CHAPTER 34
WALKING APPLIANCES AND
MEANS OF TRANSPORT
TRAINING SPLINTS
These are indispensable for the vast majority of severe incomplete or complete spastic
lesions of the spinal cord. Before prescribing proper calipers, bivalved splints made from
plaster or Paris are used. These splints are made individually by our physiotherapists, and
care is taken to ensure that the edges of the anterior shell well overlap the posterior one
to prevent any friction of the soft tissues between the two shells. Five to six bandages
of plaster of Paris are sufficient for making the splint, which, of course, must be padded.
The splint, which reaches from mid-thigh to mid-calf is fastened by a crepe bandage.
The splint is also provided with a toe-raising spring to ensure dorsi-flexion of the foot.
These training splints have proved invaluable throughout the years, and certain patients
for whom, from one reason or another, calipers from steel or duraluminium were not
prescribed, took their splits home to continue their standing exercises in them (Fig. 241).
WALKING CALIPERS
Non-weight-bearing calipers only are used at Stoke Mandeville for distal and mid-
thoracic lesions. They are used for providing stability of the paralysed legs, but at the
same time they must be as light as possible, and the weight of each caliper for adults
must not be greater than 4 Ib. The metal side bars are made from duralumin or specially
light steel. Duralumin is used mainly for young adults or children. The leather top and
calf cuffs are fastened by straps, which is time saving for putting on and taking off the
brace. The automatic self-locking knee joint is the Hoffmann type with supporting knee
cap, and the strap catch enables the patient to unlock or lock the brace easily without
assistance. Only in very spastic cases with increased flexion spasticity is some assistance
necessary to lock the hinge. We prefer the ring lock knee hinge to the pawl lock knee
hinge, as the latter, when the hinge is unlocked, tends to damage the trousers. The metal
side bars fit into sockets in the heel of the shoes. A simple toe raising spring is attached
to a lug or D-ring on the shoe to avoid foot drop. Patients with inversion or eversion of the
foot need T-straps attached to their calipers (Fig. 246). When the tibialis anterior and
posterior muscles are paralysed and the foot, due to the action of the peroneal muscles,
turns into a valgus position, this may be prevented by means of an outside steel and inside
T-strap. In a case with paralysis of the peroneal muscles, the varus deformity of the foot
is corrected by an inside steel and an outside T-strap. An associated equinus deformity
may be controlled by an additional drop foot stop or a toe-raising spring (see above).
Whatever type of appliance has been prescribed, it is the duty of the spinal specialist
as well as the physiotherapist to ensure the proper fitting of the appliance as soon as it is
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