COMPARATIVE-STUDY OF CONVENTIONAL HIP-KNEE-ANKLE-FOOT ORTHOSES VERSUSRECIPROCATING-GAIT ORTHOSES FOR CHILDREN WITH HIGH-LEVEL PARAPARESIS

We evaluated eight children with thoracic or high lumbar-level parapar esis for metabolic performance while ambulating with custom fabricated thermoplastic hip-knee-ankle-foot orthoses (HKAFOs) and reciprocating -gait orthoses (RGOs). Seven of the eight children had myelomeningocel e. Each patient was tested in both systems at self-selected speeds in a crossover study design. At self-selected speeds, the level of exerci se intensity for both thoracic and high-lumbar patients with either or thosis was lower than that for normal children. The average metabolic cost of walking in the RGO was twice that of normal children, as compa red with six times normal in HKAFOs. For the four thoracic-level patie nts, there was a significantly higher oxygen cost of ambulation in usi ng HKAFOs versus RGOs. No significant difference in metabolic performa nce was found for the high-lumbar patients. Velocity of ambulation was faster in the RGOs than in the HKAFOs. For thoracic-level patients, o ur data suggest that an RGO will provide a faster, more energy-efficie nt gait than a statically locked HKAFO. For high-lumbar patients, no s ignificant difference was found between the two orthoses. Seven of eig ht children preferred the RGO over the HKAFO.