The influence of orthotic gait training with an isocentric reciprocating gait orthosis on the walking ability of paraplegic patients: a pilot study (original) (raw)
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JPO Journal of Prosthetics and Orthotics, 2017
Objectives Functional ability defines a person's ability to walk, with or without the aid of appropriate assistive devices, safely and sufficiently to carry out mobility-related activities of daily living. Longitudinal evaluation of the efficiency of gait training positively affecting these parameters has not been reported. Therefore, the aim of this study is to provide evidence supporting the progression of walking speed and functional ambulation over 12 weeks of orthotic gait rehabilitation using an isocentric reciprocating gait orthosis (IRGO) in patients with spinal cord injury (SCI). Materials and Methods Twelve patients with SCI participated in this study. Gait evaluation was performed at baseline and at 4, 8, and 12 weeks following intervention with an IRGO and specific gait training. Gait speed and endurance were measured by the 10-m walk test and the 6-minute walk test, respectively. The Functional Independence Measure (FIM) locomotor subscale and the Walking Index for ...
Spinal Cord, 2012
Objectives: Mechanical orthoses, such as the hip knee ankle foot orthosis (HKAFO) and the isocentric reciprocating gait orthosis (IRGO), are both used for walking in spinal cord injury (SCI) patients. The aim of this study was to analyze the energy expenditure during walking with these orthoses compared with a powered gait orthosis (PGO) in patients with SCI. Methods: Five patients with SCI who were experienced users of HKAFOs participated in this study. Subjects were also fitted with an IRGO and PGO and underwent a specific gait training program. Patients walked along a flat walkway using the three types of orthosis at their self-selected walking speed. A stop watch and a polar heart rate monitor were used to measure the speed of walking and heart rate. Results: Walking speed, the distance walked and the physiological cost index (PCI) all improved with both the new PGO and the IRGO as compared with the HKAFO. Conclusions: A PGO can improve walking speed and the distance walked and reduce the PCI of walking as compared with mechanical orthoses, probably due to the activated movements of the lower limb joints.
Spinal cord series and cases, 2015
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.
Spinal Cord, 2014
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.
Annals of Rehabilitation Medicine, 2020
Objective To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries.Methods Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT ...
Effect of powered gait orthosis on walking in individuals with paraplegia
Prosthetics & Orthotics International, 2013
Background: The important purpose of a powered gait orthosis is to provide active joint movement for patients with spinal cord injury. Objectives: The aim of this study was to clarify the effect of a powered gait orthosis on the kinematics and temporal–spatial parameters in paraplegics with spinal cord injury. Study Design: Quasi-experimental. Methods: Four spinal cord injury individuals experienced gait training with a powered gait orthosis for a minimum of 6 weeks prior to participating in the following walking trials: walking with an isocentric reciprocating gait orthosis and walking with both separate and synchronized movements with actuated orthotic hip and knee joints in a powered gait orthosis. Specific parameters were calculated and compared for each of the test conditions. Results: Using separate and synchronized actuated movement of the hip and knee joints in the powered gait orthosis increased gait speed and step length and reduced lateral and vertical compensatory motion...
Walking ability of spinal cord injury individuals: How to improve it?
Technology and Health Care, 2017
BACKGROUND: Subjects with Spinal Cord Injury (SCI) should use various assistive devices to stand and walk. Unfortunately they suffer from slow walking speed, high energy consumption, and too much force applied on upper limb while walking. The aim of this study was to determine the gap between the gait performance of SCI and normal subjects to conclude how the performance of SCI can be improved. METHOD: Three groups of SCI walked with orthosis, SCI walked without orthosis, and normal subjects were recruited in this study. The normal subjects also walked with the same orthoses as SCI subjects. Some parameters such as ranges of motion of hip, knee and spatiotemporal gait parameters were evaluated by use of Qualysis motion analysis system. The difference between the gait parameters of three groups were evaluated by use of two sample t test. RESULTS: The mean values of hip joint range of motion of normal subjects while walking with and without orthosis were 48.3 ± 2.5 and 18.5 ± 8.8 degrees, respectively (p-value = 0.00). There was a significant difference between walking speed of normal subjects with and without orthosis. The walking speed of SCI subject with and without orthosis differed significantly. CONCLUSION: Although use of orthosis enable SCI subjects to stand and walk, but has some restrictions. As use of orthosis decreased the abilities of normal subjects it can be concluded that more attention should be done on design of orthosis and style of walking.
Spinal Cord, 2016
Objective: Orthoses for various joints sections are considered to greatly influence the gait function and energy expenditure in spinal cord-injured (SCI) patients. The aim of this review was to determine the influence of orthoses characteristics and options on the improvement of walking in patients with SCI. Methods: A search was performed using the Population Intervention Comparison Outcome (PICO) method, based on selected keywords; studies were identified electronically in the Science Direct, Google Scholar, Scopus, Web of Knowledge and PubMed databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to report the results. Assessment of the quality of all articles was performed based on the Physiotherapy Evidence Database (PEDro scale). Results: Twelve studies evaluated the effects of different hip joint options on walking parameters and energy expenditure. Five studies investigated the role of knee joint options on gait parameters and compensatory trunk motion. Only five studies analyzed modified ankle joints on gait parameters in SCI patients. Nine studies analyzed gait parameters in SCI patients as powered orthoses and exoskeleton. These studies had a low level of evidence according to the PEDro score (2/10). Conclusion: The various joint types of orthoses appear to be critical in the improvement of walking in patients with SCI. In particular, 'user friendly' orthoses that support the related structure such as the hip joint with a reciprocating mechanism, activated knee joint and movable ankle joint with dorsiflexion assist enable SCI patients to optimize their walking pattern when wearing an orthoses system.
Spinal cord, 2000
To examine the influence of social, physical and psychological factors in determining the usage/non usage of reciprocating gait orthosis (RGO) in spinal cord injury (SCI) patients. Prospective clinical trial. A large rehabilitation hospital in Rome, Italy. Twenty four SCI patients of traumatic aetiology (all fulfilling the criteria to prescribe the device). Social, physical and neurological examination according to ASIA standards; psychological enquiry by means of the Eysenck Personality Questionnaire (EPQ) and the scale for self rating anxiety and depression of the Cognitive Behavioural Assessment. After 1 year follow up 11 (46%) of our patients no longer used the RGO. There was no statistically significant difference between patients who used the RGO and those who rejected the orthosis with regard to social and physical data. There was a significant difference (P=0.005 at the end of training and P=0.003 at 1 year follow up) with regard to functional ambulation level. With regard t...
Journal of Neurotrauma, 2006
The aim of this review is to examine the physical determinants for functional walking as well as the efficacy of gait rehabilitation after spinal cord injury (SCI) in humans. The results indicate several important physical determinants in gait. Examples are provided of different interventions that produce beneficial effects on outcome measures of gait such as gait speed, stride length, walking endurance, motor recovery, and gait quality. These findings need to be considered in current SCI rehabilitation practices, but the efficacy of certain interventions remains unclear. Well-designed clinical trials are needed to provide evidence of the role of physical determinants in the development of new concepts and principles in locomotor recovery after SCI. This review focuses on relevant literature, and informs rehabilitation specialists and basic scientists about the physical determinants and factors to consider for optimization of gait training in individuals with incomplete SCI.