Comparison of the quality of life in individuals with spinal cord injury wearing either reciprocating gait orthosis or hip knee ankle foot orthosis: a cross-sectional study.

BACKGROUND: The quality of life (QoL) for patients with spinal cord injuries (SCI) is lower than that for healthy individuals. The main purpose of prescribing orthoses for these individuals is to improve their mobility and QoL. The hip knee ankle foot orthosis (HKAFO) has been the conventional choice for such patients, whilst the reciprocating gait orthosis (RGO) is a more contemporary option. Although the impact of these two types of orthoses on the biomechanics of walking has been previously evaluated in patients with SCI, there has been no specific comparison of their relative effects on QoL. OBJECTIVES: This study aimed to evaluate the Sickness Impact Profile (SIP-68) QoL questionnaire's total score and its sub-scores in patients with SCIs wearing either RGOs or HKAFOs. METHODS: This study was performed on 22 participants (11 participants wearing RGOs and 11 wearing HKAFOs). QoL scores were evaluated in each group of patients using the total and sub-scores from the SIP-68 questionnaire. RESULTS: There were no significant differences in the total SIP-68 scores between the RGO and HKAFO groups (p = .57). However, emotional stability and emotional independence sub-scores were significantly lower for the RGO users than for the HKAFO users (p = .03 and p = .01), respectively. CONCLUSIONS: Based upon this preliminary study, participants wearing RGOs or HKAFOs had similar QoL scores. However, those wearing RGOs may experience better emotional stability, communication, and emotional independence. This preliminary study does not provide definite conclusions since a large randomized control trial is required to compare the effects of these orthoses on the QoL scores in patients with SCIs.Implications for rehabilitationOur main aim in the current investigation was to shed light on the question that does the biomechanical superiority of the RGO to the HKAFO leads to better quality of life in SCI subjects who are using RGO. Regarding the fact that the primary goal of rehabilitation of people with SCI is to improve their quality of life, it seems that the more complicated newer orthosis (RGO) has no difference with the older type (HKAFO) in achieving the rehabilitation goals. More studies will in fact be necessary to find a definitive answer for this important question.According to the findings of our study, it seems to be more appropriate to prescribe RGO for male participants with higher body weight.

Thoracic-weight-bearing Socket and Reciprocating Gait Prosthesis for Pelvis Disarticulation Amputee: A Case Report / 中国康复理论与实践

Objective:To design, fit and use a thoracic-weight-bearing socket and reciprocating gait prosthesis for amputee pelvis disarticulation. Methods:A case after pelvis disarticulation amputation was reported. The main weight of the socket bore on lower thorax, and the socket suspended with the pressure from anterior-posterior sides. Walking prosthesis was consisted of the socket, reciprocating hip joint, prosthetic knee joint and SACH foot. The prosthesis was adjusted alignment, and the patient was trained to walk with the prosthesis. Results:The patient could stand for four hours a time with the socket, and walk 200 meters in 30 minutes assisted with axillary crutches. The score of modified Barthel Index improved from 41.5 admitted to hospital to 93 (with socket) or 83 (with prosthesis) as discharged. Conclusion:Pelvis disarticulation amputees could stand up with socket with reasonable weight bearing and suspension and walk in reciprocating gait with reasonable components and joints, right alignment and gait training, to improve activities of daily living.

Effects of Two Different Hip-Knee-Ankle-Foot Orthoses on Postural Stability in Subjects with Spinal Cord Injury: A Pilot Study.

