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 (original) (raw)
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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, 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.
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 ...
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.
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, 2013
Perceived risk of falling is an important factor for people with spinal cord injury (SCI). This study investigated the influence of ankle joint motion on postural stability and walking in people with SCI when using an orthosis. Methods: Volunteer subjects with SCI (n ¼ 5) participated in this study. Each subject was fitted with an advanced reciprocating gait orthosis (ARGO) equipped with either solid or dorsiflexion-assist type ankle-foot orthosis (AFOs) and walked at their self-selected speed along a flat walkway to enable the comparison of walking speed, cadence and endurance. A force plate system and a modified Falls Efficacy Scale (MFES) were utilized to measure postural sway and the perceived fear of falling, respectively. Results: There were significant differences in the mean MFES scores between two types of orthosis (P ¼ 0.023). When using two crutches, there was no significant difference in static standing postural sway in the medio-lateral (M/L) direction (P ¼ 0.799), but significant difference in the antero-posterior (A/P) direction (P ¼ 0.014). However, during single crutch support, there was a significant difference in both M/L (P ¼ 0.019) and A/P (P ¼ 0.022) directions. Walking speed (7%) and endurance (5%) significantly increased when using the ARGO with dorsi flexion assisted AFOs. There was no significant deference between two types of orthoses in cadence (P ¼ 0.54). Conclusions: Using an ARGO with dorsiflexion-assisted AFOs increased the fear of falling, but improved static postural stability and increased walking speed and endurance, and should therefore be considered as an effective orthosis during the rehabilitation of people with SCI.
Prosthetics & Orthotics International, 2013
Background: Ankle foot orthoses (AFOs) are usually used for patients with incomplete spinal cord injury (ISCI) to provide support in walking. Objectives: The aim of this study was to compare the effect of AFOs, with and without ankle hinges, on specific gait parameters during treadmill training by subjects with ISCI. Study Design: Quasi-experimental. Methods: Five patients with ISCI at the thoracic level participated in this study. Gait evaluation was performed when walking 1) barefoot 2) wearing a solid AFO and 3) wearing a hinged AFO. Results: The mean step length when walking barefoot was 26.3 ± 16.37cm compared to 31.3 ± 17.27 cm with a solid AFO and 28.5 ± 15.86 cm with a hinged AFO. The mean cadence for walking barefoot was 61.59 ± 25.65 steps/min. compared to 50.94 ± 22.36 steps/min. with a solid AFO and 56.25 ± 24.44 steps/min with a hinged AFO. Significant differences in cadence and step length during walking were only demonstrated between the barefoot condition and when we...
Critical Reviews in Physical and Rehabilitation Medicine, 2019
Spinal cord injury (SCI) leads to deficits in volitional motor control resulting in increased energy expenditure during walking and ultimately causing limited ambulation. Excessive energy expenditure during ambulation with assistive device like crutches and walkers in addition to orthosis using various walking techniques results in discontinuation of walking and reversion to wheelchair use. This ultimately results in loss of the benefit of weight bearing and physical activity offered by walking. Therefore, knowledge of the energy cost of various walking techniques used with common assistive devices is necessary to train patients in energy-efficient walking techniques and encourage greater engagement in indoor-outdoor walking activity. This study aimed to explore energy expenditure in three common walking techniques used by patients with SCI: four-point gait with crutches, swing-through gait with walker, and three-point gait with walker. Twenty-one participants (13 males; 8 females) with post-traumatic dorso-lumbar SCI (mean age 28 years) were assessed for energy expenditure during the three walking techniques. Energy expenditure (kcal), oxygen consumption (VO 2), metabolic equivalent (MET), and rate of perceived exertion (RPE) on Borg's scale were recorded. Energy expenditure was the highest using the swing-through gait with walker (876.3 kcal; VO 2 13.04 mL/kg/min) followed by three-point gait with walker (678.2 kcal; VO 2 12.07 mL/kg/min) and then four-point gait with crutches (252.3 kcal; VO 2 9.43 mL/kg/min) over four minutes of walking. Energy expenditure was lower by 68% and oxygen consumption by 28% during four-point gait with crutches compared to swing-through gait with walker, and by 35% compared to three-point gait with walker (p < 0.05) owing to decreased peak vertical loading forces for crutches compared to a walker. In conclusion, four-point gait with crutches is recommended for its therapeutic value in training indoor-outdoor walking in individuals with dorso-lumbar SCI.
Disability and Rehabilitation: Assistive Technology, 2020
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 ¼ .57). However, emotional stability and emotional independence sub-scores were significantly lower for the RGO users than for the HKAFO users (p ¼ .03 and p ¼ .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. ä IMPLICATIONS FOR REHABILITATION Our 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.
Recovering the ability to stand and walk independently can have numerous health benefits for people with spinal cord injury (SCI). Wearable exoskeletons are being considered as a promising alternative to conventional knee-ankle-foot orthoses (KAFOs) for gait training and assisting functional mobility. However, comparisons between these two types of devices in terms of gait biomechanics and energetics have been limited. Through a randomized, crossover clinical trial, this study compared the use of a knee powered lower limb exoskeleton (the ABLE Exoskeleton) against passive orthoses (KAFOs), which are the current standard of care for verticalization and gait ambulation outside the clinical setting in people with SCI. Ten patients with SCI completed a 10-session gait training program with each device followed by user satisfaction questionnaires. Walking with the ABLE Exoskeleton improved gait kinematics compared to the KAFOs, providing a more physiological gait pattern with less compen...