Postural rehabilitation in paraplegic patients using the reciprocating gait orthosis

Background. To evaluate the effect of training on postural control in the upright position in paraplegic patients who were using advanced reciprocating gait orthoses (ARGOs). Methods. Experimental design: a comparative case-control study with the assessment of postural control before and after training, Setting: the Intensive Neuromotor Rehabilitation Unit, Trevi. Study subjects: four paraplegic patients with dorsal lesions, who were already using orthoses. One patient dropped out of the study. Interventions: A training programme designed to reinforce the supralesional muscles; to enhance cardiorespiratory capacity and to improve posture in the upright position. Measurements: the fall threshold during abrupt perturbations on a dynamic platform and surface EMG recordings from the latissimus dorsi and the pectoralis major muscles. Results. The following changes in muscle activity were documented: the massive co-contraction shown at baseline was replaced by more co-ordinated activation following training. Also noted during the course of training were gradual increases in the fall threshold, excursion and velocity. Conclusions. Training led to improved postural control in the upright position, as documented by the patients' increased resistance to perturbations. This result may be partly accounted for by an improvement in the co -ordination of the muscle groups studied. All in all, the training improved postural control in the upright position in paraplegic patients using ARGOs.