mustang
Tommy, aged 3, achieves encouraging gait
progress with R82’s Mustang
Tommy, an inquisitive 3-year-old from Immingham, Humberside has
recently started using R82’s Mustang gait trainer that allows proper
positioning and support for children while they learn the skills of
stepping and walking.
Tommy lives with Tuberous Sclerosis Complex
which has caused the growth of benign tumours,
particularly in his brain and affects movement and
abilities. Tommy has high tone in his lower legs and
requires a lot of support to facilitate walking and to
progress developmentally.
Tommy recently started attending Humberston
Park Special School, Grimsby, where Frances
George, Specialist Physiotherapist, MSc, BSc, HPC,
MCSP has introduced “walking and stepping” focus
groups to assess the walking patterns of children
with different abilities.
Frances explains: “To encourage a child to walk, it
is important to understand the 3 gait phases of a
normal walking pattern – the heel strike, stance
phase and toe off which happen reciprocally. If a
child makes a heel strike with the right foot, then
a stance phase will be happening on the left –
creating stability and placing the hip and knee in a
neutral position. A step forward into toe off extends
the hip and knee before allowing the knee to flex
and the leg to swing through. This is then followed
by the knee extending and the foot dorsi-flexing to
create a heel strike. During this process, weight is
transferred from the back to the front foot which
creates sway or a “lateral shift”. This entire process
allows propulsion forwards and is the walking
pattern we want to achieve when we place a child
in a walker.”
Humberston Park started using R82’s Mustang
18 months ago. An older child was struggling to
find the correct position in the walker they were
using and their feet were becoming wider apart.
School staff explored options for other walkers and
decided on the Mustang which led to dramatic
improvements.
The Mustang is designed to assist gait in a wide
range of abilities and currently there are five
children at Humberston Park, aged between
3½ to 16 years, benefitting from regularly using
the walker in integrated therapy and education
sessions. The anterior position is ideal for users
unable to fully weight bear on their feet, or if motor
skills are reduced and the user needs support
around the trunk and pelvis. The posterior position
can be used for those children who have improved
gait development, more advanced trunk stability
and who are capable of bearing their full weight.
Humberston Park School assess children in
the Mustang over the course of several therapy
sessions, allowing time for them to adjust and
for staff to see if the equipment is suitable. After
monitoring Tommy’s gait for a few weeks whilst he
settled at the new school, Frances felt the Mustang
could help re-educate his walking pattern. Tommy
has a scissor gait which means he often steps
on his own feet and also uses a learned walking
“hopping” pattern. Frances ideally would like
Tommy’s left and right legs to work in isolation and
the muscles to be worked through the full range to
achieve a more reciprocal walking pattern.
Frances elaborates: “If a child has issues with
muscle strength, tightness and tone there are
often typical patterns that emerge – such as the
bottom sticking out, flexion in the hips and knees
and the legs start to scissor. The child struggles
to step forwards, as is the case with Tommy.
With other walkers, a child who has issues with
walking or stepping not only has to move their body
against gravity but also has to move the piece of
equipment as well. So they have to move their body
weight, the walker and overcome inertia. However,
the Mustang allows prone which shifts the centre
of gravity forwards of the base of support. This
assists the child in overcoming inertia, enabling
them to make that crucial first step.”
In order to help Tommy achieve a normal walking
pattern, a seat saddle has been attached to the
Mustang. The seat saddle provides a firm support
so Tommy’s hips and legs can be fixed in a set
position. The saddle can be set at a height which
supports his body weight whilst staff focus on reeducating his gait and working the correct muscles
to allow hip and knee extension. Once the correct
pattern is achieved the saddle can be lowered and
gravity can be reintroduced.
Frances explains: “To develop early stepping,
the child needs to be in a standing position – so
a correct starting position is crucial. The trunk,
shoulders, hips and feet should be in line, with
weight bearing as central as possible. This ability to
fix the Mustang’s seat firmly in different positions
allows us to monitor Tommy’s situation really well
and provides us with crucial feedback as to how we
can progress. So, for example, if we need flexion
or we want him to extend, we can adjust the seat
accordingly.”
Tommy does not have issues with tightness in his
hamstrings and can achieve a good alignment in
With other walkers...a child has to move the piece of
equipment as well. However, the Mustang allows prone
which shifts the centre of gravity forwards of the base of
support....enabling them to make that crucial first step.
R82 and Etac
R82 UK Ltd is an Etac Group company supplying R82, Etac, Molift, Immedia
and Convaid branded products in the UK and Ireland from a head office base in
Halesowen, Birmingham. The extensive range of high quality assistive products
for disabled children and adults includes wheelchairs, buggies, standing,
walking, toileting and bathing aids as well as manual and mechanical transfer
aids. Sales and distribution of these products is supported with service and
repair back up from a base in Basingstoke.
As the Mustang has different wheel configurations,
all four wheels can be fixed so that Tommy can walk
in a straight line, concentrating on achieving forward
momentum and obtaining the correct gait pattern.
This will also help develop his trunk control and
promote balance in stepping. Following on from this,
the front wheels can be unfixed so that Tommy can
go forwards or backwards and in the future, all four
wheels can be unfixed giving him complete control
over his walker and the pace he is using whilst
stepping. Although this is much more challenging
for the trunk, the Mustang supplies essential chest
support in the form of an adjustable moulded
trunk support. It provides a firm and snug fit to aid
trunk stability which allows for greater mobility and
coordination of the lower body.
For Frances, the Mustang walker is a superior
piece of equipment crucially because of the firm
support of the adjustable saddle, the essential
chest support and the prone positioning.
Simultaneously, they allow crucial alignment to be
maintained, creating the hip and knee extension
necessary for a step forwards.
Whilst still in the early stages of developing a
correct gait, Tommy has shown encouraging
progress in the short time he has spent with the
Mustang. He still has a tendency to hop but can
already place one foot in front of the other. Tommy
loves social interaction and is keen to explore.
Frances believes this self- motivation, coupled with
the Mustang’s capabilities, will ensure Tommy can
achieve long range progression in his standing and
walking abilities.
The parent company Etac AB is based in Stockholm, Sweden with manufacturing
sites across Scandinavia. The Etac Group has a truly global reach with further
subsidiary companies in the USA, Europe, Far East and Australia. The most
recent acquisition of US buggy manufacturer Convaid has further strengthened
the Etac Group’s product portfolio worldwide.
R82 UK Ltd.
Unit D4A, Coombswood Business Park, East Coombswood Way, Halesowen, West Midlands. B62 8BH
Tel. 0121 561 2222 / Fax. 0121 559 5437 / Email: [email protected] / www.R82.co.uk
© R82 UK Ltd. April 2016
hip and knee positioning, which the school are
keen to promote. To correct his scissoring, the
Mustang has an attachable leg divider, which
keeps his feet apart and prevents one treading on
the other. It can also reduce Tommy’s tendency
to hop by encouraging a reciprocal pattern from
the left foot to the right, accompanied by an ideal
weight shift – instead of both feet being placed
together and pushed through to a hop forwards.