Application of Knee Robotic Orthosis to Improve the Walking Performance of People with Post-Polio Syndrome

Abstract

IntroductionPoliomyelitis has been considered a statutory notifiable infectious disease in Hong Kong since 1948. Approximately 15% to 80% of patients suffer from post-polio syndrome (PPS) with an increased risk of falling and chronic pain. Most of them relied on the use of knee lock-type orthoses as aids. This study aimed to evaluate the effect of using a custom-fit knee robotic orthosis on their gait performance.Materials and MethodsA case series report was used for this study on a group of individuals suffering from chronic PPS who used orthoses and had a history of falling. A knee robotic orthosis was custom-fit for eight sessions of walking practice. Assessments included laboratory gait analysis, functional measures, and subjective ratings of exertional level. Pain responses were recorded to evaluate the effect of using the knee robotic orthosis on participants’ gait performance.ResultsFive participants completed the study in using the knee robotic orthosis. All achieved reduction in shoulder tilting and trunk swaying movement on walking at the anterior-posterior and the medial-lateral direction. A total of 80% of the study participants achieved reduction in trunk rotation movement, lower-limb circumduction, and hip hiking movement on the affected side on walking. All study participants were able to demonstrate improvement in their gait symmetry after using the knee robotic orthosis as reflected by the symmetric index improvement of kinematics. The rate of perceived exertion and the visual analog scale of pain in all study participants were reported lower when they used the knee robotic orthosis. However, the 10-m walking time achieved was longer.ConclusionsThe knee robotic orthosis had a positive effect on remediating the abnormal kinematics of PPS patients using conventional lock-knee orthosis after eight sessions of training practice. Reduction in the limping gait pattern and improvement in gait symmetry was achieved in using a knee robotic orthosis for walking. The chronic pain response and the physical exertional level on walking were also reduced. However, the walking speed achieved was slower.Clinical RelevanceThe application of the knee robotic orthosis for walking assist is new to most of the PPS patients. The positive outcomes achieved merit further research for future clinical practice.