A long-term review of severely disabled spina bifida patients using a reciprocal walking system

Purpose : The purpose of the study was to establish long-term compliance of paediatric spina bir da patients using a reciprocal walking orthosis, pres cribed to enhance function and long-term therapeutic benefit. Methods : Data from current clinical notes of 28 spina bir da patients pres cribed with the Parawalker reciprocal walking orthosis between 1973 and 198 4 were compared with those established for the purposes of research at the time of original prescription. Patients were supplied via an on-going treat ment regime by a specialist multi-disciplinary team. Regular followup was a n essential element of the clinical policy. This enabled effective monitori ng of patient performance and requirements. It also ensured that accurate d ata was maintained. Clinical and walking performance details were recorded at the time of supply. Current clinical notes from routine follow-up review s for patients in the study were scrutinized to establish present status, a mbulation performance and medical history. Results : Fourteen patients had thoracic lesions - the remainder having hig h, mid lumbar or variably diagnosed lesions. The period of use ranged from 4.6 to 18.1 years (average = 9.71 years) The orthosis was first prescribed at 3.6 years to 13.9 years. Discontinuation occurred at between 11.2 and 23 .9 years. None of the patients suffered a pressure sore or bone fracture. Conclusions : Long-term continuation of reciprocal walking within a control led treatment regime was established. This enabled confirmation that compre hensive health care systems can achieve improvements in patient function, t ogether with overall cost savings because of the reductions in pressure sor es and bone fractures identified for such activity.