STUDY DESIGN: Pilot study. PURPOSE: Evaluation of two different hip-knee-ankle-foot orthoses (HKAFOs; medial linkage reciprocating gait orthosis [MLRGO] and isocentric reciprocating gait orthosis [IRGO]) using gait and postural stability analysis in four subjects with spinal cord injury (SCI). OVERVIEW OF LITERATURE: To the best of our knowledge, no study has evaluated postural stability in subjects with SCI when using MLRGO and IRGO. METHODS: The relative efficacy of each orthosis was evaluated with relevant gait parameters, and an assessment of postural stability and sway during usage was made. Each analysis was conducted following an appropriate period of training and acclimatization. The gait parameters employed in the study were walking speed, cadence, and endurance; these were recorded and analyzed using current, validated methods. Postural stability was assessed using a verified force plate measurement system, and a modified Falls Efficacy Scale (mFES) was used for the measurement of postural sway and the perceived fear of falling. RESULTS: Walking speed, cadence, and endurance increased with the use of both HKAFOs. When the two types of HKAFOs were compared, all the parameters showed a slight (but not significant) increase with the use of MLRGO compared with the use of IRGO. In contrast, there were slight but insignificant improvements in postural sway with the use of IRGO. However, although there were no significant differences between the two sets of mFES scores, there was a slightly reduced fear of falling with the use of MLRGO compared with the use of IRGO in the static standing position. CONCLUSIONS: It is noteworthy that meaningful interpretations of results can only be drawn if a larger sample is employed. This pilot study showed no significant data; however, the results indicate that the use of MLRGO is superior to that of IRGO in terms of potential improvement in the mobility and confidence levels of subjects with SCI.

Effect of Orthotic Gait Training with Isocentric Reciprocating Gait Orthosis on Walking in Children with Myelomeningocele.

Background: Mechanical orthoses are used to assist in standing and walking after neurological injury in children with myelomeningocele (MMC). Objectives: To evaluate the influence of orthotic gait training with an isocentric reciprocating gait orthosis (IRGO) on the kinematics and temporal-spatial parameters of walking in children with MMC. Methods: Five children with MMC were fitted with an IRGO. They walked at their own comfortable cadence using the orthosis. The hip joint angle, spatial temporal parameters, and compensatory motions were measured and analyzed. Results: Significant increases in walking speed and step length were demonstrated following orthotic gait training during walking with the IRGO. The sagittal plane hip range of motion was also significantly increased; however, the vertical and horizontal compensatory motions were significantly decreased. Conclusion: This study evaluated the influence of gait training with an IRGO on the kinematics and temporal spatial parameters in MMC children. The findings showed that orthotic gait training improved hip joint range of motion, increased walking speed and step length, and decreased lateral and vertical compensatory motions during level-ground walking trials.

Influence of Reciprocating Link When Using an Isocentric Reciprocating Gait Orthosis (IRGO) on Walking in Patients with Spinal Cord Injury: A Pilot Study.

Background: Studies collectively imply that the reciprocal link has no effect on walking when using reciprocating gait orthoses (RGOs). There may be differences between the 2 configurations of the RGO (eg, isocentric reciprocating gait orthosis [IRGO] and IRGO without reciprocating link), but the specific benefits and problems encountered in their use must be understood. Purpose: To highlight more evidence for the mechanical function of the reciprocal link in RGOs used for walking by individuals with spinal cord injury (SCI). Methods: Nine people with SCI participated in this study. Gait analysis was performed in 2 conditions (walking with IRGO and walking with IRGO without reciprocating link) in a random order. The Vicon digital capture system was used to obtain kinematic data. Results: There were significant differences between each orthotic configuration in terms of speed of walking (p = .029), step length (p = .048), hip joint range of motion (ROM) (p ≤ .001), and lateral and vertical compensatory motions (p ≤ .001). There was no significant difference between each orthotic configuration in cadence (p = .162). Conclusion: The reciprocating link in IRGO improved the walking parameters in SCI patients.

Application of a paraplegic gait orthosis in thoracolumbar spinal cord injury.

