Eli Razon from Easy Walking Inc. has introduced a new device to the neuromuscular community. Tina Duong, a PT from Children’s National Medical Center, has recently had some hands-on experience. Michelle Eagle (Newcastle) and Laura Case (Duke) have also commented.
The thought is that this device might be useful for boys/adolescents in the transition stage (loss of ambulation) and/or potentially to help regain ambulation following fracture.
The concept of this walker-like device is similar to a body weight support system except the support is coming from the hydraulic device that is attached to the bicycle seat. The hydraulic device allows for vertical displacement during walking and movement of the pelvis. As most of you have seen with products similar to this, most people who use it kind of just hang on the seat; this device provides the ability to sit when tired (in locked position) or the fluidity of the up and down movement similar to what is required during walking when in the unlocked position. It is considered an active-assisted device because it decreases the eccentric load with walking and assisting with concentric knee and hip extension. It does not require the use of upper extremity strength to be upright allowing freedom to be hands free and more functional.
In order to propel forward, the boys will need to have some antigravity strength of hip flexors, quadriceps and his extensors. Boys who are much weaker will not be able to use the device as efficiently, as the devide does not provide the force coupling that the boys get with the stander to receive the stretch of the lower extremities. The device offers more assist with weight bearing.
Clearly, it will be useful/helpful for some of the boys. Please seek advice and guidance from expert PTs who follow your son.
As always, PPMD sees it as our responsibility to ask the questions you would ask, whenever a new product is introduced to the community. We are continuing to ask questions and will pass along any information we learn. Below are some of the answers we received from Tina Duong.
1. I would love to understand more about the mechanics. Because of trunk weakness in Duchenne, help me to understand how the trunk is supported.
There are straps that are connected around the chest piece similar to a pelvic belt but it would not be full support for someone with significant trunk weakness.
2. Removing the body weight and enabling walking has significant benefits to include maintaining weight on the spine, contracture prevention, and potentially some impact on bone density. Do you see this device potentially replacing the stander? And is there a time when weakness in the trunk might limit its use?
I think the stander would continue to be useful for kids who need more support especially at the trunk. This device is great because it allows for varying degrees of weightbearing while the stander only gives you the option of 100% weightbearing or no weightbearing (well, with tilt options in the middlle…). Currently, moderate to severe trunk weakness would probably make this device less effective, but Eli [of Easy Walking Inc.] has always been very creative and great to work with that we could probably work together to build something to better support the trunk as needed if this device were to be used as a stander, as well as, a walker. This would be a more effective stander than the typical prone or supine standers that expect people to be entirely upright and many kids find uncomfortable. I think this would act more like the Easy stander.
3. Do you see this device as part of a PT regimen or would the individual be able to utilize it in school or outside in place of a scooter/wheelchair?
Absolutely! There is so much that can be done for cardiovascular fitness because of the reduced load and weightbearing through the lower extremities. I think it is the next best thing to swimming. The boys could get the benefits of movement outside the water. Therapist could do gait training with the device to show kids how to use and be more comfortable with it for an efficient walking pattern, then only adjust as needed. Of course, this should not be used as a strengthening device. This device could be used anywhere you could think of that a walker would be useful. Also, it will be better for the kids who are losing the ability to walk to be more stable and hopefully its use will decrease falls and fractures that are a result of these falls.
4. Is this typically covered by insurance? Medicaid?
Our current vendor has submitted 5 to insurance and there are a few denials, but insurance has approved for a few as well. This varies depending on the insurance company. Because the device is so new and innovative, there is no correct code for this device and it gets coded under a general code so the reimbursement % or rate is lower compared to other devices. Many of these devices need very strong letters of justification, but I think the justification would help the approval of these devices in the US.