ORLAU Parawalker

What is it? 
The ORLAU Parawalker is a type of Reciprocal Walking Orthosis that is designed to enable paraplegic and other patients to walk.  (‘Reciprocal walking’ means taking alternate steps with one foot and then the other – as in ‘normal’ walking.)
 
Who is it for? 
The orthosis (sometimes called a ‘splint’ or ‘brace’) is intended primarily for paraplegics – i.e. those patients who have no voluntary control of the muscles in the lower body because of damage to the spinal cord.

Paraplegia can result from a number of causes:

  • Congenital  (e.g. Spina Bifida)
  • Traumatic  (e.g. as a result of a road traffic or other accident)
  • Disease  (e.g. spinal tumour)
  • Other causes (e.g. vascular trauma)

ORLAU has also successfully helped patients who have lost the ability to walk naturally as a result of Polio and other conditions.

The orthosis can be used by patients from as young as 5 years of age through to fully grown adults.

How does it work? 
The orthosis is manufactured to individual patient dimensions so that it fits closely from just under the armpits down to the ground.  It is (usually) worn outside clothing and locking knee joints keep the user’s legs straight during standing and walking.  Special joints at the hips allow just enough fore-and-aft movement to permit a stepping pattern.
The knee and hip joints have quick-release mechanisms to allow the user to sit on a chair or couch – the position usually adopted when putting the device on and taking it off (though some find it easier to do this whilst lying down).

Crutches (or, for younger users, a wheeled walking frame such as a rollator) must always be used with the orthosis.  This is necessary to maintain balance and to allow the use of the arms and upper body muscles to raise each foot off the ground in turn and to provide the forward propulsion forces.
 
Where can it be used? 
That depends very much on the individual.  Many patients use it for purely therapeutic purposes – in other words, they understand the benefits of standing and walking and it is an important part of their exercise programme.  Others wear it at school, at home or at work because it allows them to perform certain tasks that would otherwise be difficult - or even impossible – to achieve.

What are the benefits? 
Quite a lot of research evidence has been gathered showing that standing and walking exercise helps with such things as:

  • urinary drainage
  • bowel function
  • improvement in peripheral circulation
  • reducing the incidence of pressure sores
  • reducing osteoporosis

Many people believe that there are social and psychological benefits as well.

So why don't all paraplegics use these? 
Good question!  The answer is in several parts.

Walking is very hard work.  Studies have shown that the energy used by paraplegics can be anything between 5 and 10 times greater than that involved in normal walking.  You have to be very, very determined if you are going to be a successful user.

You need the right environment.  It can be difficult to move about in the confined space of the home – simply because there isn’t enough room.  You also have to work out how the use of the Parawalker is going to fit into your daily routine – lots of wheelchair users live very busy lives.

The fact is that, in view the two issues listed above, some spinal injuries consultants believe that there is little point in even suggesting it to their patients as a form of treatment.

How do I know if I might be a suitable candidate? 
If you are referred to ORLAU for this treatment then the first step will be a thorough assessment.  A consultant and/or an experienced physiotherapist will want to know about your clinical history, your home/ school/work circumstances and a good deal more besides!  Your sitting balance, ability to perform independent transfers, and strength and fitness will be examined and all of the issues about being a Parawalker user will be discussed.  Some patients are given an exercise programme to develop their skills or to help reduce their weight before going on to the next stage.

How is it supplied? 
You will need to be measured – this can take place at the same time as the assessment.  The orthosis is then factory built to an ‘intermediate fit’ stage so that you can stand up and staff can check that it is a good fit. 

You return again (these appointments are usually three or four weeks apart) to be supplied and trained.  The training programme is thorough and usually takes three weeks (much less for children – they adapt far more quickly).  The usual procedure is that you will stay in one of our hospital wards for three nights each week and have your training from 10.00am – 3.00pm Monday to Thursday.  You get two long weekends off in the middle.  You learn first using parallel bars, then with crutches.  When you’re ready you practise out of doors – going up and down slopes and small kerbs, across hard surfaces and on grass.

Even when this is over and you take your Parawalker home, we still keep a close eye on things.  You will return roughly every six months for a review so that we can complete our clinical and mechanical safety checks. For further information contact ORLAU