Is your Mobility Device a Mobility Device or a Disability Device?
Mobility impacts the way we see the world and the way the world sees us.
The human body is designed to coordinate and balance movement between the left and right side of the body with the feet striking the ground from heel to toe. The ability to develop and maintain that kind of movement is a head-to-toe process that impacts physical, cognitive, and psychosocial abilities. In individuals born with conditions that affect mobility learning how to walk does not always follow a predictable pattern of development. The way the body is aligned and moves when walking affects the quality and quantity of a person’s ongoing balance, muscle strength and upright posture.
Traditional canes, crutches and walkers are not designed to maintain upright posture or the stability and alignment of the weight bearing joints. They are designed to maintain balance by extending the users base of support. Continued use of traditional canes, crutches and walkers causes an unnatural gait unrelated to age, injury or a condition that a person is born with. To maintain balance when using traditional canes, crutches and walkers, the user’s arm or arms must extend away from the body, and they must lean forward or to one side. The head, the line of sight, and the top of the spine are drawn downward and forward. When you look down at the ground when you walk, your visual field becomes too small. The size of a person’s visual field determines their cognitive processing speed and level of balance. In order not to fall forward when you walk with your head and line of sight downward, the size of your step and stride must become smaller. The feet are unable to strike the ground from heel to toe and the core muscles that help maintain upright posture and the vertical alignment and stability of the weight bearing joints become weaker.
Any physical skill that involves motor behavior needs to be developed and then maintained. Children with SB who have movement in the knees and feet can learn to walk. Whether they continue walking as they become adults or transition to a wheelchair will depend on how well they develop and maintain the alignment of their weight bearing joints and the strength of the muscles that help balance and coordinate movement. No one has ever regained, developed, or maintained that ability from continuously misaligning and forcing their body to be moved in ways it was not designed for.
The minimum standard for all crutches, canes and walkers should be that they help maintain or develop better posture, muscle strength and a more normal step stride and walking gait. They should not force people to continuously misalign and move their body’s in ways they were never designed for to maintain balance. The result of using mobility devices that misalign and move the body in ways it was never designed for is a stiff stooped unnatural gait and secondary or acquired disability that leads to a loss of mobility. When mobility devices keep users more upright when they walk, they have a larger visual field, faster cognitive processing speed and better balance. They also have more stability and vertical joint alignment and less pain.
In January of 2013 I became physically disabled in a life altering car accident. I was told by my surgeons after two years of surgeries and procedures that I would never walk normally again. I realized two things in April of 2015 when I started relearning how to walk. The first was that the reason that I was so badly disabled was not from my car accident. It was from the acquired or secondary disability caused from the way my crutches, walker and traditional cane had continuously misaligned and moved my body to maintain balance. The second was that if I kept using traditional canes and crutches, my surgeons would be right, and I would never walk normally again. Because of my background in human biomechanics, I built, used, and then patented a cane that acted as a third foot and allowed my body to be upright, aligned and moved the way it was designed to be aligned and moved. With continued use, I regained the ability to walk normally again despite the prognosis I was given by my surgeons.
The cane that I invented was chosen as a 2020 CTIP Portfolio Member.
The West Coast Consortium for Technology & Innovation in Pediatrics (CTIP) is a pediatric medical device accelerator centered at Children's Hospital Los Angeles funded by the U.S. Food and Drug Administration.
I was recently asked by Dr. Alex Van Speybroeck, of Children’s Hospital Los Angeles, to modify arm crutches used by children with SB and paralysis with my cane/crutch foot. Dr Van Speybroeck has tried them and after the adapted crutches are tried out in clinic by children with SB and paralysis over the next few months, Dr. Van Speybroeck will decide whether to proceed with a formal study. Developing mobility devices that maximizes mobility, upright posture and the vertical alignment and stability of the weight bearing joints may or may not keep children and adults with SB mobile longer before transitioning to wheelchairs. Keeping a person more upright with their weight bearing joints more vertically aligned helps prevent excess strain on the spine and allow the muscles to be used more efficiently making it easier to get across the playground or the boardroom.
Michelangelo said, “The greater danger for most of us lies not in setting our aim too high and falling short, but in setting our aim too low and achieving our mark.”
For people with conditions and injuries that affect mobility to have better long-term outcomes, the standard for mobility devices needs to be set higher than maintaining balance. If continued use of a mobility device causes a person to acquire more disability not less, then we need to ask why it’s called a mobility device and not a disability device.