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PubMed2005

Promoting child safety in primary care: a cluster randomised controlled trial to reduce baby walker use.

BACKGROUND: Baby walkers are commonly used items of nursery equipment, but cause more than 3000 injuries each year in the UK. There is currently little evidence regarding the effectiveness of interventions in primary care to reduce walker use. AIM: To evaluate the effectiveness of an educational package provided by midwives and health visitors to reduce baby walker possession and use. DESIGN OF STUDY: Cluster randomised controlled trial. SETTING: Sixty-four general practices in Nottingham and North Nottinghamshire, UK. METHOD: An educational package aimed at discouraging mothers-to-be from obtaining and using a walker was delivered by midwives and health visitors to 1174 mothers-to-be of at least 28 weeks gestation. The control arm received usual care. Primary outcome measures were the possession and use of a walker. Secondary outcome measures included the frequency and duration of walker use, knowledge and attitudes towards walkers, plans to use a walker with future children, recommending a walker to a friend, and use of stair gates and fire guards. RESULTS: Intervention arm participants were significantly less likely to own (odds ratio [OR] = 0.63, 95% confidence interval [CI] = 0.43 to 0.93) or to use a walker (OR = 0.26, 95% CI = 0.08 to 0.84). They were significantly less likely to plan to use a walker with their next child (OR = 0.52, 95% CI = 0.31 to 0.86) or to agree that walkers keep children safe (OR = 0.35, 95% CI = 0.16 to 0.78). There was some evidence that they were less likely to recommend a walker to a friend (OR = 0.51, 95% CI = 0.28 to 0.91) or to agree that they help children to walk more quickly (OR = 0.53, 95% CI = 0.29 to 0.95). CONCLUSION: An educational package delivered by midwives and health visitors was effective in reducing baby walker possession and use. Providers of primary healthcare services should include baby walker education in their injury prevention strategy and child health promotion programme.

Accident Prevention↗
PubMedDate not supplied

Technical considerations in the selection and performance of walkers.

The walker is a mobility aid that provides a portable base of support. People of all ages use different kinds of walkers for a variety of reasons. With the correct walker, many people stroll along at the same pace as their companion. Today, walkers are available in a variety of styles and colors and have numerous accessories. It is the purpose of this article to describe the various types and models of walkers and accessories that are available. Our goal is not to recommend or rate the walkers but to help you find the right walker. The ultimate selection of a walker will depend on a cooperative effort between the physiatrist, physical therapist, and medical equipment supplier. Before you purchase a walker you should test it out to decide if it is the right one for you. The physical therapist who supplies your walker should adjust for your height and should check the physical fit of the equipment. Moreover, the physical therapist should demonstrate the proper gait for walking. During the past few years radical changes have occurred in the design and style of walkers. We expect this trend to continue with more attractive, easier-to-use products to be introduced regularly. If you think that your walker is outdated and is not adapting to your lifestyle, talk with your physiatrist regarding alternatives. Today, walkers are as different as their users. Find the best one for you by taking a test walk in your home and community.

Equipment Design↗
PubMed2003

Midwives' knowledge of, attitudes to and practice with baby walkers.

OBJECTIVE: to determine community midwives' knowledge, attitudes and practice with regard to baby walkers. DESIGN: survey, using questionnaires. SETTING: primary care, East Midlands, UK. PARTICIPANTS: Sixty-five community midwives participating in a cluster randomised controlled trial to reduce baby walker use. FINDINGS: there was a 94% response. Seventy per cent of the midwives, felt that it was part of their role to discuss baby walkers, and 62% felt that giving advice about walkers before birth acceptable. The midwives had a limited knowledge of baby walker injury risk and only one midwife had any baby walker-related health education material. Three attitude scales were computed and indicated that the midwives held a negative view of baby walkers and were positive about baby walker health education, believing that parents hold a positive attitude to baby walkers. Those midwives who had used a walker with their own children were more positive about baby walkers and less positive about baby walker health education. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives are willing to be involved in baby walker health education during pregnancy. However, they require evidence-based knowledge and materials rather than relying on personal experience.

Adult↗
PubMed1998

Parental decisions to use infant walkers.

