Gait in spinal cord injured patients

Research output: Contribution to journalArticlepeer-review

Abstract

This review of the literature beings by outlining the main indications and contraindications for the use of orthoses in spinal cord injured patients. It goes on to examine the residual muscle activity to call into play in reactivating ambulation in the paraplegic subject, and secondly the lost muscle components which are fundamental to effective postural control. The review then addresses the joints to stabilise in order to compensate for the loss of neuromuscular strength following the lesion and to restore postural stability. There then follows a description of the mechanical systems used in recent years for that purpose. Their different structural and functional characteristics are described. Details are given about the advantages and disadvantages of the hybrid systems, which feature functional electrical stimulation. Data is presented on the use and nonuse of the various orthoses in everydaily life, with attention drawn to the high incidence of discontinuance of the KAFO systems in subjects with lesions above D10, and to the finding that reciprocating systems continue to be used over time even in subjects with high spinal injuries. An analysis of the purposes for which these systems are used indicates that the prevalent use is for therapeutic exercise as opposed to an alternative to wheelchair locomotion. There is some debate in the literature concerning the general physical benefits of being able to maintain the upright position. The conclusion reached following the analysis of the energy costs associated with the different orthoses is that underlying the high incidence of discontinuance over time is the excessive effort coupled with the slow speed of gait - the former being considerably higher and the latter far lower than that associated with use of the wheelchair. In fact this is why subjects find it necessary to use the wheelchair during the performance of their daily activities. This literature review concludes with an exploration of the potential of FES and treadmill training to improve gait in SCI patients.

Original languageEnglish
Pages (from-to)145-157
Number of pages13
JournalEuropa Medicophysica
Volume34
Issue number3
Publication statusPublished - 1998

Keywords

  • Gait
  • Paraplegia
  • Spinal cord injuries rehabilitation

ASJC Scopus subject areas

  • Rehabilitation

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