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Guidelines for Functional Use of the Pacer Gait Trainer

Pacer is a unique and versatile walking frame for a wide range of abilities. It gets children going early to improve strength and balance, initiating forward motion training and offering support and control through to adult mobility.

In the Pacer Gait Trainer children with a wide variety of disabilities can gain independent movement while provided with appropriate prompt support.

The versatility of the Pacer allows you to customize the adjustments needed for each child and, as the child's motor skills improve, reduce the prompts.

Guidelines for Functional Use of the Pacer, is presented as a series of topics.

Features of the Pacer:

Use of the Pacer:

The Pacer meets the criteria of the MOVE Curriculum, an activity-based and child-centered approach to teaching functional motor skills. More information about Mobility Opportunities Via Education is available at www.move-international.org

Caregivers and families will benefit by understanding the full possibilities of the Pacer.


The Frame

The Pacer comes in five sizes: Mini, Small, Medium, Large and XL. (Figure 1)

Figure 1
Figure 2
Figure 1
Figure 2

Without accessories the frame can serve a child well in an anterior or posterior position. It’s sturdy and serviceable with versatile casters. You can add Handholds for comfort of use. (Figure 2)

The telescoping uprights allow for smooth height adjustment so the Pacer can grow with your child. The medium and large frames can be folded for storage or transport. (Figure 3) (Figure 4)

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Figure 4
Figure 3
Figure 4

All prompts are modular. To mount the prompts, open the clamp by turning the adjustment knob. (Figure 5) Attach the prompt and tighten the clamp. Prompts can be positioned anywhere along the top bar of the Frame but there are recommended locations detailed in the Product Guide. (Figure 6)

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Figure 6
Figure 7
Figure 5
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Figure 7

The communication tray attaches anywhere on the upper bar of the Frame. It can tilt up and down or rotate as desired, adjusted with only one knob. (Figure 7)


The Arm Prompts

We recommend placing the Arm Prompts just in front of the uprights along the top bar of the Frame, when using the Pacer in the anterior position. (Figure 8) There is a lot of adjustability inherent in the design of the Arm Prompts, which allows for a wide variety of positioning options.

Figure 8
Figure 8

For a more detailed explanation of how to achieve this adjustability, read the Arm Prompt Adjustability article.

The Arm Prompts, used in conjunction with other prompts, provide the support and positioning needed for each individual child. The versatility of Arm Prompt positioning accommodates users with contractures. (Figure 9)

With the Arm Prompts horizontal, placed with elbows below the shoulders, weight is shared through the shoulder girdle and arms, freeing the legs to move. (Figure 10)

Tilting the Arm Prompts down can encourage a child in extended arm use prior to transitioning to walking with Handholds. (Figure 11)

Arm Prompts can also be placed along the front bar of the Frame for a child in a forward-leaning position.

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Figure 10
Figure 11
Figure 9
Figure 10
Figure 11

The Chest Prompt

Place the Chest Prompt clamps just behind the uprights of the frame, when using the Pacer in the anterior position. (Figure 12) Adjust the Chest Prompt height with the white button on the clamp.

Figure 12
Figure 12

Clamps can be placed on the inside or the outside of the frame, depending on the size of the child. Further width adjustment is possible if you loosen the Chest Prompt knobs and slide the supports laterally, retightening the knobs securely. Use the same knobs to adjust the Chest Prompt tilt in 15° increments, for a forward-leaning position.

Place the padded Chest Prompt around the child for maximum support leaving enough room under the armpits with no discomfort. For some users, the Chest Prompt is more successful when positioned lower, as a support around the abdomen. This prompt can either be adjusted and secured snugly for a dependent user, or fastened more loosely for a child who demonstrates improved strength and stability. Allowing more movement within the chest prompt may enable weight-shifting and some rotation of the trunk during gait, while still providing balance-control assist, thus encouraging development of more trunk control. (Figure 13)