OBJECTIVE: To assess parental decision making in the acquisition of an infant walker and the influences surrounding that decision. DESIGN/METHODS: Caretakers of children attending a residents' continuity practice during a one month period were invited to participate in a structured interview to assess various aspects of infant safety. Ten questions specifically addressed infant walkers and the decision to acquire one; seven questions collected demographic data. RESULTS: One hundred and fifty four primary caretakers participated. Of these, 77% (n = 119) of caretakers used infant walkers for their child. For children who were not first born, 85% of caretakers had used walkers with their other children. No statistically significant differences were found between walker users and non-users with respect to the sex or birth order of the child, race, education, or (type of) caretaker. Also, no differences were found between these groups with respect to having received safety information from the pediatrician. For users, 97% heard about walkers before their baby's birth, but 65% did not decide to use one until after the birth. In addition, 61% of walker users stated that no one influenced their decision to get a walker and 75% bought their own. These decisions were not affected by caretaker education or birth order of the child. Finally, 78% believed that walkers were beneficial, and 72% believed that walker use accelerated development of independent walking skills. CONCLUSIONS: Mothers purchased walkers because of no uniformed perception of benefit. A period of time, up to several months in length, exists from when the first mother hears about walkers until she decides to purchase one. Until legislation can be passed banning walkers, this period of time may provide a window of opportunity for appropriate anticipatory guidance in the form of intense media assisted, antiwalker campaigns.

Decision Making↗
PubMed1996

Tumor cells expressing the herpes simplex virus-thymidine kinase gene in the treatment of Walker 256 meningeal neoplasia in rats.

A promising strategy in the treatment of neoplastic meningitis involves the use of herpes simplex virus-thymidine kinase (HSV-tk)-modified cells. In these experiments the authors used cells expressing HSV-tk to treat meningeal carcinomatosis in the rat Walker 256 model. Intrathecal injection of 2 x 10(5) Walker cells resulted in a median survival time of 15 days. Up to 80% of animals implanted with HSV-tk-modified Walker cells (Walker-tk+) and treated with ganciclovir showed long-term survival (120 days or more), whereas the remaining animals died from tumor growth between 37 and 44 days after implantation. Tumor cells from an animal in which the treatment failed were cultured in vitro and were shown to be still sensitive to ganciclovir. However, continuous ganciclovir administration for 6 weeks rather than 2 weeks did not improve survival. Histopathological studies confirmed leptomeningeal infiltration in the untreated Walker or Walker-tk+ animals. Walker-tk+ cells were mixed with Walker cells in 1:1, 10:1, or 50:1 ratios, respectively, and implanted intrathecally; the animals were treated with ganciclovir. All groups of treated animals had long-term survivors, with 40% of the rats in the 10:1 and 50:1 groups demonstrating long-term survival and absence of microscopic tumors in the brain or spinal cord. Similarly, murine fibroblast HSV-tk virus-producer cells improved survival. Walker-tk+ cells were better than fibroblast-producer cells in improving the survival of animals with Walker tumors at low (1:1) but not at high (10:1) effector-to-target cell ratios. Repeated intrathecal administration of Walker-tk+ cells resulted in inhibition of established Walker tumors. The authors conclude that Walker-tk+ cells are at least as effective as murine virus-producer cells and could be used in the treatment of meningeal neoplasia.

3T3 Cells↗
PubMed2001

Injuries associated with infant walkers.

In 1999, an estimated 8800 children younger than 15 months were treated in hospital emergency departments in the United States for injuries associated with infant walkers. Thirty-four infant walker-related deaths were reported from 1973 through 1998. The vast majority of injuries occur from falls down stairs, and head injuries are common. Walkers do not help a child learn to walk; indeed, they can delay normal motor and mental development. The use of warning labels, public education, adult supervision during walker use, and stair gates have all been demonstrated to be insufficient strategies to prevent injuries associated with infant walkers. To comply with the revised voluntary standard (ASTM F977-96), walkers manufactured after June 30, 1997, must be wider than a 36-in doorway or must have a braking mechanism designed to stop the walker if 1 or more wheels drop off the riding surface, such as at the top of a stairway. Because data indicate a considerable risk of major and minor injury and even death from the use of infant walkers, and because there is no clear benefit from their use, the American Academy of Pediatrics recommends a ban on the manufacture and sale of mobile infant walkers. If a parent insists on using a mobile infant walker, it is vital that they choose a walker that meets the performance standards of ASTM F977-96 to prevent falls down stairs. Stationary activity centers should be promoted as a safer alternative to mobile infant walkers.

Accidental Falls↗
PubMed1997

A guideline for the design of a four-wheeled walker.

