The Physiological Cost Index of Walking with an Isocentric Reciprocating Gait Orthosis Among Patients with T12–L1Spinal Cord Injury

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 T12 – L1spinal cord lesions.Methodology: Six chronic paraplegic subjects who had T12 – L1spinal 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 +/− 2.00 m/min) was significantly faster ( p = 0.009) than ambulation using the bilateral KAFOs (5.51 +/− 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 +/− 0.77 beats/m) was significantly lower ( p = 0.0306) than that of the bilateral KAFOs (6.77 +/− 3.28 beats/m).Conclusion: Paraplegic patients with T12 – L1spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.

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The effect of trunk extension on physiological cost index in spinal cord injury patients when using the advanced reciprocating gait orthosis: A pilot study

Prosthetics and Orthotics International ◽

10.1177/0309364615592700 ◽

2016 ◽

Vol 40 (6) ◽

pp. 696-702 ◽

Cited By ~ 1

Author(s):

Mokhtar Arazpour ◽

Mohammad Samadian ◽

Mahmood Bahramizadeh ◽

Monireh Ahmadi Bani ◽

Masoud Gharib ◽

...

Keyword(s):

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Walking Speed ◽

Well Being ◽

Walking Distance ◽

Cost Index ◽

Physiological Cost ◽

Cord Injury ◽

Trunk Extension

Background:People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users.Objective:The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension.Study design:Quasi experimental study.Methods:Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate.Results:Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ.Conclusion:Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis.Clinical relevanceIt is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.

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The physiological cost index of walking with mechanical and powered gait orthosis in patients with spinal cord injury

Spinal Cord ◽

10.1038/sc.2012.162 ◽

2012 ◽

Vol 51 (5) ◽

pp. 356-359 ◽

Cited By ~ 33

Author(s):

M Arazpour ◽

M A Bani ◽

S W Hutchins ◽

R K Jones

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cost Index ◽

Physiological Cost ◽

Powered Gait Orthosis ◽

Cord Injury

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Validity of the Polar V800 heart rate monitor for assessing cardiac autonomic control in individuals with spinal cord injury

Motriz Revista de Educação Física ◽

10.1590/s1980-65742021003221 ◽

2021 ◽

Vol 27 ◽

Author(s):

Patrícia Castro ◽

Arthur de Sá Ferreira ◽

Agnaldo José Lopes ◽

Tainah de Paula ◽

Roberto Miranda Ramos Costa ◽

...

Keyword(s):

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Autonomic Control ◽

Heart Rate Monitor ◽

Cardiac Autonomic Control ◽

Cord Injury

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The Effect of Lower Leg Casting on Energy Cost During Independent Ambulation: Considerations for Clinical Practice

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2014.1474 ◽

2014 ◽

Author(s):

Cindy LaPorte ◽

Daie Johnson ◽

Kiersten Koen ◽

Lena Hardy ◽

Valda Montgomery

Keyword(s):

Heart Rate ◽

Energy Cost ◽

Gait Speed ◽

Walking Speed ◽

Lower Leg ◽

Walk Test ◽

Resting Heart Rate ◽

Cost Index ◽

Physiological Cost ◽

Independent Ambulation

Purpose: The purpose of this study was to investigate the effects of dominant leg, lower leg casting on energy cost during independent ambulation. The Physiological Cost Index, predicted VO2max, and gait speed values of a Quarter-Mile Walk Test, with and without lower leg casting, were utilized to determine energy cost. Methods: Thirty-five subjects who were 23 to 32 years old (mean age 25.37 ± 2.02) performed the Quarter-Mile Walk Test at their comfortable walking speed on two occasions, one with and one without lower leg casting. Resting heart rate, walking heart rate, and time to complete the test were recorded. Physiological Cost Index, predicted VO2max, and gait speed formulas were used to calculate results.Results: Physiological Cost Index increased when walking with the lower leg cast, but was not statistically significant (p=.3939). A statistically significant decrease was seen with predicted VO2max (p< .0001) and gait speed (p< .0001) when walking with a lower leg cast. Conclusions: Predicted VO2max and gait speed decreased when walking with a lower leg cast on the dominant leg. This finding indicates that as subjects altered their self-selected speed, predicted VO2max decreased with gait speed.

