Longitudinal assessment of oxygen cost and velocity in children with myelomeningocele: Comparison of the hip-knee-ankle-foot orthosis and the reciprocating gait orthosis

Oxygen consumption and cost and velocity were evaluated over time in 23 chi ldren with myelomeningocele to determine whether differences exist when chi ldren walk with hip-knee-ankle-foot orthoses (HKAFOs) versus reciprocating gait orthoses (RGOs). Children using HKAFOs had similar oxygen cost as chil dren using RGOs while achieving a faster velocity. Children walking with HK AFOs into adolescence had a faster velocity and lower oxygen cost than chil dren who discontinued use of their HKAFOs. No significant differences in ve locity or oxygen cost were found between children who continued to walk wit h RGOs and those who discontinued use of their RGOs. Upright ambulation may progress from ambulation with an RGO, when the child's upper extremity str ength to mass ratio is low, to an HKAFO when upper extremity strength impro ves and velocity or keeping up with peers is of concern. Wheelchair mobilit y should be offered when speed and an energy-efficient method of community mobility are desired.