Children who have difficulty initiating forward movement may have more success when in the forward-leaning position. The key to providing the appropriate amount of forward-lean is the placement and angle of the Hip Positioner, Chest Prompt, and Arm Prompts. To increase forward-lean move the Hip Positioner back and the Arm Prompts forward, and adjust the Chest Prompt tilt for maximal comfort. (Figure 14)

The amount of forward-lean can be decreased as mobility skill improves. Positioning the Arm Prompts near the uprights, with the Chest Prompt vertical, encourages an upright standing position. (Figure 15)

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Figure 14
Figure 15
Figure 13
Figure 14
Figure 15

Some children are not able to initiate step-taking when they are in the upright position. The forward leaning posture keeps their hips back and places their center of gravity forward to promote better forward momentum. This can be desirable for a child who demonstrates spasticity or extensor tone. It is important to note that placing the Hip Positioner further back can play a key role in obtaining optimal positioning of the pelvis when in a forward-lean. After sufficient practice, some children will develop the skills they need to allow them to move to a more upright position.


Hip Positioner

Customize the versatile Hip Positioner for the positioning needs of a specific child.

The Hip Positioner (Figure 16) seat is wide at the back to help bear the child’s weight. It has four adjustable straps with which to position the pelvis as needed.

With the Frame in the anterior position, attach the two posterior straps onto the Handhold posts located at the posterior end of the Frame. Adjust the length of all four straps to assure optimal positioning. The seat portion of the Hip Positioner is raised by adjusting the height of the Handhold posts and by adjusting the straps of the Hip Positioner. The anterior portion of the Hip Positioner should be located toward the front, between the child’s legs.

Options for the anterior strap placement will depend on which prompts are in use, and on the desired position for the child. The anterior straps can be attached to the lateral crossbar of the Chest Prompts or to the Chest Prompt posts (Figure 17). Attaching the anterior straps to the Chest Prompt will position the child’s pelvis slightly behind the trunk and will assure that the child is on the weight-bearing surface of the Hip Positioner. The anterior straps can also be attached to the Arm Prompt posts (Figure 18) or to the front bar of the frame. Or they can attach just in front or just behind the frame uprights, in front of the Chest Prompt. When appropriate, anterior straps can be attached onto the Handhold posts to help retain the pelvis in position. The anterior straps should be secured in position and adjusted to the optimal length for each child.

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Figure 17
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Figure 18

When the Hip Positioner is used to assist weight-bearing, it is important that the wider part of the seat is placed under the ischium, and the straps are adjusted to the appropriate height. You can order a Hip Positioner Pad for more comfortable cushioning and in some cases, it can help promote hip abduction.

As the child gains strength in the lower extremities and no longer needs assist with weight-bearing, the Hip Positioner can be lowered. Used this way, the Hip Positioner guides the pelvis, and acts as a safety sling rather than a weight-bearing assist.


Pelvic Support

The Pelvic Support is another accessory option that provides weight-bearing assistance and that is softer, more flexible, and narrower. Some clients, such as those in early intervention, or adolescents of a larger size, may not require the more rigid support or the amount of abduction that the Hip Positioner provides. The softer design of the Pelvic Support provides a more comfortable fit for larger users, and for those whose legs have a tendency to scissor, or for anyone for whom the Hip Positioner is simply too bulky. It is ideal for the youngest walkers and others who need weight bearing support with minimal abduction.

Like the Hip Positioner, the Pelvic Support provides weight bearing assistance as needed while the client builds strength and stamina. And like the Hip Positioner, the Pelvic Support also attaches to the handholds. For attachment and positioning options, you can apply the same concepts as for the Hip Positioner.

Because the Pelvic Support is softer and more flexible, the optimal pelvic support may be provided best when the attachments of the front and back straps are in close proximity. This can be accomplished by turning the handholds so that the ring attachment is forward. Place the handholds facing forward, and then place the front strap buckles on the chest prompt crossbars, to bring the front and back ends of the Pelvic Support closer together to act as a more secure and more comfortable sling seat. (See Figure 19, blue arrows.)