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Walking with functional electrical stimulation and unlocking braces in thoracic-level paraplegia

Journal of Automatic Control ◽

10.2298/jac1301027b ◽

2013 ◽

Vol 21 (1) ◽

pp. 27-30

Author(s):

Jacques Bobet ◽

Suling Chong ◽

Robert Rolf ◽

Richard Stein

Keyword(s):

Heart Rate ◽

Trunk Muscles ◽

Joint Angles ◽

Cost Index ◽

Flexor Reflex ◽

Physiological Cost ◽

Thoracic Level ◽

Ankle Foot Orthoses ◽

Reaction Forces ◽

Stimulation Of

Walking was tested in 4 people with thoracic-level paraplegia using stimulation of quadriceps muscles, the flexor reflex and unlocking knee-ankle-foot orthoses (KAFO). Heart rate, speed, distance, kinematics and ground reaction forces were measured while subjects walked using a walker. None of the subjects could walk without the system; all could walk continuously for at least 4 minutes with it. Joint angles and some other kinematic features resembled normal walking, but the walking was too slow (average speed: 3.8 m/min.) and too demanding (heart rate: 128 b/min; physiological cost index: 15 b/m) to be practical. Subjects supported about 1/3 of their weight with their arms during stance and about 2/3 during swing. Our results suggest that the braces reduced the effort needed and that the low speeds were due to both a lack of power at push-off and the time needed to stabilize the hip and trunk. The high heart rates arose from excessive contraction of the arm and trunk muscles for balance and propulsion.

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Cardiovascular and Metabolic Responses to Electrical Stimulation-Induced Leg Exercise in Spinal Cord Injury

Methods of Information in Medicine ◽

10.1055/s-0038-1636852 ◽

1997 ◽

Vol 36 (04/05) ◽

pp. 372-375 ◽

Cited By ~ 9

Author(s):

J. R. Sutton ◽

A. J. Thomas ◽

G. M. Davis

Keyword(s):

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Cardiac Output ◽

Electrical Stimulation ◽

Knee Flexion ◽

Flexion Extension ◽

Cord Injury ◽

Leg Exercise ◽

Leg Muscle

Abstract:Electrical stimulation-induced leg muscle contractions provide a useful model for examining the role of leg muscle neural afferents during low-intensity exercise in persons with spinal cord-injury and their able-bodied cohorts. Eight persons with paraplegia (SCI) and 8 non-disabled subjects (CONTROL) performed passive knee flexion/extension (PAS), electrical stimulation-induced knee flexion/extension (ES) and voluntary knee flexion/extension (VOL) on an isokinetic dynamometer. In CONTROLS, exercise heart rate was significantly increased during ES (94 ± 6 bpm) and VOL (85 ± 4 bpm) over PAS (69 ± 4 bpm), but no changes were observed in SCI individuals. Stroke volume was significantly augmented in SCI during ES (59 ± 5 ml) compared to PAS (46 ± 4 ml). The results of this study suggest that, in able-bodied humans, Group III and IV leg muscle afferents contribute to increased cardiac output during exercise primarily via augmented heart rate. In contrast, SCI achieve raised cardiac output during ES leg exercise via increased venous return in the absence of any change in heart rate.

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Effects of compression stockings on sympathetic activity and heart rate variability in individuals with spinal cord injury

Journal of Spinal Cord Medicine ◽

10.1179/2045772311y.0000000054 ◽

2012 ◽

Vol 35 (2) ◽

pp. 81-88 ◽

Cited By ~ 14

Author(s):

Diana Rimaud ◽

Paul Calmels ◽

Vincent Pichot ◽

Francois Bethoux ◽

Frederic Roche

Keyword(s):

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Heart Rate Variability ◽

Sympathetic Activity ◽

Compression Stockings ◽

Cord Injury

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Diurnal Blood Pressure Variation in Quadriplegic Chronic Spinal Cord Injury Patients

Clinical Science ◽

10.1042/cs0800271 ◽

1991 ◽

Vol 80 (3) ◽

pp. 271-276 ◽

Cited By ~ 30

Author(s):

Henry Krum ◽

William J. Louis ◽

Douglas J. Brown ◽

Graham P. Jackman ◽

Laurence G. Howes

Keyword(s):

Blood Pressure ◽

Spinal Cord ◽

Heart Rate ◽

Spinal Cord Injury ◽

Ambulatory Monitoring ◽

Pressure Variation ◽

Night Time ◽

Cord Injury ◽

Blood Pressure Variation ◽

Neurologically Intact

1. Measurement of blood pressure and heart rate over a 24 h period was peformed in 10 quadriplegic spinal cord injury patients and 10 immobilized, neurologically intact orthopaedic subjects by using the Spacelabs 90207 automated ambulatory monitoring system. 2. Systolic and diastolic blood pressure fell significantly at night in orthopaedic subjects but not in quadriplegic patients, and night-time blood pressures were similar in both groups. 3. Cumulative summation of differences from a reference value (cusum analysis) confirmed a markedly diminished diurnal blood pressure variation in the quadriplegic patients. 4. These findings could not be accounted for on the basis of blood pressure variations during chronic postural change. 5. Heart rate fell significantly at night in both groups. 6. The findings suggest that the increase in blood pressure during waking hours in neurologically intact subjects is a consequence of a diurnal variation in sympathetic activity (absent in quadriplegic patients with sympathetic decentralization) which is independent of changes in physical activity.

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