A medial linkage orthosis to assist ambulation after spinal cord injury

The influence of orthosis options on walking parameters in spinal cord-injured patients: a literature review

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.

The influence of new reciprocating link medial linkage orthosis on walking and independence in a spinal cord injury patient

OBJECTIVES

The purpose of this paper is to describe the development and evaluation of a new medial linkage reciprocating gait orthosis (MLRGO) that incorporates a reciprocal mechanism and is sensitive to pelvic motion to potentially assist paraplegic patients to walk and provide functional independence.

CASE DESCRIPTION AND METHODS

The new orthosis was constructed and tested by a 20-year-old female paraplegic subject with transverse myelitis at T10 level, who was 4 years post injury and had also been an isocentric reciprocating gait orthosis (IRGO) user for 2 years. She received gait training for 12 weeks before undertaking gait analysis, and also completed a questionnaire that was designed to assess the perceived functionality of the new MLRGO when compared with an IRGO.

RESULTS

The results demonstrated improvements in gait velocity, step length and cadence, and also improvement in functional independence with the new orthosis compared with an IRGO.

CONCLUSION

The results demonstrated that this new MLRGO could be used for paraplegic patients who would like an improvement in functional independence and ambulation.

Comparison of new medial linkage reciprocating gait orthosis and isocentric reciprocating gait orthosis on energy consumption in paraplegic patients: a case series

OBJECTIVES

As energy consumption during orthotics walking has main role in rehabilitation of walking in individuals with spinal cord injury (SCI), the aim of this study was comparison between new medial linkage orthosis (new MLO) and isocentric reciprocating gait orthosis (IRGO) on energy consumption in paraplegic patients.

METHODS

Four people with motor incomplete SCI (mean age 34.5 years, mass 73 kg and height 175 cm with injury levels ranging from T8-T12) participated in this study. Gait evaluation was performed using new MLO compared with using conventional IRGO. Walking speed and heart rate were measured to calculate the physiological cost index (PCI) to estimate metabolic energy consumption.

RESULTS

Reductions in energy consumption were observed using new MLO compared with using IRGO, but the difference was not statistically significant. However, walking distance and walking speed also improved, but not significantly.

CONCLUSION

All subjects had faster speeds of walking, walked longer distances and had lower PCI when using new MLO compared to walking with IRGO. Consequently, this orthosis should be examined and considered with larger sample size.

Design and analysis of a new medial reciprocal linkage using a lower limb paralysis simulator

STUDY DESIGN

A feasibility study on the effect of a new reciprocating orthosis on specific gait parameters for use by people with spinal cord injury.

OBJECTIVES

The aim of this study was to design and develop a new medial linkage orthosis (MLO) mechanism incorporating a reciprocating motion and to determine its efficacy in improving specific spatiotemporal, kinematic and kinetic parameters while ambulating when worn by healthy subjects. This was achieved via the use of a lower limb paralysis simulator (LLPS).

METHODS

A reciprocating joint with a remote center of motion was designed for use as an MLO. A prototype was fabricated and incorporated into an orthosis and equipped with a saddle to make the reciprocating motion possible. The efficacy of the orthosis was evaluated on four able-bodied healthy subjects who were trained to walk with the MLO attached to the LLPS.

RESULTS

Mean walking speed, stride length, stride time and cadence was 0.09±0.007 m s(-1), 0.42±0.01 m, 4.89±0.45 s and 29.54±4.32 steps min(-1), respectively, when healthy subjects walked with the new orthosis. The mean hip joint torque produced was 0.36±0.13 Nm.

CONCLUSION

In this study a new MLO was designed and fabricated that provided a reciprocating mechanism using a four-bar mechanism to set the virtual axis of the mechanism in a more proximal position than hinge-type joints. Further investigation is currently underway to assess its effect on gait parameters and energy expenditure in paraplegic patients.

Evaluation of the performance of paraplegic subjects during walking with a new design of reciprocal gait orthosis

BACKGROUND

Spinal cord injury (SCI) influences a person's ability to stand and walk. Various orthoses have been developed to solve these standing and walking problems, however, patients still experience high energy consumption during walking and high forces on the upper limbs. A new reciprocal gait orthosis (RGO) was designed to address these problems. The aim of this study was to evaluate the performance of the new orthosis design with paraplegic subjects.

METHOD

Three paraplegic subjects with the lesion at level T12 and three able-bodied subjects were included in this study. Hip and pelvis range of motion and vertical ground reaction force were evaluated using the Qualysis motion analyzer system and a Kistler force plate. Energy consumption was measured with the Polar heart rate monitoring system. The differences between SCI individuals when walking with a Knee Ankle Foot Orthosis (KAFO) and the new RGO, and the differences between able-bodied and paraplegic subjects were evaluated by the use of paired sample and two sample t test, respectively.

