Prediction of gait outcome with the knee–ankle–foot orthosis with medial hip joint in patients with spinal cord injuries: a study using recursive partitioning analysis

Abstract

Study design: Retrospective study of the degree of gait independence achieved by persons with spinal cord injury (SCI) using knee-ankle-foot orthosis with a medial single hip joint (MSH-KAFO). Objective: To examine the effects of the neurological level, degree of paresis, age, and inhibitory physical/other factors on the gait with a MSH-KAFO in patients with SCIs. Setting: Three university hospitals and two rehabilitation hospitals in Japan. Methods: The 45 patients (36 men, nine women) examined included 10 with injuries in the cervical cord between C6 and C8 (group C), 20 with injuries in the upper-middle thoracic cord between T4 and T10 (group UT), and 15 with injuries in the lower thoracic-lumbar cord between T12 and L1 (group TL). Mean age was 34.0 years (range 16-68 years). Of these patients, 13 used the Walkabout, four used the gear joint, and 28 used the Primewalk as the medial hip joint. Recursive partitioning, which predicted the final status of gait from the level, degree of paresis, age, and inhibitory factors, was performed, and a decision tree for gait was constructed. Inhibitory factors were spasticity, involuntary spasms or muscle contractions, pain, contracture, weakness of the upper extremities, and decreased motivation to perform gait exercise. The degree of gait independence was rated on the following five-point scale: outdoor independent gait (5 points), indoor independent gait (4 points), indoor supervised gait (3 points), indoor assisted gait (2 points), and gait within parallel bars (1 point). New branches were added to the decision tree for gait based on the clinical experience, thereby constructing a new decision tree. Results: The coincident ratio between the value predicted on the basis of the decision tree of gait and the value actually observed was 53.3%. The coincident ratio between the value predicted on the basis of the modified decision tree of gait and the actually observed value was 68.9%. Conclusion:The results provide valuable information to medical teams that may assist prescription of gait orthoses.

Comparison of energy efficiency between Wearable Power-Assist Locomotor (WPAL) and two types of knee-ankle-foot orthoses with a medial single hip joint (MSH-KAFO)

“…Walkabout, Primewalk and hip and ankle-linked orthosis (HALO) are commonly available to most clinical practices. [5][6][7] They have great standing stability, enabling the wearer to stand with their hands free when wearing the orthosis. Users can also put on and take off this type of orthosis in their wheelchairs.…”

“…However, both the lateral and medial systems are difficult to use regularly because of the high loads applied to the upper limbs. 6,8 Gait-assisted robots for patients with paraplegia, such as ReWalk, have been shown to provide most users with the ability to independently transfer and walk. 9,10 However, it is unlikely that wearers can put them on and take them off in their wheelchairs because of the lateral system, and will likely need to use chairs.…”

Orthoses for Spinal Cord Injury Patients

“…Four studies assessed the cadence in walking with orthoses associated with medial single hip joints in SCI patients. The mean of this parameter was reported as being 70.02 steps/min when using the WO [67] and 50.9 steps/min when walking with any type of medial single hip joints orthosis [73]. Significant difference in cadence between the HALO and PW devices (74.1 vs. 58.9) was reported by Genda et al [12].…”

The Effects of Hippotherapy on Standing Balance in Patients with Incomplete Cervical Spinal Cord Injuries: A Pilot Study

“…0.7 ± 0.5 0.7 ± 0.6 0.7 ± 0.5 0.8 ± 0.6 0.6 ± 0.5 0.6 ± 0.6 0.8 ± 0.6 0.9 ± 0.6 0.6 ± 0.5 0.6 ± 0.5 NC 1.2 ± 1.0 1.2 ± 1.1 1.2 ± 1.0 1.3 ± 1.7 1.1 ± 1.0 1.3 ± 1.2 1.2 ± 1.0 1.3 ± 1.2 1.1 ± 1.0 1.0 ± 0.9 PO 0.9 ± 0.7 0.8 ± 0.6 0.9 ± 0.7 0.8 ± 0.7 1.0 ± 0.8 0.9 ± 0.9 0.8 ± 0.6 0.8 ± 0.6 0.9 ± 0.7 0.8 ± 0.6 PC 1.7 ± 1.4 1.7 ± 1.6 1.8 ± 1.5 1.9 ± 1.8 1.5 ± 1.2 1.8 ± 1.4 1.9 ± 1.6 2.0 ± 2.0 1.5 ± 1.3 1.3 ± 1.1 HR 1.1 ± 0.9 1.1 ± 0.9 1.1 ± 0.9 1.2 ± 1.0 1.0 ± 0.7 1.0 ± 0.8 1.2 ± 1.0 1.3 ± 1.1 1.1 ± 1.0 0.9 ± 0.9 HL 1.1 ± 0.9 1.0 ± 0.9 1.1 ± 1.0 1.2 ± 1.0 1.0 ± 0.8 0.9 ± 0.8 1. standing ability of patients with spinal cord injuries, as they have weak extremities [26]. According to these results it may be hard to maintain the positive effects of hippotherapy, including patients' reduced tightness, relaxation, and spasticity in their lumbar-hip-pelvic muscles in a standing position.…”