Manual

Properly gait training with the Spartan device is a low-risk activity. Below is the information that you, as the “operator,” need to understand what is proper for a given user. An operator need not be a physical therapist or trainer, although it is recommended that anyone who wishes to use the device initially seek guidance from one. Inclusion Threshold The person can be brought to an upright, standing position. With the necessary support mechanisms in place (platform walker, pelvic harness, etc.) the person can be safely manipulated to achieve a cyclical stepping motion without undue falling risk. The integrity of their bones, ankle joints, knee joints, and hip joints will not be threatened by the activity. General Safety To perform gait or locomotor training with the Spartan is to subject the user to the internal and reaction forces normally associated with walking, as well as the external forces exerted on the user’s body through the device itself. Furthermore, the user gains gravitational potential energy by standing, and will be performing a complex task that they may need to acclimate to before feeling stable. It will take time for the user to learn how best to maneuver their body and for the operator to learn how best to maneuver the device. It may require a small trialand-error period before the device is calibrated for a best fit to the user (slide-hinge placement and elastic ankle supports). Given these challenges as well as any others that are specific to the user’s disability presentation and the support equipment being used, it is recommended that you progress slowly to a state of standard-speed assisted ambulation. When assisting the user with knee extension, exert a controlled and gradual force into the Spartan’s handle so that the knee enters full or near-full extension guardedly and without extra force. A knee brace may be worn underneath the device. While executing the swing phase with one of the user’s legs (pulling, rotating up), be sure to remember to hold (as needed) the opposite knee in extension so that the user has clearance for the swing leg and so their only load bearing leg does not buckle. For users with a history of compromised skin health, it is recommended that you periodically check their skin at all points of contact with the device. The ankle attachment does not need to be fitted as snugly as the thigh attachment. Be observant and check for skin discoloration or any other signs of significantly impaired blood flow.

Support Systems for Various Degrees of Functionality

Below are four support system categories formed from the SCI model of disability, all of which assume an ASIA A or B injury in which the individual has re-gained nearly no motor control. From these categories, it is the operator’s responsibility to extrapolate a fit for the individual who will be using the Spartan. This may be tricky when extrapolating to TBI patients, stroke patients, or anyone else who doesn’t present similarly to the SCI model. Be prudent and always over-support; if, through practice, it becomes clear that the individual is over-supported, then reduce as you see fit. Possible reasons to reduce support may include: reduced set-up time, fewer people needed to conduct the activity, and less impingement to the user’s body; obviously, these are all small rewards, so reducing support should only be done if the increased risk to the user is negligible. As the operator, it is your responsibility to evaluate the individual in question and determine the degree to which they must be supported during gait training. The intent should be to provide enough support such that if the Spartan device were to fail entirely (suppose the straps broke off completely and the individual’s legs were left unsupported), the individual would not be exposed to undue risk of injury. Likely Support System for Low-Functioning Quads (~C6-C4) For users with little or no upper-extremity strength, a platform walker equipped with a pelvic-support harness is required. The Spartan will be affixed to the user while they are sitting down. To achieve sitto-stand, gentle forward pressure may be applied into the Spartan’s thigh fixtures to block forward motion in the user’s knees while two trainers manually lift the user into an upright position. At this point, maintaining extension using the Spartan, have one trainer support the user’s torso, and have the third trainer affix the pelvic harness. During stepping, a second trainer may be needed to stand near the user and help support their trunk using a gait belt. The walker itself will need to be advanced via some external mechanism; this can be done by looping a gait belt around the operator and front of the walker, by making it the dual responsibility of the second trainer, or by incorporating a third trainer. Likely Support System for High-Functioning Quads (~C7-T1) For users with adequate upper extremity strength, a platform walker is required. The Spartan will be affixed to the user while they are sitting down. To achieve sit-to-stand, gentle forward pressure may be applied into the Spartan’s thigh fixtures to block forward motion in the user’s knees while the user places their hands/forearms on the platform and lifts themselves into a stand. A second trainer may be required to assist with this stage. If the user can be bear their weight with their arms in the event of a device failure, then a second trainer is unnecessary during stepping. If the magnitude of their strength and control is questionable, a second trainer with a gait belt around the user’s torso is required. If advancing the walker during stepping is choppy or difficult, it will need to be advanced via some external mechanism; this can be done by looping a gait belt around the operator and front of the walker, by making it the dual responsibility of the second trainer, or by incorporating an additional trainer.

Likely Support System for Paras without Core Stability

(~T1-T8) For users with adequate upper extremity strength, a platform walker is recommended, but a standard walker may be used. The Spartan will be affixed to the user while they are sitting down. To achieve sitto-stand, gentle forward pressure may be applied into the Spartan’s thigh fixtures to block forward motion in the user’s knees while the user places their hands/forearms on the walker and lifts themselves into a stand. A second trainer may be required to assist with this stage. If the user can be bear their weight with their arms in the event of a failure, then a second trainer is unnecessary during stepping. If the magnitude of their strength and control is questionable, a second trainer with a gait belt around the user’s torso is required. If advancing the walker during stepping is choppy or difficult, it will need to be advanced via some external mechanism; this can be done by looping a gait belt around the operator and front of the walker, by making it the dual responsibility of the second trainer, or by incorporating an additional trainer. Likely Support System for Paras with Core Stability (~T8 & down) For users with adequate upper extremity strength and core stability, a platform walker is recommended, but a standard walker may be used. The Spartan will be affixed to the user while they are sitting down. To achieve sit-to-stand, gentle forward pressure may be applied into the Spartan’s thigh fixtures to block forward motion in the user’s knees while the user places their hands/forearms on the walker and lifts themselves into a stand. A second trainer may be required to assist with this stage. If the user can be trusted to bear their weight with their arms in the event of a failure, then a second trainer is unnecessary during stepping. If the magnitude of their strength and control is questionable, a second trainer with a gait belt around the user’s torso is required.