ORLAU Swivel Walker

What is it?
The ORLAU Swivel Walker is a piece of equipment that is designed to help people – adults and children – who cannot stand and walk on their own.  This kind of equipment used to be called a ‘splint’ or ‘brace’; these days we call it an ‘orthosis’.  It is most often used by paraplegics – i.e. patients who have no control of the muscles in their lower body and legs because of damage to the spinal cord.  Other people who have used it successfully include those with muscular dystrophy and some with cerebral palsy.  It allows the user to stand and move about indoors independently and with their hands free for ….. well, for whatever they want to do.


Who is it for?
ORLAU has successfully used this orthosis with children as young as one year of age.  The advantage of supplying it this early is that the child can be upright and mobile at the same stage in their development as the able bodied child.  Many children will progress to the ORLAU Parawalker at the age of five years or so but, for some, the extent of their disability may be such that the Swivel Walker remains the best choice for them. 
At the other end of the scale, there is an adult version that can be used by those in their mature years.  We are not aware of any other orthosis that allows adult walking activity for those with spinal lesions above T4 level.
 

How does it work?
The orthosis provides rigid support across the hips and knees in order to compensate for partial or complete lack of muscle control.  Simple fastenings that are quick and easy to open and close are used at the feet, knees and chest.  A few users can get in and out by themselves, but most will need help with this.  Most will get in and out with the orthosis lying flat on the floor or leaning against a chair or couch, and nearly everyone needs help getting upright and back again.  For larger children and adults this usually means that a patient hoist is needed.  Not every type of hoist is suitable – there must be a big enough range of movement to lift all the way from lying into standing.  Those that are mounted on ceiling tracks are best.
Once upright, the orthosis needs only to be rocked sideways a little to make the frame automatically swivel gently in turn on each footplate so that it ‘walks’ forwards.  Shifting weight from side-to-side with movement of the shoulders is enough and, with a bit of practice, most people also learn how to turn corners and to move backwards.  It is important to realise, though, that it is a somewhat unnatural form of walking.  Most users find that it offers a useful addition to their therapy – research evidence points to the fact that a programme of standing and walking exercise helps with such things as:

  • reducing the incidence of pressure sores;
  • reducing osteoporosis;
  • improving urinary drainage and bowel function;
  • improving peripheral circulation.

For adult users, the Swivel Walker is often useful in the home when they want to undertake those activities that can only be done in standing – we can probably all think of a number domestic tasks where this is the case.

 

Where can it be used?

There are limitations over this.  The user does not use crutches or any other aids to maintain their balance.  The frame stands upright on its two footplates and can only be used on level surfaces.  This effectively means that it can only be used indoors.  There can be additional problems in the home if the floor is covered with a particularly deep-pile carpet.


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 Swivel Walker user will be discussed.  Some patients are given an exercise programme to develop their skills 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.  It is important to make sure that the orthosis is a good ‘snug’ fit and so each one is made to individual patient measurements.
You will return, typically after about four to six weeks, to be supplied and trained.  There are some final fitting tasks that must be performed and the training is usually fairly straightforward – children in particular often learn very quickly.  This stage of the process can usually be completed in a single day.
Even when this is over and you take your Swivel Walker 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.


The ORLAU Standing Frame 
This is a modified version of the Swivel Walker.  As the name suggests, it offers support only for standing, but many of the therapeutic benefits listed above can still be gained.
It differs in two important respects from the many other standing frames on the market:
The upright section hinges on the base.  This means that it can be tilted to an angle to lean on a couch or chair, or laid flat at floor level.  The user can be lifted in and out, raised to the upright position and lowered again, all with the aid of a suitable patient hoist.  The Manual Handling difficulties associated with the management of larger and heavier patients are thus solved.


It is assembled to the individual user’s measurements.  In this way, it can be made to accommodate many of the deformities of the spine and the lower limbs that preclude the use of other types of frame.


In recent years, ORLAU has had considerable success in using the Standing Frame for children with more severe problems arising from Cerebral Palsy and other neurological conditions.


All standing frames are mounted on braked castor wheels that allow them to be moved around with the user in the supported position.  For the smaller size of frame (suitable for those up to about 12 years of age) ORLAU can also offer a combination of the two types of equipment described above.  The Swivel Walker can quickly be immobilised by fitting an ‘outrigger’ (similar to the Standing Frame base).  This can be useful in school where, in a busy classroom with a lot of activity going on, the extra stability provided by the base frame offers valuable safety to the user.  Removal of the outrigger quickly converts the orthosis back into a walking device.