Paraplegic gait orthosis has been shown to help paraplegic patients stand and walk, although this method cannot be individualized for patients with different spinal cord injuries and functional recovery of the lower extremities. There is, however, a great need to develop individualized paraplegic orthosis to improve overall quality of life for paraplegic patients. In the present study, 36 spinal cord (below T4) injury patients were equally and randomly divided into control and observation groups. The control group received systematic rehabilitation training, including maintenance of joint range of motion, residual muscle strength training, standing training, balance training, and functional electrical stimulation. The observation group received an individualized paraplegic locomotion brace and functional training according to the various spinal cord injury levels and muscle strength based on comprehensive systematic rehabilitation training. After 3 months of rehabilitation training, the observation group achieved therapeutic locomotion in 8 cases, family-based locomotion in 7 cases, and community-based locomotion in 3 cases. However, locomotion was not achieved in any of the control group patients. These findings suggest that individualized paraplegic braces significantly improve activity of daily living and locomotion in patients with thoracolumbar spinal cord injury.

Comparison of gait between healthy participants and persons with spinal cord injury when using the advanced reciprocating gait orthosis.

BACKGROUND: The advanced reciprocating gait orthosis (ARGO) has a rigid structure which provides restricted movement at the hip, knee, and ankle joints and incorporates a pelvic section with an extended section in the lumbar region. Healthy subjects, when walking with an RGO in situ, could feasibly demonstrate the level of limitation in movement imposed by ARGO-assisted ambulation. OBJECTIVE: The aim of this study was to compare the function of the advanced reciprocating gait orthosis when fitted with the dorsiflexion-assist ankle-foot orthoses on temporal-spatial parameters and kinematics of walking in both able-bodied people and those with spinal cord injury. STUDY DESIGN: Quasi experimental design. METHODS: Data were acquired from six able-bodied and four spinal cord injury subjects who used an advanced reciprocating gait orthosis which incorporated dorsiflexion-assist ankle-foot orthoses. Kinematics and temporal-spatial parameters were calculated and compared. RESULTS: All able-bodied individuals walked with speeds which were only approximately one-third that of when walking without an orthosis. The mean step length and cadence were both reduced by 48% and 6%, respectively. There were significant differences in hip, knee, and ankle joint range of motions between normal walking and walking with the advanced reciprocating gait orthosis both in able-bodied subjects and patients with spinal cord injury. There were also significant differences in the speed of walking, cadence, step length, hip range of motion, and ankle range of motion when using the advanced reciprocating gait orthosis between the two groups. CONCLUSION: Temporal-spatial parameters and lower limb sagittal plane kinematics of walking were altered compared to normal walking, especially when spinal cord injury subjects walked with the advanced reciprocating gait orthosis compared to the able-bodied subjects. CLINICAL RELEVANCE: To produce an improvement in RGO function, an increase in walking performance should involve attention to improvement of hip, knee, and ankle joint kinematics, which differs significantly from normal walking.

The effect of trunk extension on physiological cost index in spinal cord injury patients when using the advanced reciprocating gait orthosis: A pilot study.

BACKGROUND: People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users. OBJECTIVE: The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN: Quasi experimental study. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate. RESULTS: Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ. CONCLUSION: Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis. CLINICAL RELEVANCE: It is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.

Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia.

UNLABELLED: Historically, persons with paralysis have limited options for overground ambulation. Recently, powered exoskeletons have become available, which are systems that translate the user's body movements to activate motors to move the lower limbs through a predetermined gait pattern. As part of an ongoing clinical study (NCT01454570), eight nonambulatory persons with paraplegia were trained to ambulate with a powered exoskeleton. Measurements of oxygen uptake (VO2) and heart rate (HR) were recorded for 6 min each during each maneuver while sitting, standing, and walking. The average value of VO2 during walking (11.2 +/- 1.7 mL/kg/min) was significantly higher than those for sitting and standing (3.5 +/- 0.4 and 4.3 +/- 0.9 mL/kg/min, respectively; p < 0.001). The HR response during walking was significantly greater than that of either sitting or standing (118 +/- 21vs 70 +/- 10 and 81 +/- 12 beats per minute, respectively: p < 0.001). Persons with paraplegia were able to ambulate efficiently using the powered exoskeleton for overground ambulation, providing potential for functional gain and improved fitness. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; NCT01454570; "The ReWalk Exoskeletal Walking System for Persons with Paraplegia (VA_ReWalk)"; https://clinicaltrials.gov/ct2/show/NCT01454570.