More people use assistive technology devices to compensate for mobility impairments than for any other general type of impairment. Increasing numbers of people with mobility or balance problems use walkers with four wheels. Four-wheeled walkers are often outfitted with seats to make it possible to travel longer distances with intermediate resting periods. The dangers of sitting on a parked walker are well known. Many physiotherapists tell walker users to park the walker against a wall to prevent injury in case the user forgets to apply the brakes or the brakes fail. To design a safer walker that can be used for sitting, the demands placed on it must be measured. With these data, three modes of walker instability must be considered: first, the brakes may hold but the wheels may slide along the ground; second, the entire walker may tip over; and third, the brakes may fail to hold the wheels in place, and they may begin to roll. Mathematical models can be constructed to simulate how different walker designs will perform. By this process, design improvements can be made for existing walkers, and future walker designs can also be proposed.

Aged↗
PubMed1996

Infant walker injuries persist in Canada after sales have ceased.

OBJECTIVE: To identify the source of acquisition of infant walkers and attitudes regarding the continuing use of walkers following an injury to an infant in order to design preventive strategies. DESIGN: Descriptive and retrospective. SETTING: Emergency department of a children's hospital involved in primary, secondary and tertiary care. PATIENTS: All patients presenting with injuries associated with infant walkers over a 42-month period. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Source of acquisition of infant walker and actions taken after the injury. RESULTS: The demographic and outcome data of the 36 patients were similar to previous reports. The caretakers of 26 patients were reached by telephone. Eight walkers were purchased in the United States and 18 were second-hand acquisitions (new walkers are not available for sale in Canada). Only two families continued using their walkers in the same fashion as prior to the injury. CONCLUSIONS: Although new infant walkers are not sold in Canada, injuries associated with their use continue. An aggressive public education campaign discouraging infant walker use and an incentive driven recall campaign to retrieve circulating walkers are seen as complimentary preventive strategies. A similar approach should be considered in other countries that choose to regulate infant walkers.

Accidental Falls↗
PubMed1996

[Patterns of use, popular beliefs and proneness to accidents of a baby walker (go-cart). Bases for a health information campaign].

Baby walkers are a potential cause of accidents in infants from 6 months to 1 year of age. We conducted a study to determine the patterns of walker use, the different points of view of the parents and the baby walker-related injuries in our health district. For this purpose, between November 1, 1992 and January 31, 1993, a questionnaire was given to 207 parents of infants between the ages of 3 and 24 months in order to evaluate the socioeconomic situation and to determine the patterns of walker use. We found that 42% of the infants between 4.3 and 13.4 months of age had a baby walker and 46.7% of them used it daily. There was a significant inverse relationship between the walker usage and the maternal level of education. Of the infants who used walkers, 24.9% had experienced an accident (falls 76.2%, injuries 14.3% and hospital admission 4.8%). The accidents were significantly more common in boys. The advantages reported by parents (for using walkers) were: 46.3% none, 34.2% comfort, 10.9% infant amusement, 12.9% help to walk earlier. Dangers reported by the parents included: 27.2% none, 33.5% leg deformities, 43% accidents (33.5% injuries and 12% falling down stairs). In conclusion, our results show a slightly lower number of walker users and walker related accidents when compared to other reports. Parents have mistaken notions about the use of baby walkers. Hence, the need for continued health education campaigns related to this subject remain.

Accidental Falls↗
PubMed2001

Comparison of anterior and posterior walkers with respect to gait parameters and energy expenditure of children with spastic diplegic cerebral palsy.

The purpose of this study was to compare gait pattern and energy consumption in children with spastic diplegic cerebral palsy, when using anterior and posterior walkers, and to determine which walker should be recommended as a walking aid for these children. Ten spastic diplegic cerebral palsied children, of average age 9 years, were enrolled in this study. Before assessment, they had all received a practice period of 1-month to familiarize themselves with both types of walker. Gait characteristics were evaluated by computer-based kinematic gait analysis using Vicon 370 Motion Analysis, and energy expenditure was determined by KBI-C while they were using the walkers. The oxygen consumption rate was significantly lower whilst using the posterior walker, as was the oxygen cost. Walking velocity and cadence on gait analysis showed no significant difference between the walker types. However, step length, single support time and double support time were significantly different for the two walkers. Flexion angles of the trunk, hip and knee were lower using a posterior walker. Gait analysis data and oxygen consumption measurements indicated that the posterior walker has more advantages in terms of upright positioning and energy conservation than the anterior walker.

Biomechanical Phenomena↗
PubMed1999

Effects of baby walkers on motor and mental development in human infants.

