SUMMARY Seventy‐two normal children aged between three and 12 years were assessed to establish their walking function. Speed of walking and heart rate were monitored continuously, both barefoot and in shoes, over eight consecutive lengths of a 25m walkway. Since heart rate is affected by speed, the physiological cost index (PC1)—which combines the two parameters—was calculated for each child, both barefoot and in shoes. Speed tends to increase and walking heart rate to decrease with age. However, resting heart rate also decreases with age, so the PCI has the same range for all ages. The mean PCI in shoes was 0.4 and barefoot was 0. 38. The PCI for children with pathological gait is appreciably greater than that for normal children, so the PCI is a valuable quantitative indicator of the level of handicap. RÉSUMÉ Index du coût physiologique de la marche chez I'enfant normal et son utilisation comme indicateur dhandicap physique Soixante douze enfants normaux, âgés de trois a 12 ans, ont été examinés pour établir leur fonction de marche. La vitesse de marche et le rythme du coeur ont été enregistrés continuellement, à la fois en marche pied nu et en chaussures, sur huit trajets consécutifs d'une plate‐forme de 25 mètres. Le rythme cardiaque étant modifié par la vitesse de marche, I'index de coût physiologique (ICP) combinant les deux paramètres a été calculé pour chaque enfant, pied nu et en chaussures. La vitesse tend à s'accroitre et Ie rythme cardiaque de marche à décroitre avec I'âge. Cependant, le rythme cardiaque de repos décroit aussi avec I'âge, si bien que le ICP demeure constant pour tous les Lges. L'ICP moyen àété de 0·4 en chassures et de 0·38 pieds nus. L'ICP d'enfants à démarches pathologiques s'est révélé nettement plus élévé que celui de I'enfant normal et I'ICP apparait un indicateur quantitatif valable du degré de handicap. ZUSAMMENFASSUNG Physiologischer Energieumsatzindex beim Gehen für gesunde Kinder und seine Anwendung als Indikator fir körperliche Behinderung 72 gesunde Kinder im Alter zwischen drei und 12 Jahren wurden untersucht, um ihre Funktion beim Gehen zu beurteilen. Gehgeschwindigkeit und Herzfrequenz wurden über acht aufeinanderfolgende Gehstrecken von 25m. sowohl barfuβ als auch in Schuhen kontinuierlich aufgezeichnet. Da die Herzfrequenz durch die Geschwindigkeit beeinfluβ wird, wurde der physiologische Energieumsatzindex (PC1)—der die beiden Parameter verbindet—für jedes Kind für beide Versuchsanordnungen berechnet. Die Geschwindigkeit nimmt mit dem Alter zu und die Herzfrequenz beim Gehen nimmt ab. Die Ruheherzfrequenz jedoch nimmt mit dem Alter ebenfalls ab, sodaβ der PCI für alle Altersstufen denselben Bereich hat. Der mittlere PCI beim Gehen in Schuhen war 0·4 und barfup 0·8. Der PCI bei Kindern mit pathologischem Gang ist betrachtlich höher als der für gesunde Kinder, sodaβ der PCI ein guter quantitativer Indikator für den Grad einer Behinderung darstellt.

This study examines the evidence which supports the importance of maintaining relative abduction for effective reeiprocal walking in high level paraplegic patients. In comparisons of orthoses, where this can only be achieved mechanically, those with higher lateral rigidity consistently showed greater levels of walking efficiency. The influence on hybrid systems of functional electrical stimulation (FES) of the gluteal muscles, where the primary function is to maintain abduction, also showed reductions in overall energy cost, reductions in upper limb effort, or both. Examination of the effect of increasing lateral rigidity of a purely mechanical orthosis by 10% showed that significant energy cost reductions were achieved (30% reduction in Physiological Cost Index) for patients with thoracic lesions experienced in reciprocal walking. A review of FES research suggested that for the modern healthcare sector the cost effectiveness of purely mechanical systems make them an attractive means of routinely providing the functional and therapeutic benefits of walking for high level paraplegic patients. In the prevailing climate of strict budgetry control a case is made for concentrating more research resources on improving still further walking efficiency, and resolving the outstanding problems of functionality and cosrnesis in such systems for reciprocal walking.

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SummaryA clinical review of 50 adult patients with high level complete spinal lesions, for whom the ORLAU Para Walker had been prescribed, was undertaken at routine clinical follow-up visits using a questionnaire. The patients had an average age of 31'7 years, an average weight of 68'8 kg, an average height of 1'74 m and 78% had a complete lesion at T9 or above. With an average follow-up period of 34'4 months (min 7 months), 64% were continuing to use the device on a regular basis and more than 78% of those who responded had achieved complete independence. Analysis of the results provides further evidence that the ORLAU Para Walker is a clinically viable routine treatment for appropriate paraplegic patients with complete mid-thoracic lesions. The need for more precise clinical criteria to further improve the rate of long term use was identified.

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