The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis - a pilot study.

OBJECTIVE: When walking with an advanced reciprocating gait orthosis (ARGO), ankle and knee joint motion is restricted which causes an un-cosmetic gait compared to normal walking. The purpose of this study was to develop and evaluate a rocker modification for use with the ARGO in order to improve hip joint kinematics, walking speed, step length and cadence. METHOD: Spinal cord injury patients (n = 4) with thoracic-level injury participated in this study, and walked with a standard ARGO and one which was also adapted with a rocker sole in a randomized order. RESULTS: Mean walking speed and step length were both significantly increased by volunteer SCI subjects when ambulating using the ARGO adapted with a rocker sole compared to the standard ARGO. Cadence was not significantly affected, but swing time was significantly reduced and mean hip flexion and extension were both significantly increased when walking with the adapted ARGO. CONCLUSION: The rocker sole modification produced an increase in walking speed and step length, and improved sagittal plane hip joint kinematics when ambulating using an ARGO. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard unmodified version. Implications for Rehabilitation The ARGO adapted with a rocker sole could be used by spinal cord injury patients. A major advantage of the walking with the ARGO adapted with a rocker sole was increased of walking speed and step length, and improvement of the sagittal plane hip joint kinematics. The findings of this study would appear to provide useful data for rehabilitation teams who utilize orthoses to walk and rehabilitate SCI subjects. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard un-modified version.

The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients: A pilot study.

BACKGROUND: Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users. OBJECTIVES: To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN: Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses. METHODS: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed. RESULTS: Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation. CONCLUSION: Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk. CLINICAL RELEVANCE: Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.

Sensor-based hip control with hybrid neuroprosthesis for walking in paraplegia.

The objectives of this study were to test whether a hybrid neuroprosthesis (HNP) with an exoskeletal variable-constraint hip mechanism (VCHM) combined with a functional neuromuscular stimulation (FNS) controller can maintain upright posture with less upper-limb support and improve gait speed as compared with walking with either an isocentric reciprocating gait orthosis (IRGO) or FNS only. The results show that walking with the HNP significantly reduced forward lean in FNS-only walking and the maximum upper-limb forces by 42% and 19% as compared with the IRGO and FNS-only gait, respectively. Walking speed increased significantly with VCHM as compared with 1:1 reciprocal coupling and by 15% when using the sensor-based FNS controller as compared with HNP with fixed baseline stimulation without the controller active.

Modeling effects of sagittal-plane hip joint stiffness on reciprocating gait orthosis-assisted gait.

Upright ambulation is believed to improve quality of life for persons with lower-limb paralysis (LLP). However, ambulatory orthoses for persons with LLP, like reciprocating gait orthoses (RGOs), result in a slow, exhausting gait. Increasing the hip joint stiffness of these devices may improve the efficiency of RGO-assisted gait. The small, diverse population of RGO users makes subject recruitment challenging for clinical investigations. Therefore, we developed a lower-limb paralysis simulator (LLPS) that enabled nondisabled persons to exhibit characteristics of RGO-assisted gait, thereby serving as surrogate models for research. For this study, tests were conducted to determine the effects of increased hip joint stiffness on gait of nondisabled persons walking with the LLPS. A motion capture system, force plates, and spirometer were used to measure the hip flexion, crutch ground reaction forces (GRFs), and oxygen consumption of subjects as they walked with four different hip joint stiffness settings. Increasing the hip joint stiffness decreased hip flexion during ambulation but did not appear to affect the crutch GRFs. Walking speed was observed to initially increase with increases in hip joint stiffness, and then decrease. These findings suggest that increasing hip joint stiffness may increase walking speed for RGO users.