Because baby walkers enable precocious locomotion in very young, otherwise prelocomotor infants, walker experience might be conceptualized in terms of early enrichment. However, walker devices prevent visual access to the moving limbs by design. Therefore, prelocomotor walker experience may be conceptualized in terms of early deprivation, reminiscent of that created in a classic series of animal experiments on the critical role of visual feedback in developing motor systems. This study analyzed motor and mental development in 109 human infants, with and without walker experience, between the ages of 6 and 15 months. Walker-experienced infants sat, crawled, and walked later than no-walker controls, and they scored lower on Bayley scales of mental and motor development. Significant effects of walker type, frequency, and timing of walker exposure were observed. Considering the injury data along with the developmental data, the authors conclude that the risks of walker use outweigh the benefits.

Child Development↗
PubMed2001

Maternal use of baby walkers with young children: recent trends and possible alternatives.

OBJECTIVES: To examine recent trends in baby walker and exersaucer use, and to assess maternal motivations for choosing to use or not use these devices with children. SETTING: Small, Midwestern city in the United States. METHODS: Retrospective telephone survey with a sample of 329 mothers who provided information about their use of walkers and exersaucers with 463 children born in Columbia, Missouri between January 1994 and April 1999. RESULTS: Baby walker use in the sample declined fairly steadily from 1994 to 1999, whereas exersaucer use increased during the same period. Altogether 88% of mothers were aware of the injury risks associated with walkers, and this knowledge was the most commonly reported reason for abstaining from walker use. Remarkably, 38% of participants with knowledge of walker risks nevertheless used these devices. Participants reported many reasons for using walkers and exersaucers, including child entertainment, perceived developmental benefit, easy availability, and improved safety of exersaucers. CONCLUSIONS: Public knowledge of the hazards of walkers seems to be high, and this awareness is a likely factor in many caregivers' decisions not to use them. Future interventions should focus particular attention on those caregivers who continue to use walkers despite knowledge of the associated risks. In addition to persuasive interventions, alternatives to walkers should be encouraged. Exersaucers represent one viable alternative, and should be promoted as such by the media, pediatricians, and other child care professionals.

Chi-Square Distribution↗
PubMed2006

Success in the prevention of infant walker-related injuries: an analysis of national data, 1990-2001.

OBJECTIVE: Here we describe the epidemiologic characteristics and secular trends of infant walker-related injuries among children who are younger than 15 months in the United States. METHODS: A retrospective analysis was conducted of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission, 1990-2001. Sample weights that were provided by the National Electronic Injury Surveillance System were used in all analyses to adjust for the inverse probability of case selection and make national projections regarding infant walker-related injuries. RESULTS: An estimated 197200 infant walker-related injuries occurred among children who were younger than 15 months and treated in US emergency departments from 1990 through 2001. Five percent of these children required admission to the hospital. The number of infant walker-related injuries remained relatively constant from 1990 through 1994, averaging 23,000 cases per year. After the introduction in 1994 of stationary activity centers as an alternative to mobile infant walkers and the implementation of the revised American Society for Testing and Materials F977 voluntary infant walker standard in 1997, there was a marked decrease in the number of infant walker-related injuries. Overall, there was a 76% decrease in the number of injuries from 1990 to 2001 from 20,900 injuries in 1990 to 5100 in 2001. Soft tissue injuries and lacerations represented 63% of the injuries. Trauma to the head region occurred in 91% of cases. Skull fractures were the most common (62%) type of fracture. Falls down stairs was the mechanism of injury in 74% of cases. CONCLUSIONS: The adoption of passive injury-prevention strategies, such as use of stationary activity centers as alternatives to mobile infant walkers and redesign of infant walkers to prevent falls down stairs, were associated with a marked decrease in the number of infant walker-related injuries.

Accident Prevention↗
PubMed1997

How effective are brakes on infant walkers?

62 children, between the ages of 9 and 18 months old, were observed in an instrumented walker to measure the peak horizontal pull forces. These pull forces were later used to evaluate an infant walker with a braking system that would stop on the top step of the stairs before falling down the stairs. This brake system is activated when part of the walker crosses over the edge of the top step. Using the range of horizontal pull forces generated by the 62 children, the horizontal brake system for walkers would not always prevent the walker from falling down the stairs. Four floor surfaces were compared: carpet, vinyl, glossy wood, and unfinished wood. The walker brake system did not always stop the walkers on these floor surfaces. Using the measured weights and horizontal forces of the 21 nonwalking children between 9 and 13 months old who represent children who typically fall down the stairs in a walker, a simulation procedure was completed to represent the worse possible force condition, the peak horizontal force, for each of the 21 children. During this simulation, brakes would have failed all the time for 18 of the 21 children, and at least half the time for the remaining 3 children. These brake systems may provide false security to parents who use these walkers, since there are no published standards regarding the performance of brake systems for infant walkers as a safety device.

