Safety is the number one priority in therapy. Here are a few of the things to consider as you use the Spartan for your training.
The Spartan has been used by dozens of PTs and trainers, and a much greater number of disabled users. To date there have been no injuries sustained during Spartan use.
Ensuring the safety of the Trainee and Operator demands safe practices. Each person must know what they are doing and maintain awareness and control at all times during any activity.
Evaluating potential trainees for the Spartan
It is important to judge whether Spartan gait training could expose a trainee to undue risk of harm.
To make this judgement, consider the trainee’s physical health and ability level, and then contrast that with how the activity in question will affect them.
Spartan gait training involves bringing the patient into an upright standing posture, and thus If the patient weighs over 350 lbs, it is strongly advised to not use the Spartan for their therapy regimen.
Spartan gait training involves an operator applying push and pull forces through the Spartan to exert control over the trainee’s kinematics.
As with all forms of gait training, it is important to consider the trainee’s knee and ankle joint integrity. Joint tightness poses much less risk than joint looseness. If necessary, the Spartan can be used in conjunction with a knee cage that mechanically prevents hyperextension.
*An important note about applying anterior pressure to the thigh: there should be very few instances in which the operator must actually push into the trainee’s knee to extend it. Best practices involve simply blocking forward progression of the trainee’s knee during the loading response, mid-stance, and terminal stance gait phases. The body’s natural motions and plum line usually takes care of the knee extension in all other phases. If they do not, again the protocol is just blocking, not pushing.
If the trainee has diminished skin health, the Spartan (or any strapped-on device) could pose a problem. The training involves anterior thigh cuff pressure, posterior thigh strap pressure, posterior ankle strap pressure, and ankle band tension pulling the foot into some combination of dorsiflexion, eversion, or inversion, and internal or external rotation.
Endurance and Strength
The patient will be subjected to some of the typical internal and external forces associated with walking, such as ground-reaction at heel strike [pause] and weight shifting. Trainees should have adequate endurance and strength for the therapy.
Case by Case Basis
The specific set of inputs will almost always be slightly different trainee to trainee. This activity cannot realistically be divided into essential parts and analyzed completely for risk. It ultimately comes down to your knowledge and your judgement.
General Safety Guidelines
The Spartan should only be operated by a healthcare professional or caregiver who has read the user manual and understands how to use the device.
The Spartan may not be appropriate for all potential users. Any individual considering using the Spartan should seek the counsel of their physical therapist and/or physician to assess whether it is safe for their participation in load-bearing forced-use gait training with the Spartan.
Training may involve some or all of the following actions:
- Bringing an individual (the patient or client, henceforth called the “Trainee”) to an upright, standing position.
- Applying push and pull forces through the Spartan to the Trainee’s body in order to manipulate their movements. Said forces will be concentrated superficially at the following locations on the Trainee’s body:
- Via the thigh cuffs and straps to both lower extremities, in an area centered several inches superior to the patella (however not overlapping the patella).
- Pressure may be applied anteriorly to assist with knee extension, as well as posteriorly to assist with knee flexion and knee advancement into the sagittal plane.
- Via the ankle straps to both legs, in an area centered several inches superior to the ankle joint. Pressure may be applied posteriorly to assist with knee extension and swing-through of the lower leg during stepping.
- Via the shoe sleeves to both feet. The elastic ankle bands may be affixed to one or multiple locations on the shoe sleeve to exert pull forces to the user’s foot.
- Depending on the ankle band configuration, the foot may be biased to one or any combination of the following kinematics: dorsiflexion, internal or external rotation, inversion or eversion.
- Achieving a cyclical stepping motion with some or none of the Trainee’s bodyweight supported externally. This motion may be produced entirely by the Trainee, entirely by the Operator (the medical professional or caregiver controlling the Spartan) through Spartan manipulations, or in most cases by a combination of both.
Gait training with the Spartan should be done on smooth and level surfaces only.
Although the Spartan can be used to enhance a Trainee’s ability to maintain an upright standing posture, it should never be the only means of preventing the Trainee from falling. An ancillary support system that aides the Trainee in controlling their trunk and hip movements, as well as reducing the risk of falling to acceptably low levels, should always be used in conjunction with the Spartan.
The recommended maximum Spartan User weight is 350 pounds.
Operators and Trainees should visually and manually inspect the Spartan and all components before each use. Never use the Spartan if there is evidence of excessive wear or damage to any part or component. Ensure there are no cracks, missing parts, or loose hardware. Inspect the shoe sleeves, ankle bands, thigh straps, and ankle straps for signs of material weakness or damage (including the shear and peel strength of the hook and look material). Check for looseness or “play” in all of the device joints (handle joint, sliding hinge joint, swing arm joint) as well as in the thigh and ankle cuff connections.
These safety instructions are not intended to be comprehensive. Gait training with the Spartan is a complex activity with high inter-user variance in application technique and risk. If the activity is to be done without a medical professional, it is highly advised that the intended Operator be trained by a medical professional first.