Name: GMFCS Level: Date: Physiotherapist: Details of Previous Walkers Trailed (Including

Novita Walker Assessment

Name: ...... GMFCS level:...... Date:...... Physiotherapist: ………………………

Details of previous walkers trailed (including outcomes): ...... Treatment options that may effect walker choice (eg: Botox, Baclofen, surgery) ......

Part A: Motivation and Family Goals

1. Motivation of child to move. Does the child display any of the following abilities?  Interest in their environment  Attempts to move towards person/toy/object of interest  Floor mobility – rolling, crawling, creeping

Do these indicate that a walker should be prescribed?  Yes  No (May need to work on postural and movement skills / motivation to avoid prescribing a walker which will not be used)

Comments:......

Document Code: F-D-CLS 3.11-2 Printed version may be superseded. Page 1 of 5 Date Last Reviewed: 22/06/2010 Refer to online Quality System for current version.

Next Review Due: 22/06/2013 Approved by: Director Client Services Level 5 Document Owner: Director, Client Services 2. Goals of the child and family Consider the Goals with the child and family. These may be:  Recreational walking (where the child is transferred into the walker for the experience of moving around in their environment. This does not imply progression to independent walking)

 Gait training (with a view to increasing skills to achieve more independent walking)

 Independent walking (with the use of the walker)

Comments:......

......

Part B. Physical Assessment:  Children of GMFCS levels II to V will require minimal to maximal support.  Can the child bear weight through their legs? If no -->> standing frame.

Handy Hint: Automatic Stepping vs Facilitated Stepping Automatic stepping: can be therapist initiated. This is done by standing the child and assisting them to shift their weight forwards (lean forwards), when they will automatically lift legs one at a time to take a step. This is not a controlled movement. Facilitated stepping: the child tries to take a step and the therapist helps them to control the movement by shifting weight or rotating the pelvis, or rotating the trunk to help with foot placement. Consider whether the child needs to have hips free to initiate steps or assistance with forward propulsion. Handy Hint: Biomechanical Assessment. If the child has limitations due to increased muscle tone or decreased joint movement, a biomechanical assessment may be required to clarify issues which may be addressed with the use of splinting or specific spasticity management

Document Code: F-D-CLS 3.11-2 Printed version may be superseded. Page 2 of 5 Date Last Reviewed: 22/06/2010 Refer to online Quality System for current version.

Next Review Due: 22/06/2013 Approved by: Director Client Services Level 5 Document Owner: Director, Client Services Assessment Parameters Weight NB. What is the weight of your client? All equipment has maximum user weight limits, including walkers. A chosen walker should allow for your child to  ------increase in weight as they grow.

Support Handy Hint. What support does the child need in standing? The support required will need to be provided by the walker.  Minimal support Support can limit the child’s ability to move if they are using total  Support via trunk movement patterns. Can the child step after the trunk and pelvis  Support via pelvis are stabilized?  Support via upper limbs  Anterior chest support with strap Trunk  Variable forward tilt  Forward tilt required to assist with stepping.  Shoulder guards  Consider deg and where support is required.  Lateral chest support Upper limbs  Elbows extended  Gutters  Forearm support  Anterior bar handle  Asymmetrical  Tray Pelvis  Needs to be stabilized  Lateral pelvis supports  Pommel  Saddle Stepping assistance  Spring mechanism When being assisted to walk, does the child require  Leg guides  Assistance to initiate stepping  Central bar  Assistance to achieve reciprocal movement  Reciprocal leg straps  Assistance with foot placement  Leg bracing  AFOs /Splints

Document Code: F-D-CLS 3.11-2 Printed version may be superseded. Page 3 of 5 Date Last Reviewed: 22/06/2010 Refer to online Quality System for current version.

Next Review Due: 22/06/2013 Approved by: Director Client Services Level 5 Document Owner: Director, Client Services Directional / speed control  Swivel wheels Will the child require assistance to  Front /  Rear  Change direction  Locking swivels (option to fix direction)  Control direction of movement  Brakes  Control of speed?  Ski (These issues may become clearer with trialling)  Anti-tippers  Adjustable resistance from wheels Transfers Considerations:  Independent How will the child transfer in and out of the walker?  Standing transfer…………………..  Manual lift  Hoist  TPCP to be modified  Training of carers Environment Considerations: Where will the walker be used?  Terrain assessed  Home  Doorways / pathways assessed  Outside  Transfers required  School  Other…………………………..  Other…………………………..  Discussion with other stakeholders Wheels  Pneumatic Consider terrain and maintenance  Solid  Wide castors Strength / Endurance  Seat or support required on walker  Fatigues easily  Seat required close by.  Walks short distances (within a room)  Physical assistance required  Walks longer distances (from room to room)  Stand by assistance required  Other:

Document Code: F-D-CLS 3.11-2 Printed version may be superseded. Page 4 of 5 Date Last Reviewed: 22/06/2010 Refer to online Quality System for current version.

Next Review Due: 22/06/2013 Approved by: Director Client Services Level 5 Document Owner: Director, Client Services Transportation Considerations: How will the walker be transported?  Weight Considerations:  Size  Boot of car  Foldable  Van Comments………………………………  Station wagon  Only used in 1 environment

PART C: Development of Walker Prescription

Final Walker Goals: ......

......

Final Walker Parameters: ......

......

Final Walker Prescription

......

...... Funding  ALCMF/Other (non ILEP) ……………………………………………………………… Date......

……………………...... Therapist signature

Document Code: F-D-CLS 3.11-2 Printed version may be superseded. Page 5 of 5 Date Last Reviewed: 22/06/2010 Refer to online Quality System for current version.

Next Review Due: 22/06/2013 Approved by: Director Client Services Level 5 Document Owner: Director, Client Services