Accidental Falls↗
PubMed1984

Head injuries related to the use of baby walkers.

To determine what proportion of head injuries in children under 24 months of age who presented to an emergency department were related to the use of baby walkers, we reviewed the charts of 52 such children. Walkers were involved in 42% of the head injuries in the children under 12 months of age and in none of those in the children aged 12 to 24 months. All walker-related injuries, including skull fractures in three children, involved stairs (p less than 0.001). Questionnaires were also sent to all families with children aged 3 to 18 months attending a private pediatric practice to determine the prevalence of falls involving baby walkers among these children and the factors associated with such falls. Of the 152 responding families 82% reported using or having used a walker. Thirty-six percent of the families reported that their child had a fall while in a walker, with 8.8% of the falls resulting in contact with a doctor. Walker-related falls were directly associated with time spent in the walker (p less than 0.001) and with a previous fall from the walker by an older sibling (p less than 0.03). Since there is no demonstrated benefit of walkers, their use should not be encouraged, and parents should be advised of their potential danger.

Craniocerebral Trauma↗
PubMed2001

Walker-assisted gait in rehabilitation: a study of biomechanics and instrumentation.

While walkers are commonly prescribed to improve patient stability and ambulatory ability, quantitative study of the biomechanical and functional requirements for effective walker use is limited. To date no one has addressed the changes in upper extremity kinetics that occur with the use of a standard walker, which was the objective of this study. A strain gauge-based walker instrumentation system was developed for the six degree-of-freedom measurement of resultant subject hand loads. The walker dynamometer was integrated with an upper extremity biomechanical model. Preliminary system data were collected for seven healthy, right-handed young adults following informed consent. Bilateral upper extremity kinematic data were acquired with a six camera Vicon motion analysis system using a Micro-VAX workstation. Internal joint moments at the wrist, elbow, and shoulder were determined in the three clinical planes using the inverse dynamics method. The walker dynamometer system allowed characterization of upper extremity loading demands. Significantly differing upper extremity loading patterns were identified for three walker usage methods. Complete description of upper extremity kinetics and kinematics during walker-assisted gait may provide insight into walker design parameters and rehabilitative strategies.

Adult↗
PubMed1997

Infant walker use, injuries, and motor development.

OBJECTIVES: To study the impact of infant walker use on motor development and injuries. POPULATION: One hundred and eighty five parents or primary care givers who attended a Singapore government polyclinic from September 1993 to February 1994, with their infants between 7 to 10 months, for a developmental assessment session. SETTING: A government polyclinic in Singapore. METHODS: The parent or primary care giver answered questions pertaining to infant walker use and injuries attributed to its use. Each infant was then given the Singapore modified version of the Denver Developmental Screening Test (DDST-S), along with a full clinical examination; both testers were blinded to walker use. RESULTS: One hundred and sixty seven (90%) of 185 infants used walkers regularly, and 21 (12.5%) of the users had one or more injuries. Most injuries were minor, such as bruises and swellings on the head, forehead, face, and cheeks. None of the children who did not use walkers showed any abnormal DDST-S results whereas 18 (10.8%) of the 167 walker users had either abnormal or questionable DDST-S results. CONCLUSIONS: 12.5% of walker users had one or more injuries and walker use may also delay the child's motor development. These findings will help the physician or nurse in primary care settings to advise parents about the potential hazards of walker use.

Accidents, Home↗
PubMed1999

[Recognition on the gender of point-light walkers moving in different directions].

When we see a series of moving lights attached to a walker's major joints, we can recognize it as a human body in motion (Bruce & Green, 1990; Johansson, 1973). Moreover, observers can recognize the walker's gender from such a display (Barclay, Cutting, & Kozlowski, 1978; Cutting & Kozlowski, 1977; Cutting, Proffitt, & Kozlowski, 1978). For gender recognition, Cutting and his colleagues suggested that male and female walkers respectively have unique walking styles caused by differences in the position of their center of moment (Cm). However, previous studies of gender recognition used only side views of these point-light walkers. The present study investigated gender recognition by presenting subjects with three kinds of views of the point-light walkers: profile views of rightward movements, approaching movements, and 3/4 profile diagonal movements. Subjects' task was to judge if the walker was male or female. The results showed almost the same judgement accuracy for all directions in male walkers, and the highest accuracy for the approaching movement in female walkers. The subjects tended to judge the presented walkers to be male more frequently than female.

Female↗