Axxon Exclusive
GEOFFROY DELLICOUR, physiotherapist at CHN William Lennox, technical advisor at UCL and designer of the Wheeleo®
One of the main objectives of neurological rehabilitation is to maximize functional independence through the recovery of walking. The gait of a hemiplegic person is usually characterized by a decrease in speed, an asymmetrical pattern (length, weight-bearing, duration of support, static, etc.), as well as an increased risk of falling.
The goal of rehabilitation is to lead the patient to the greatest possible functional autonomy in the shortest possible time, as lengths of stay are increasingly reduced. The physiotherapist aims to provide high-intensity exercises with a large number of repetitions.
To avoid inducing negative plasticity (learning a bad movement), it is essential to do everything possible to ensure that the patient spontaneously and quickly adopts a gait as close to normal as possible, with as few compensations as possible.
The use of orthoses capable of compensating for a strength deficit or limiting the negative effect of spasticity will help achieve this goal. Additionally, the physiotherapist must offer mobility assistance adapted to the patient’s abilities and walking conditions, which should evolve in parallel with the patient’s improving capabilities.
Considering these characteristics, four types of devices emerge:
Until recently, this last category did not exist. The Wheeleo® was designed to fill this gap.
The purpose of this article is to review the benefits and limitations of this new mobility aid, after two years of use in neurological rehabilitation services in Wallonia.
The Wheeleo® induces two types of effects:
Direct effect: The effect on gait parameters is immediate, comparable to that of orthoses. These changes are present as long as the technical aid is used. They allow the patient to walk earlier with fewer compensations, from the beginning of rehabilitation and in the sequelae phase. These effects are observable and used as therapeutic levers.
Long-term effect: The Wheeleo® is also used to optimize gait quality over time. The repetition of a better quality movement promotes positive brain plasticity. Like orthoses, robotics, or weight-relief systems, the Wheeleo® helps establish a better walking pattern from the first steps.
The underlying hypothesis is that rehabilitation can be optimized in terms of speed and quality. However, a clinical study is necessary to rigorously validate this hypothesis.
Let’s review the effects observed concretely in rehabilitation services.
The Wheeleo® can be used by a patient with paralysis of an upper limb. It combines the effect of the rollator (constant ground support) with one-handed manipulation. In the same way that a rollator has replaced lift-up walkers, the Wheeleo® presents itself as a more fluid alternative to the quadripod cane.
The constant ground support allowed by the Wheeleo® provides continuous assistance, unlike a quadripod cane that must be lifted with each cycle. This avoids periods of imbalance, especially in patients with severe deficits. With a quadripod cane, these patients adopt a so-called ‘three-step’ gait, which is more jerky:
Three-point gait allows for maintaining two points of support on the ground for greater stability, but it slows down movement and makes it less fluid. Thanks to the Wheeleo®, the patient can maintain ground support throughout the gait cycle, which helps them transition more quickly to a two-point gait, closer to normal walking.
This change towards a more fluid gait is often immediately perceived by the patient. It is one of the most striking effects observed with the Wheeleo®, which facilitates the return to a more natural walking pattern.
As motor skills and balance improve, the patient can gradually adopt a two-point gait with a simple cane or crutch. The Wheeleo® therefore represents a transitional stage that accelerates this evolution.
It should be noted that the quad cane, being too heavy and with too much inertia, is not suitable for a two-point gait. This is where the Wheeleo® finds its therapeutic value.
The two-point gait, unlike the three-point gait, generates positive effects on walking speed. The elimination of the stopping phase leads to a spontaneous increase in walking speed.
The study by Deltombe et al. (2020) shows an average increase of 50% in spontaneous speed among hemiparetic individuals during a 6-minute test with the Wheeleo®, compared to the same test performed with a classic quad cane.
This refers to the spontaneous speed, which is the speed freely chosen by the patient based on their balance and energy expenditure. A patient who feels more stable naturally tends to accelerate their walking.
Several factors can explain this improvement:
The use of the Wheeleo® therefore allows, at an earlier stage, a faster and more fluid gait. In the study by Deltombe et al., the 10-meter test at spontaneous speed with the Wheeleo® is as fast as the one performed at rapid (forced) speed with a quad cane.
When the patient walks with a quad cane in a three-point gait, they often stop in double support to move the cane. They then seek a position of maximum stability, with both feet at the same level, which creates an asymmetry in step length.
The transition to a two-point gait with the Wheeleo® reduces this need for compensation and potentially decreases asymmetry. This reduction in asymmetry in turn contributes to an increase in speed and better fluidity of movement.
However, it is important to note that step length asymmetry can have several causes. Not all of these will necessarily be corrected by the Wheeleo® or by the two-point gait, particularly in cases of equinus, hip flexion contracture, or joint pain.
The study by Deltombe et al. (2020) highlights significantly higher satisfaction among patients using the Wheeleo®, compared to those using a quad cane. This satisfaction relates to ease of use and the feeling of security while walking.
When the Wheeleo® is properly indicated, it brings real added value in terms of autonomy, mobility, and comfort. The patient feels more free in their movements, which promotes better participation in rehabilitation and daily activities.