RESULT

The results showed that energy consumption and gait analysis outcomes with new RGO orthosis were better than the KAFO. However, there was a large difference between paraplegic and able-bodied subjects while walking with the new orthosis.

CONCLUSION

The new RGO design performed better than a KAFO in terms of energy consumption, walking style and vertical ground reaction force. Therefore, it appears that RGO may be a useful orthosis for patients with paraplegia. Implications for Rehabilitation Walking and standing of the subjects with spinal cord injury (SCI) improve their physiological and physiological health. This study introduces a new type of orthosis design in order to improve the abilities of SCI subjects during walking and standing. It seems that the new design works better than available orthoses (KAFO).

The Araz medial linkage orthosis: a new orthosis for walking in patients with spinal cord injury: a single patient study

BACKGROUND

This article describes the development and evaluation of a new medial linkage orthosis to potentially assist paraplegic patients to ambulate.

CASE DESCRIPTION AND METHODS

The orthosis was initially designed using the solid works program and was subsequently evaluated when used by a spinal cord injury subject to test the structure during standing and walking. Gait analysis was used to compare the medial linkage orthosis to a standard hip-knee-ankle-foot orthosis.

FINDINGS AND OUTCOMES

The results demonstrated improvements in gait velocity, step length, and decreased compensatory motions in the new orthosis compared to the hip-knee-ankle-foot orthosis.

CONCLUSIONS

The results propose that this new Araz medial linkage orthosis could be used to assist paraplegic subjects who have adequate ranges of motion and also with weakness or reduced tone to stand and walk. Clinical relevance The Araz medial linkage orthosis can potentially provide standing and walking assistance for spinal cord injury patients.

The Physiological Benefits and Problems Associated with using Standing and Walking Orthoses in Individuals with Spinal Cord Injury—A Meta-analytic Review

Spinal cord injury (SCI) patients use two transportation systems that include orthosis and wheelchair. It was claimed that standing and walking bring some benefits for SCI patients, such as decreasing bone osteoporosis, preventing pressure sores, and improving various physiological functions. The main question posted here is as follows: Is there enough evidence to support the effect of walking with orthosis on the health status of the patients with SCI? A review of the relevant literature was carried out in Bioengineering Unit of Strathclyde University. The benefits of orthoses were evaluated. Evidence reported in the literature regarding the effectiveness of orthoses for improving the health condition of SCI patients is conflicting. The benefits that were mentioned in various research studies regarding using the orthosis include decreasing bone osteoporosis, preventing joint deformity, improving bowl and bladder function, improving digestive system function, decreasing muscle spasm, improving independent living, improving respiratory and cardiovascular systems function. Improvement of independence living and physiological health of the patients are the only two benefits that are supported by strong evidence. Unfortunately, conflicting results in the literature have led to criticism of most hypotheses based on theoretical grounds, with the effects of using orthoses on the health status remaining a matter of considerable debate.

Hybrid functional electrical stimulation with medial linkage knee-ankle-foot orthoses in complete paraplegics

We have previously restored ambulation in paraplegics by performing hybrid functional electrical stimulation (FES) with medial linkage knee-ankle-foot orthosis (MLKAFO). The most common MLKAFO (hinge-type MLKAFO) has the hypothetical axis that is lower than the physiological hip joint position, resulting in slow velocity and short step length. A new MLKAFO (sliding-type MLKAFO), which uses sliding medial linkages, has been developed to correct the axial discrepancy of the hinge-type MLKAFO that causes limited hip joint excursion. There have been reports of instability associated with sliding medial linkages, but the mechanism of this instability is unclear. The purpose of the present study was to evaluate the effects of FES with MLKAFOs on ambulation in paraplegics. Two complete paraplegic patients (levels T8 and T12, respectively) participated in this study. Kinematics data during ambulation were obtained using a motion analysis system. We measured gait velocity and hip progression during the standing phase. The sliding-type MLKAFO produced faster gait velocity than did the hinge-type MLKAFO, but it caused pelvis instability without FES. Pelvis instability was controlled by hybrid FES using the sliding-type MLKAFO. With hybrid FES, the sliding-type MLKAFO provides better gait performance than the hinge-type MLKAFO, but the hinge-type MLKAFO provides greater pelvis stability during walking. Moreover, FES provides sufficient propulsion to allow the complete paraplegics to walk.