Functional Performances for Paraplegia with Three Different Types of Walking Orthoses: A Case Report

Most paraplegic patients used their wheelchairs as a transportation tool, but largely confined by environment that didn't adapt for them. In this study, we introduced the new walking system to the paraplegia and the rehabilitation team workers in Taiwan. We obtained the clinical experience how to manufacture, modify and fitting the orthoses during training sessions. Isocentric Reciprocal Gait Orthosis (IRGO) is a hip-knee-ankle-foot orthosis (HKAFO) which controls hip extension while assisting reciprocal hip flexion. It comprises laterally placed hip joints that connect bilateral knee-ankle-foot orthoses (KAFOs) to a thoracolumbar corset. Walkabout Orthosis (WO) consists of two KAFOs joined by a single axis hip joint called the Walkabout Unit. The hip joint is positioned between the medial uprights of the KAFOs, under the perineum, and is designed for easy removal from the KAFOs. We performed clinical tests of the new IRGO and WO in a paraplegic patient with T12 motor complete lesion. The results were as follows. (1) Walking speed on a level surface: IRGO=0.39 m/sec, WO=0.14 m/sec, and KAFOs=0.14 m/sec. (2) Step length: IRGO=58.82 cm/step, WO= 24.82 cm/step, and KAFOs=18.63 cm/step. (3) Cadence: IRGO=39.96 steps/min, WO=33.17 steps/mm, and KAFOs=45.61 steps/mm. (4) PCI: IRGO=1.36 beats/m, WO=3.28 beats/m, and KAFOs=4.47 beats/m. In the functional assessment tasks, the results included the following. (1) He could independently perform donning and doffing the orthosis, changing positions from sitting to standing and from standing to sitting, and walking on a level surface with all three type orthoses. (2) Walking up and down the ramps: IRGO=stand-by assistance, WO and KAFOs=minimal assistance. (3) Getting up and down the stairs: IRGO, WO, and KAFOs were stand-by assistance. (4) Up and down the curb of 3.0 cm height IRGO was stand-by assistance; WO and KAFOs were moderate assistance. In summary, the IRGO performed a quicker and more independent gait, while the WO achieved a more stable standing and easy don-doff by himself than conventional KAFOs. Furthermore both of them walked with less energy consumption than conventional KAFOs.