The Wheeleo® is a mobility aid manipulated with one hand. Like any unilateral aid, if used improperly, it can accentuate an already present asymmetry of the body, especially if the patient leans on it excessively.
To limit this risk, the handle is adjusted to a high position, with the elbow bent. This allows for light support for balance, without overloading the upper limb.
In some cases of lateropulsion, this adjustment can even be used for corrective purposes. By placing the Wheeleo® on the “healthy” side at a lower height, it encourages the trunk to lean to the correct side, counterbalancing a natural tendency to lean towards the pathological side.
Finally, as soon as the affected upper limb has sufficiently recovered, the use of a rollator can be considered. This offers two-handed support, which is more symmetrical and favorable for balanced body posture.
One of the major advantages of the Wheeleo® is its constant ground support, which contributes to better patient stability during walking. The aid naturally positions itself in front and to the side, where support is most effective, and remains there regardless of the phase of the gait cycle.
Unlike a classic cane, which can end up beside or behind the patient at the end of the stance phase (an unfavorable position for balance), the Wheeleo® maintains an optimal and secure position.
In practice, patients often achieve walking autonomy more quickly with the Wheeleo®, as they can use it outside of physiotherapy sessions as well. This allows them to actively participate in their own rehabilitation.
In case of imbalance, it’s difficult to lift a cane on which one is leaning. The Wheeleo®, on the other hand, allows for a more natural and immediate shift of support, helping to restore balance. In many cases, it’s already in the right place to anticipate an imbalance.
Upon returning home, stability, along with comfort, is often cited as the most beneficial element by patients.
Patients very quickly perceive the changes induced by using the Wheeleo®: a smoother gait, greater stability, and improved confidence in their motor skills.
This positive feeling fuels a reinforcement loop: the patient is more motivated, walks more, with better quality, and progresses faster. The priority objective of achieving autonomy then becomes a source of stimulation and engagement in rehabilitation.
This dynamic leads to an overall gain in motivation, an essential lever in any functional recovery process.
The rollator is recognized for significantly improving walking comfort and quality thanks to its symmetrical support. However, its indoor use can be limited by bulkiness or the inability to maneuver in confined spaces.
The Wheeleo® then constitutes an ideal complementary alternative. It allows maintaining the sensation of continuous ground support, while being much more maneuverable and less bulky. This makes it a perfectly suitable solution for use in narrow spaces (bedroom, bathroom, hallways).
Manipulating a mobility aid can involve a significant cognitive load. The patient often needs to think about placing the cane in the right spot, synchronizing their steps (especially in three-point gait), and managing overall balance.
This divided attention sometimes prevents focusing on other essential elements: obstacle crossing, positioning of the paretic foot, postural straightening, etc. The phenomenon is even more pronounced in patients suffering from hemispatial neglect or sensory extinction.
The Wheeleo® considerably reduces this cognitive load. It naturally positions itself where the patient needs it, without any particular coordination effort. This allows the patient to focus their attention on the walk itself.
This ease is particularly appreciated during complex maneuvers: turning around, walking backward, side steps… all essential in daily movements at home.
User feedback indicates an overall increased sensation of comfort when using the Wheeleo®. This comfort is explained by several combined factors:
These elements contribute to making walking less tiring, more natural, and more reassuring, thus promoting regular use in patients’ daily lives.
Although the Wheeleo® has many advantages, certain usage limitations must be taken into account for appropriate prescription:
The choice of a walking aid device should always be made in consultation with a healthcare professional. It is recommended to accompany the patient during initial use to ensure proper adaptation.
The Wheeleo® is now fully part of the range of mobility aids available for patients in neurological rehabilitation. Halfway between a cane and a rollator, it can be used as a transition tool after parallel bars and before a simple cane.
It is also suitable for people who retain significant motor sequelae and for whom the Wheeleo® can represent a long-term mobility solution, at home or in an institution.
Initially designed for neurology, the Wheeleo® also shows interest in other pathologies, such as disorders related to aging, osteoarthritis, or general weakness. Therefore, it is not the pathology itself that determines the indication, but the type of motor deficit.
As an innovative device, the Wheeleo® is not yet included in an official nomenclature, and therefore does not benefit from reimbursement. It is all the more important that its use is well supervised, and that the patient is advised and accompanied during the initial handling.
The majority of the benefits described here are derived from clinical observation. Two studies (Deltombe 2020 and Devos 2019, pending publication) have already been conducted. It is crucial to continue research, in both acute and chronic situations, to scientifically validate the benefits of the Wheeleo® in accelerating and improving the quality of rehabilitation.
For more information, visit www.wheeleo.be.
The author would like to thank the Physiotherapy Service of CHN William Lennox as well as Florent Evrard (Delta) for their careful proofreading and valuable contributions to this article.
Article published in the AXXON Exclusif magazine of September 2020, the quarterly publication by AXXON reserved for members of the professional physiotherapy association (Belgium).
View it online: AXXON Exclusif – September 2020 – Benefits and limitations of the Wheeleo in neurological rehabilitation – Geoffroy Dellicour
Download it in pdf:
Please fill in this short form so that we can contact you to arrange a test.