Pelvic Support Adjustments
Figure 19

To determine the best size of Pelvic Support, measure the thigh circumference at the level where the pelvic support will be positioned. Half of this measurement will be the key user dimension to select Pelvic Support size. (See Figure 20).

Pelvic Support Key Dimensions
Figure 20

Thigh Prompts

The Thigh Prompts (Figure 21) attach to the frame and are usually placed about halfway between the Chest Prompt and the back of the frame. Loosen the knobs for positioning up or down as well as medially or laterally (Figure 22). Tighten knobs again to secure the desired position.

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Figure 22

Thigh Prompts provide either adduction control or abduction control, depending on what is needed (Figure 23). The straps will maintain leg separation, and the outer curved portion will limit abduction. Using the Thigh Prompts can also prevent the child’s body from twisting in the Pacer. Thigh Prompts maintain leg alignment while swinging forward and back with the child’s leg motion.

Figure 21
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Figure 24

Sometimes the post of the Chest Prompt protrudes below the top bar and interferes with the Thigh Prompts. If this is the case the clamps of the Chest Prompt and the clamps of the Thigh Prompt should be placed on opposite sides of the top bar of the Frame (Figure 24). Here we see that the caregiver chose to place the Thigh Prompt clamps on the outside and the Chest Prompt clamps on the inside of the bar allowing the Thigh Prompt to swing freely. You can also lower the height of the Frame, and move the Chest Prompt post higher up, so that the post does not protrude as much below the top bar.


Ankle Prompts

The Ankle Prompts attach under the bottom bar of the Frame. (Figure 25) To install the Ankle Prompts, insert the end of the rod without the latch into the slot of the rear caster (Figure 26) and then snap the spring-loaded latch end into the slot of the front caster. Adjust the two spring adjusters, which control the stride length of the child, as needed. (Figure 27) Adjust the strap length to control foot positioning and prevent scissoring.

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Figure 24
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Figure 27

Casters

The Caster that does it all! These casters are very versatile. Use any combination of features as needed. (Figure 28)

Swivel lock: Unlocked casters allow swivel and enable steering to left and right. Lock the swivel lock on all casters to move in a straight line. This benefits a child learning to take reciprocal steps who is unable to control the lateral movement of the Pacer. Unlock the swivel lock of only the front or only the back casters for variable steering. Use this feature to improve motor planning for environment negotiation.

Figure 26
Figure 27
Figure 28
Figure 29

Variable drag: Slow the forward motion by adjusting the variable drag. This serves as a partial brake for children who cannot easily control the forward movement of the Pacer or find it too fast. Alternatively, using this feature may increase muscle strength. Setting the drag on one of the posterior casters can guide the forward movement of the Pacer for a child who tends to veer to one side.

Brake: Press the brake lever on each caster for transfers, for prompt adjustments, or for stationary occupations or lower extremity weight-bearing practice. Lift to release the brake.

Ratchet control: Set the one-way ratchet control (lever in the "down" position) to prevent involuntary backward movement for a child who has difficulty preventing backward motion. (Figure 29).


The Posterior Position

To use the Pacer in the posterior position, the Arm Prompts are placed with the opening of the frame in front of the child. Attach the Arm Prompt clamps near the uprights of the Frame or farther forward, depending on the child's positioning needs. The cross bar of the upper Frame behind the child can serve as a posterior guide to the pelvis when the height of the Frame and Arm Prompts are adjusted appropriately. (Figure 30)

The Chest Prompt can be lowered in place to serve as a hip corral. (Figure 31)

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Figure 29
Figure 30
Figure 31

You have the option of using the Handholds rather than the Arm Prompts. (Figure 31) Some children may hold on to the upper bar of the Frame.

Many caregivers prefer the posterior position, because there is less obstruction in front of the child. Some children can even kick a ball and participate in other peer activities by using the Pacer this way.


Transfer Into The Pacer


Prompt Reduction: Concepts for Skill Building


Please note: This article does not replace the direct personal advice of a medical professional. Appropriate use of the Rifton Pacer requires the prior approval and ongoing guidance of a qualified therapist.