NF-walker and botulinum toxin therapy for children with spastic tetraparesis

Aim: To study the role of NF-walker as additional therapeutical aid for children with multi-level botulinum toxin treatment.

Method: Case report of 3 children with spastic or spastic-dystonic tetraparesis (GMFCS-Level IV, age 4–10 years, follow up 6–12 months). All received multi-level treatment with botulinum toxin A and used NF-walker in daily life. Criteria for NF-walker use were: high motivation to verticalise although stability and balance is poor, no contractures, no severe mental retardation, support of carers for daily use.

Results:

static: physiological straight body position, regulation of body tonus, strengthening of trunc muscular, individual adaptation of the system to abilities of the child (stepwise take over of weight).

functional: concentration of child on movement instead of stability, no use of hands for upright position, vertical level for communication and exploration, self-determined activities.

Discussion: Botulinum toxin therapy and NF-walker have synergistic effects. Tonus reduction of extremities by botulinum toxin combined with tonus stabilisation of trunc by NF-walker supplement each other for the therapeutic goal: walking with aids. The physiological position of the body in NF-walker in combination with botulinum toxin effect prevents contractures. For certain children NF-walker seems to be the only possibilty to reach upright position and to move.

Disadvantage of NF-walker is that carers are needed to adapt the walker to the child and quite some space for movement.