The influence of orthotic gait training with an isocentric reciprocating gait orthosis on the walking ability of paraplegic patients: a pilot study.

OBJECTIVES: The aim of this study was to evaluate the influence of walking with an isocentric reciprocating gait orthosis (IRGO) by spinal cord injury (SCI) patients on walking speed, distance walked and energy consumption whilst participating in a 12-week gait re-training program. METHODS: Six people with motor complete SCI (mean age 29 years, weight 63 kg and height 160 cm with injury levels ranging from T8 to T12) participated in this study. Gait evaluation was performed at baseline and after 4, 8 and 12 weeks. Walking speed and heart rate were measured to calculate the resulting physiological cost index (PCI). RESULTS: Reductions in energy consumption were observed after 4, 8 and 12 weeks compared with baseline but were not significant. However, walking distance increased significantly (P=0.010, P=0.003 and P=0.005, respectively) and also did so during the 8-12-week period (P=0.013). Walking speed also improved, but not significantly. CONCLUSION: Intensive gait training with the IRGO improved walking speed and the distance walked by paraplegics, as well as reducing the PCI of walking, as compared with baseline during the whole 12-week period. This indicates that further improvements in these parameters may be expected when utilizing gait training longer than 8 weeks.

The efficiency of orthotic interventions on energy consumption in paraplegic patients: a literature review.

Study design:This is a systematic literature review.Objectives:Different types of orthoses have been developed to enable and facilitate ambulation in individuals with paraplegia. However, their effect on energy consumption while ambulating is not clear. The objective of this review was to compare the energy expenditure required to walk with these devices.Methods:Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, and based on selected keywords and their composition according to the Population Intervention Comparison Outcome (PICO) method, a search was performed in Science Direct, Google Scholar, Scopus, Web of Knowledge and PubMed databases. The searches were restricted to papers published in the English language and were conducted during February 2014; the last access to the database was on 25 February 2014. A total of 24 articles were chosen for final evaluation.Results:Hybrid orthoses reduce energy consumption compared with mechanical orthoses when used for walking by paraplegic patients. The isocentric reciprocating gait orthosis has been shown to be more effective than other reciprocating orthoses in reducing energy consumption. Energy consumption when walking with powered orthoses (PO) and hybrid orthoses was also reduced compared with when walking with conventional orthoses.Conclusions:The hybrid orthoses and PO could be effective alternatives in rehabilitation for spinal cord injury patients to help improve the energy consumption.Spinal Cord advance online publication, 20 January 2015; doi:10.1038/sc.2014.227.

Comparison of gait between healthy participants and persons with spinal cord injury when using a powered gait orthosis-a pilot study.

OBJECTIVES: The aim of this study was to evaluate the effect of a powered gait orthosis (PGO) on the temporal-spatial parameters and kinematics of walking in both healthy participants and persons with spinal cord injury (SCI) using three-dimensional motion analysis to facilitate further development of such devices. METHODS: Kinematics and temporal spatial data were obtained from three healthy participants and four persons with SCI who walked using the same design of PGO. RESULTS: Walking speed was reduced by 28% and step length by 29% in healthy individuals when walking with PGO compared with normal walking and that recorded for persons with SCI was approximately one-third that of normal walking. There were significant differences in hip and knee joint ranges of motion in comparison between walking with PGO in healthy participants and walking with PGO in persons with SCI. CONCLUSION: Walking with a PGO by healthy participants significantly reduced critical gait parameters, and further development work is needed to produce a more effective device to match closely the gait parameters of normal walking by healthy participants. Significant differences between normal walking and that evidenced with the PGO by both healthy participants and persons with SCI were detected.

The effect of ankle joint mobility when using an isocentric reciprocating gait orthosis (IRGO) on energy consumption in people with spinal cord injury: preliminary results.

OBJECTIVES: The aim of this study was to evaluate the effect of walking with isocentric reciprocating gait orthoses (IRGOs) utilizing two designs of ankle foot orthoses (AFOs) on specific outcome measures in people with spinal cord injury (SCI). METHODS: Four volunteer SCI subjects participated in this study, and were fitted with an IRGO equipped with either solid or dorsiflexion-assisted AFOs in a randomized order. Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance and the resulting physiological cost index (PCI) to be performed. RESULTS: Increased walking speed, increased distance walked and less PCI were demonstrated in walking with the IRGO incorporating dorsiflexion-assisted AFOs as compared to walking with an IRGO plus solid AFO as a control condition. CONCLUSION: This study demonstrated that people with SCI could walk at relatively higher speeds and with greater endurance and a reduced PCI when utilizing an IRGO with dorsiflexion-assisted AFO components compared to solid ones. It is therefore concluded that the IRGO incorporating dorsiflexion-assisted AFOs may be an effective alternative in helping to reduce the energy consumption experienced by people with SCI.