The Physiological Cost Index of Walking with an Isocentric Reciprocating Gait Orthosis Among Patients with T12–L1 Spinal Cord Injury

Abstract

Objective: The objective of this study was to compare the Physiological Cost Index of walking with a reciprocating gait orthosis to that of walking with bilateral knee-ankle-foot orthoses (KAFOs) by subjects with paraplegia resulting from T 12 -L 1 spinal cord lesions. Methodology: Six chronic paraplegic subjects who had T 12 -L 1 spinal cord lesions and who previously wore bilateral KAFOs were recruited. Each subject was fitted with an isocentric reciprocating gait orthosis (IRGO) and received a standardized training program. Subjects were then asked to walk using the two orthotic devices along a 40 m rectangular pathway at a speed that was comfortable for them. The walking speed was measured using a stop watch, and a Polar Heart Rate Monitor was used to measure the heart rate of the subjects. The Physiological Cost Index (PCI) was calculated for comparison. Results: Ambulation using the IRGO (10.46 þ/7 2.00 m/min) was significantly faster (p ¼ 0.009) than ambulation using the bilateral KAFOs (5.51 þ/7 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 þ/7 0.77 beats/m) was significantly lower (p ¼ 0.0306) than that of the bilateral KAFOs (6.77 þ/7 3.28 beats/m). Conclusion: Paraplegic patients with T 12 -L 1 spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.

The influence of orthotic gait training with an isocentric reciprocating gait orthosis on the walking ability of paraplegic patients: a pilot study

“…1 The hip joints restrict hip motion in the frontal plane and permit reciprocal hip motion in the sagittal plane. The positive effect of this type of orthosis has been reported by Harvey et al, 10 Winchester et al 11 and Leung et al 9 on paraplegic patients.…”

“…Although many researchers have demonstrated that an extremely high level of exertion is needed when walking with an orthosis in this patient group, [9][10][11] it is also clear that SCI patients with high levels of spinal lesion have difficulty in walking in the early stages of orthotic gait training. 16 However, longitudinal gait training with longer periods have enabled them to walk independently and reciprocally with less level of energy consumption and faster speeds of walking in this study.…”

“…8 As previous studies have proposed the positive effects of ambulation with orthoses for SCI patients on reduction of physiological and psychological complications, this patient group should ideally facilitate their activities of daily living using a mechanical orthosis while experiencing a low level of fatigue and energy cost. 9 The design of the isocentric reciprocating gait orthosis (IRGO) was originally based on the concept of facilitating a reciprocal gait pattern for paraplegic patients, and is therefore commonly prescribed for walking and standing by SCI patients. It consists of two knee ankle foot orthoses connected laterally to a superstructure supporting the trunk, and includes hip joints that can be locked into extension once the patient is standing.…”

“…Winchester et al 11 in a comparison between the RGO and IRGO demonstrated the energy costs of walking at comfortable self-selected speeds is lower with the IRGO than the RGO. A study by Leung et al, 9 which compared two types of orthosis on energy consumption in SCI patients used 8 weeks gait training with the orthoses. Arazpour et al 8 in a comparison of a powered gait orthosis, an IRGO and a hip knee ankle foot orthosis in SCI patients, demonstrated that speed of walking, the distance walked and the physiological cost index (PCI) improved with both the powered gait orthosis and the IRGO as compared with the hip knee ankle foot orthosis, but they had only 6 weeks of gait training to accommodate themselves to the orthosis.…”

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

“…The means of speed of walking were reported 0.17, 0.19, 0.22, 0.25 and 0.34 m per second. 14,15,20,62,63 The mean of energy consumption was reported 120 ± 6 to 140 ± 11 beats per min) 144 beats per min. 14,62 In the modified hip joint category in using MLO, the values of this parameter were reported 0.11, 0.14, 0.33 m per second with WO, 16,26 0.13 with Moorong, 0.6 m per second with HALO 16,18 and 0.39 with new reciprocating MLO.…”