session of dynamic standing training improve walking speed in ambulant children with a neurological disability?

Background - Pioneering inpatient rehabilitation for children

The Great North Children’s Hospital in Newcastle upon Tyne is currently the only hospital setting in the UK that has access to Innowalk PRO devices for their patients. The paediatric physiotherapy team initially trialled the dynamic standing device in 2018, on their inpatient neurorehabilitation ward. Before this, typical inpatient rehabilitation methods included passive movements in bed, static weight bearing on a tilt table/standing frame, hydrotherapy, with progression to supported standing and walking. Therapists found the introduction of supported standing and walking to be very labour intensive and they often felt they were unable to achieve a quality/intensity of rehab that would lead to neuroplastic changes in the early stages. By introducing the Innowalk PRO as an adjunct to their typical rehabilitation methods, they soon noticed that it was a useful tool that was less therapist intensive, that could help them achieve their rehab goals sooner and ‘link’ the gap between passive/static standing and supported mobilisation. This helped with the justification of pursuing funding to have their own access to Innowalk PRO on a permanent basis. Through fundraising efforts, the physiotherapy team were able to purchase 1 Innowalk PRO Small and 1 Innowalk PRO medium.

Discovering the versatility of dynamic standing in other therapeutic settings

Once the wider therapy team saw the benefits of dynamic standing on the neurorehabilitation ward, therapists from different specialities were trained up to use the Innowalk PRO with their patients. This included physiotherapists and therapy assistants/technical instructors working within inpatient respiratory wards, special schools and the community setting. The paediatric community team set up an outpatient clinic where they offered 6 week blocks of Innowalk therapy to their patients, who would attend the outpatient gym in the hospital physiotherapy department. Initially, the patients selected for these blocks were all ambulatory, but as the team become more accustomed to the Innowalk PRO and it’s uses, they were able to invite individuals with more complex needs.

What is the Innowalk Pro?  
The Innowalk Pro is a unique, adjustable solution that enables people with moderate to profound physical disabilities to access movement and physical activity. It provides safe, guided, repetitive movement, close to normal gait, by supporting the body in an upright position with weight bearing. 

the equipment can be used in a school setting, rehabilitation centers and therapy clinics. Learn more about the Innowalk pro here.

Evaluating the success of the 6 week block sessions

As part of his 12 month community rotation, Jack Torbett decided to evaluate how effective they were being by offering one session per week to their community caseload. He wanted to look specifically at his ambulant patients who were accessing a 6 week block of outpatient Innowalk sessions, and he decided to use walking speed as an easy-to-measure outcome that is functionally meaningful for the children he treats. His research question was: Can a single weekly session of dynamic standing training improve walking speed in ambulant children with a neurological disability?

Inclusion criteria

• Ambulant child with a neurological diagnosis
• Receiving community physiotherapy input
• Able to attend 6 weekly sessions at the Great North Children’s Hospital gym

Exclusion criteria

• Non-ambulant children
• Any child smaller or larger than the recommended Innowalk PRO height/weight limits

Participants

• 5 community paediatric patients attended for 6 weekly sessions of Innowalk PRO therapy.
• 2 participants diagnosed with CP (GMFCS III), 2 with CP (GMFCS IV) and 1 diagnosed with Duchenne Muscular Dystrophy
• All participants were aged between 5-9 years old.

Methods

Before the first session each child completed a pre-intervention Timed Up and Go test (TUG). They were then measured and set up on Innowalk PRO, and went on to complete their first  session.

Each weekly session consisted of:

• 2-3 minute warm up
• A period of more vigorous exercise (duration varied depending on the functional ability of participating children)
• 2-3 minute cool down
• The children were entertained with games whilst completing sessions

Within 1 week of the sixth session:

• Final TUG test completed
• Results recorded in child's notes and in data spreadsheet
• Evaluation questionnaire filled in by participants and parents

Results

All children improved upon their initial TUG test time, suggesting that following the 6 weekly  Innowalk Pro sessions, gait speed was positively affected. However, while the results look promising, there are some limitations and things to consider:

• Sample size is very small
• TUG test is difficult to reproduce due to relying on different walking methods and the child’s motivation/engagement
• Length and intensity of Innowalk session was unable to be standardised.
• Games to keep the session more fun differed between children, which may have affected length of session/motivation
  

Positive Qualitative Feedback

The post-intervention evaluation questionnaire distributed to both parents/carers and the participants provided very good feedback for the intervention:

• All parents felt the session was beneficial to their child’s physical and mental health
• All parents felt the session was pitched at the right level of intensity
• 90% of parents mentioned they felt an improvement to their child’s energy levels throughout the week
• All children reported enjoying the games played (balloon tennis a fan favourite!!)
• All children reported feeling better after doing the sessions
• All children reported feeling either fitter, stronger or sometimes both
• All children said they would love to come back
• 80% of children reported feeling “happier” after their sessions

The questionnaire also provided opportunity for suggestions on improving the intervention block. Parents’ feedback on this was mainly logistical, around venue parking and time of day, while the children suggested:

• More variety of games
• 2 children complained of DOMS like symptoms the day after their first sessions but did not feel this prevented them from doing anything
• Some children asked for faster machines!
• Some children asked to access it more regularly.

Despite the limitations, the project shows that a single Innowalk Pro session per week can be beneficial to ambulant children, and could help towards improving gait speed, motivation, mental health and participation in therapy. We look forward to see continued use of the Innowalk Pro with a wider patient range within the Great North Childrens Hospital.