RECIPROCATING ORTHOSES FOR CHILDREN WITH MYELOMENINGOCELE - A COMPARISON OF 2 TYPES

Since 1987, 22 children with myelomeningocele have been fitted with re ciprocating orthoses. The level of the spinal lesions ranged from T10 to L4 and 13 had associated spinal deformities, Twelve of the patients currently use a Reciprocating Gait Orthosis, seven use a Hip Guidance Orthosis or Parawalker, one has progressed to a Knee Ankle Foot Ortho sis, one has died and one has been lost to follow-up. The reciprocatin g orthoses are worn for a mean of 3.5 hours per day (1 to 6.5); daily usage by girls is almost twice that by boys. The mean daily usage by c ommunity walkers is 4.2 hours (13 children) as against 2.8 hours by ho usehold ambulators (8 children). Active hip flexion is not essential a nd fixed-flexion contractures up to 35 degrees can be accommodated. Th e average breakdown rate is 0.45 per year with an average of 1.5 adjus tments each year. The average annual cost of a reciprocating orthosis is Aus$750 (pound 375, US$570); this includes fabrication, adjustments and repairs.