Comparison of the Efficacy of Two Different Medial Linkage Mechanisms in Knee-Ankle-Foot Orthoses on Walking Ability in Subjects with Spinal Cord Injury

Background:The advanced reciprocating gait orthosis (ARGO) has a rigid structure which provides restricted movement at the hip, knee, and ankle joints and incorporates a pelvic section with an extended section in the lumbar region. Healthy subjects, when walking with an RGO in situ, could feasibly demonstrate the level of limitation in movement imposed by ARGO-assisted ambulation.Objective:The aim of this study was to compare the function of the advanced reciprocating gait orthosis when fitted with the dorsiflexion-assist ankle–foot orthoses on temporal–spatial parameters and kinematics of walking in both able-bodied people and those with spinal cord injury.Study design:Quasi experimental design.Methods:Data were acquired from six able-bodied and four spinal cord injury subjects who used an advanced reciprocating gait orthosis which incorporated dorsiflexion-assist ankle–foot orthoses. Kinematics and temporal–spatial parameters were calculated and compared.Results:All able-bodied individuals walked with speeds which were only approximately one-third that of when walking without an orthosis. The mean step length and cadence were both reduced by 48% and 6%, respectively. There were significant differences in hip, knee, and ankle joint range of motions between normal walking and walking with the advanced reciprocating gait orthosis both in able-bodied subjects and patients with spinal cord injury. There were also significant differences in the speed of walking, cadence, step length, hip range of motion, and ankle range of motion when using the advanced reciprocating gait orthosis between the two groups.Conclusion:Temporal–spatial parameters and lower limb sagittal plane kinematics of walking were altered compared to normal walking, especially when spinal cord injury subjects walked with the advanced reciprocating gait orthosis compared to the able-bodied subjects.Clinical relevanceTo produce an improvement in RGO function, an increase in walking performance should involve attention to improvement of hip, knee, and ankle joint kinematics, which differs significantly from normal walking.

Download Full-text

Comparison of the effects of solid versus hinged ankle foot orthoses on select temporal gait parameters in patients with incomplete spinal cord injury during treadmill walking

Prosthetics and Orthotics International ◽

10.1177/0309364612448511 ◽

2012 ◽

Vol 37 (1) ◽

pp. 70-75 ◽

Cited By ~ 4

Author(s):

Mokhtar Arazpour ◽

Hamid Reza Tajik ◽

Gholamreza Aminian ◽

Monireh Ahmadi Bani ◽

Farhad Tabatabai Ghomshe ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Step Length ◽

Foot Orthoses ◽

Incomplete Spinal Cord Injury ◽

Gait Parameters ◽

Significant Difference ◽

Cord Injury ◽

Ankle Foot Orthoses ◽

The Mean

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 wearing a solid AFO. Significant difference was not observed between conditions in mean of ankle range of motion.Conclusion:The solid AFO was the only condition which improved cadence and step length in patients during ISCI gait training.Clinical relevanceA solid AFO could be used permanently to compensate for impaired ankle function or it could be used while retraining stepping.

Download Full-text

Effects of Two Different Hip-Knee-Ankle-Foot Orthoses on Postural Stability in Subjects with Spinal Cord Injury: A Pilot Study

Asian Spine Journal ◽

10.31616/asj.2017.0283 ◽

2019 ◽

Vol 13 (1) ◽

pp. 96-102

Author(s):

Mohammad Samadian ◽

Monireh Ahmadi Bani ◽

Navid Golchin ◽

Mohammad Ali Mardani ◽

John S. Head ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pilot Study ◽

Postural Stability ◽

Foot Orthoses ◽

Cord Injury ◽

Ankle Foot Orthoses

Download Full-text

Gait evaluation of the advanced reciprocating gait orthosis with solid versus dorsi flexion assist ankle foot orthoses in paraplegic patients

Prosthetics and Orthotics International ◽

10.1177/0309364612457704 ◽

2012 ◽

Vol 37 (2) ◽

pp. 161-167 ◽

Cited By ~ 13

Author(s):

Monireh Ahmadi Bani ◽

Mokhtar Arazpour ◽

Farhad Tabatabai Ghomshe ◽

Mohammad Ebrahim Mousavi ◽

Stephen William Hutchins

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Ankle Joint ◽

Neurological Injury ◽

Foot Orthoses ◽

Gait Parameters ◽

Cord Injury ◽

Ankle Foot Orthoses ◽

Quasi Experimental ◽

The Mean

Background:Mechanical orthoses are used for standing and walking after neurological injury. Most orthoses such as the advanced reciprocating gait orthosis typically use solid ankle–foot orthoses.Objectives:The goal of this study was to test the effects of ankle dorsiflexion assistance in patients with spinal cord injury when ambulating with an advanced reciprocating gait orthosis compared to walking with fixed ankles.Study Design:Quasi-experimental.Methods:Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis equipped with solid and dorsiflexion assist-type ankle–foot orthoses and walked at their self-selected speed. Joint angles and spatial–temporal parameters were measured and analyzed.Results:The mean walking speed and stride length were both significantly increased along with cadence by the volunteer subjects when ambulating using the advanced reciprocating gait orthosis fitted with dorsiflexion assist ankle–foot orthoses compared to the advanced reciprocating gait orthosis with solid ankle–foot orthoses. The mean ankle joint ranges of motion were significantly increased when walking with the advanced reciprocating gait orthosis with dorsiflexion assist ankle–foot orthoses compared to when using the advanced reciprocating gait orthosis with the solid ankle–foot orthoses. Knee joint ranges of motion were reduced, and hip joint ranges of motion were increased but not significantly.Conclusion:The advanced reciprocating gait orthosis fitted with the dorsiflexion assist ankle–foot orthoses had the effect of improving gait parameters when compared to the advanced reciprocating gait orthosis with solid ankle–foot orthoses.Clinical relevanceThe advanced reciprocating gait orthosis with dorsiflexion assist ankle–foot orthoses has the potential to improve hip and ankle joint kinematics and the temporal–spatial parameters of gait in spinal cord injury patients’ walking.

