Posterior Versus Anterior Walkers for Children with Cerebral Palsy-Biomechanical Analysis and Energy Consumption: a Systematic Review.

Systematically review the comparison of anterior and posterior framed walker in terms of biomechanical analysis and energy expenditure and to discuss the implications for clinical practice. A systematic literature search was performed to identify studies that evaluated the gait pattern, upper extremity (UE) kinetics and kinematics and energy consumption. Outcome measures and treatment results for them were identified. 6 studies met the criteria and were included in this systematic review. Gait analysis, UE kinetics and kinematics and energy consumption were all assessed in 4 different papers. Gait parameters were comparable between walkers but declined torso tilt was found in the posterior walker group. In UE joints, two groups showed no significant difference but adaptive therapeutic posterior walker helped decrease UE burden. Most of papers prefer posterior walkers because of low oxygen cost. For better gait pattern, less UE burden and energy consumption, the adaptive therapeutic posterior walker is relatively the proper choice among all. For future studies, crossover studies or randomized controlled trails (RCTs) with larger sample size and more accurate measurement equipment may provide more persuasive evidence. Long term effects of walker users can also be investigated. [ABSTRACT FROM AUTHOR]