Relationship between Level of Thoracic Complete Spinal Cord Injury and Ambulatory Function with Reciprocating Gait Orthosis through 3D Gait Analysis / 中国康复理论与实践

@#ObjectiveTo evaluate the relationship between the level of thoracic complete spinal cord injury(SCI) and ambulatory function wearing Reciprocating Gait Orthosis(RGO) through three dimentional gait analysis, and to explore the quantitative indicators of reconstructing walking capacity of thoracic complete SCI patients.Methods10 patients with thoracic complete spinal cord injury of lesion level from T4 to T12 who had experienced RGO gait training for at least 3 months. Three dimentional gait analysis system of Vicon Nexus 1.2 was used to test and examine the gait speed, cadence, stride length, pelvic angle of rotation, hip range of motion(ROM), crutch force, angular velocity of hip flexion and extension phases, etc. Pearson's product moment correlation coefficient and Spearman rank correlation coefficient were used to examine the relationship between the level of spinal cord injury and the kinematic and kinetic values.ResultsThe mean cadence and stride length were (37.4±2.15) steps/min and (91.6±9.09) cm. The mean hip ROM, angular velocity of hip flexion and extension phases were (42.57 °±5.43 °), (20.88 °±2.18 °)/s and (124.75 °±9.31 °)/s respectively. The gait speed, stride length, peak crutch force, hip ROM, mean crutch force and angular velocity of hip extension phase all had significant pertinence with the level of spinal cord injury.ConclusionThe limitation of hip ROM and excessive load of upper limbs mainly result in ambulatory disorder in higher thoracic complete SCI patients who should be undertaken some rehabilitation training to reduce excessive physiological load in order to improve their ambulatory capacity.

Effect of Reciprocating Gait Orthosis on Walking Ability and Activities of Daily Living of Patients with C6～T6 Spinal Cord Injury / 中国康复理论与实践

@#Objective To observe the effect of reciprocating gait orthosis on walking ability and activities of daily living (ADL) of patients with C6～T6 spinal cord injury (SCI).Methods 20 cases with C6～T6 SCI and according with type A and type B of ASIA standard received rehabilitation therapy, including training of muscle power, cardiopulmonary function, transferring mobility, ADL, bladder function, etc., before assembling the reciprocating gait orthosis, and additional gait training after fixing orthosis. The timed walking function assessment (6-min walking test and timed 10 meters walking test), gait analysis, Modified Barthel Index (MBI) and Functional Independence Measure (FMI) were used to assess pre- and post-training.Results The ADL ability of all cases improved obviously after equipping reciprocating ambulation orthosis, the walking ability also improved (P＜0.05). The mean timed 10 meters was 99.21±75.24 s, mean 6-min walk test was 41.71±29.38 m. From all patients, 14 cases achieved practicability walking ability, 6 cases achieved domestic walking ability.Conclusion The reciprocating gait orthosis combined with comprehensive rehabilitation therapy has effect on walking ability and ADL of patients with C6～T6 SCI.

Influence of an advanced reciprocating gait orthosis on walking function in complete spinal cord injury patients / 中华物理医学与康复杂志

Objective To explore the value of an advanced reciprocating gait orthosis (ARGO) combined with comprehensive rehabilitation treatment in rehabliltating complete spinal cord injury (SCI) patients. Methods Twelve patients with complete SCI at the T4~L2 level were fitted with an ARGO. Before and after fitting the ARGO,comprehensive rehabilitative excecises were conducted. After training, ambulation was evaluated, and competence in the activities of daily living was evaluated using the Barthel index and Functional Independence Measure. Results The patients' ambulation improved markedly after fitting the ARGO and training. Barthel index and FIM scres improved significantly. All 12 patients achieved therapeutic or functional ambulation. Conclusion With the aid of an ARGO, patients suffering from complete SCI below the T4 level can achieve functional walking and improve their quality of life.

Rehabilitation of Hemicorporectomy Amputee:A Case Report / 中国康复理论与实践

@#Objective To investigate the rehabilitation of pelvis disarticulation amputees.Methods A case report.Results and Conclusion Rehabilitation engineering,assisted with physical therapy,can rebuild hemicorporectomy amputees' standing and walking ability,make them look as normal as possible,help them return to the society.