Download Full-text

Using a saddle-assistive device equipped with mechanical orthosis for walking of the person with incomplete spinal cord injury

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/09544119211020146 ◽

2021 ◽

pp. 095441192110201

Author(s):

Akbar Hojjati Najafabadi ◽

Saeid Amini ◽

Farzam Farahmand

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Reaction Force ◽

Assistive Devices ◽

Assistive Device ◽

Walking Ability ◽

Vertical Force ◽

Incomplete Spinal Cord Injury ◽

Combined Application ◽

Cord Injury

The majority of the people with incomplete spinal cord injury lose their walking ability, due to the weakness of their muscle motors in providing torque. As a result, developing assistive devices to improve their conditionis of great importance. In this study, a combined application of the saddle-assistive device (S-AD) and mechanical medial linkage or thosis was evaluated to improve the walking ability in patients with spinal cord injury in the gait laboratory. This mobile assistive device is called the saddle-assistive device equipped with medial linkage or thosis (S-ADEM). In this device, a mechanical orthosis was used in a wheeled walker as previously done in the literature. Initially, for evaluation of the proposed assistive device, the experimental results related to the forces and torques exerted on the feet and upper limbs of a person with the incomplete Spinal Cord Injury (SCI) during walking usingthe standard walker were compared with an those obtained from using the S-ADEM on an able-bodied subject. It was found that using this combination of assistive devices decreases the vertical force and torque on the foot at the time of walking by 53% and 48%, respectively compared to a standard walker. Moreover, the hand-reaction force on the upper limb was negligible instanding and walking positions usingthe introduced device. The findings of this study revealed that the walking ability of the patients with incomplete SCI was improved using the proposed device, which is due to the bodyweight support and the motion technology used in it.

Download Full-text

Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study

Spinal Cord ◽

10.1038/s41393-021-00693-7 ◽

2021 ◽

Author(s):

Helge Kasch ◽

Uffe Schou Løve ◽

Anette Bach Jønsson ◽

Kaare Eg Severinsen ◽

Marc Possover ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Outcome Measures ◽

Outcome Measure ◽

Secondary Outcome ◽

Controlled Study ◽

Control Group ◽

Walking Ability ◽

Data Set ◽

Cord Injury

Abstract Study design 1-year prospective RCT. Objective Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. Methods Inclusion criteria: traumatic spinal cord injury (SCI), age 18–55 years, neurological level-of-injury Th4–L1, time-since-injury >1 year, and AIS-grades A–B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. Primary outcome measure: Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. Secondary outcome measures: Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). Results Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4–L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. Conclusion The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.

Download Full-text

Midsagittal tissue bridges are associated with walking ability in incomplete spinal cord injury: A magnetic resonance imaging case series

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2018.1527079 ◽

2018 ◽

Vol 43 (2) ◽

pp. 268-271 ◽

Cited By ~ 6

Author(s):

Denise R. O’Dell ◽

Kenneth A. Weber ◽

Jeffrey C. Berliner ◽

James M. Elliott ◽

Jordan R. Connor ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Magnetic Resonance ◽

Case Series ◽

Walking Ability ◽

Incomplete Spinal Cord Injury ◽

Resonance Imaging ◽

Cord Injury

Download Full-text

EFFECT OF LOWER EXTREMITY EXOSKELETON ROBOT IMPROVING WALKING FUNCTION AND ACTIVITY IN PATIENTS WITH COMPLETE SPINAL CORD INJURY

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419400608 ◽

2019 ◽

Vol 19 (08) ◽

pp. 1940060

Author(s):

XINGANG BAI ◽

XIANG GOU ◽

WENCHUN WANG ◽

CHAO DONG ◽

FANGXU QUE ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Adverse Events ◽

Lower Extremity ◽

Controlled Trial ◽

Walking Ability ◽

Walk Test ◽

Exoskeleton Robot ◽

Cord Injury ◽

Complete Spinal Cord Injury

The objective of this research was to evaluate the effectiveness and safety of Lower Extremity Exoskeleton Robot improving walking function and activity in patients with complete spinal cord injury. A prospective, open and self-controlled trial was conducted which include eight patients with complete spinal cord injury accepted Lower Extremity Exoskeleton Robot training with Aider 1.0 and Aider 1.1 for 2 weeks. The 6[Formula: see text]min Walk Test (6MWT), 10[Formula: see text]m Walk Test (10 MWT), Hoffer walking ability rating, Lower Extremity Motor Score (LEMS), Spinal Cord Independence Motor (SCIM), Walking Index for Spinal Cord Injury Version II (WISCI II) were recorded before, 1 week and 2 weeks after training. During the training, the incidence of adverse events (AE), the incidence of serious adverse events (SAE), the incidence of device defects and other safety indicators were observed. Compared with the pre-training, indicators (6MWT, 10MWT, Hoffer walking ability rating, WISCI II) were significantly different after 1 week of training and after 2 weeks of training. Four adverse events occurred during the training period and the incidence of adverse events was 50%. And there was no SAE or device defects. Therefore, it is safe and effective to use the lower extremity exoskeleton robot to complete the walking ability of patients with complete spinal cord injury.

Download Full-text