Development of a hybrid gait orthosis: a case report.
OBJECTIVE
The purpose of this case study was to improve stability, posture, and speed of gait in an individual with paraplegia through the application of a hybrid system including trunk-hip-knee-ankle-foot orthosis (THKAFO) with lockable joints and multichannel functional electrical stimulation (FES) with implanted electrodes.


METHODS
Two hybrid orthoses were implemented and evaluated on a person with complete absence of motor function and sensation below the T-9 level spinal cord injury. The first hybrid was a modified isocentric reciprocal gait orthosis (IRGO) with the knees controlled by FES, the ankles fixed at neutral, and the hips coupled with a reciprocator. The second hybrid had a THKAFO instrumented with lockable joints using wrap-spring clutches at the hips and knees (THKAFO-LJ) that provided free extension and allowed for flexion only when disengaged by solenoids. A microprocessor-controlled stimulator provided muscle stimulation and activation signals for the solenoids. These two hybrid systems were compared with an FES-only system.


RESULTS
The IRGO hybrid system with the hip reciprocator engaged provided a stable gait with erect posture with minimal anterior trunk lean using only quad canes for support. However, the walking speed was slow, due to limited step length imposed by the reciprocator. The walking speed with the THKAFO-LJ hybrid system was significantly faster than that with the IRGO hybrid with the reciprocator engaged, and was comparable with the FES-only gait; however, it resulted in excessive anterior trunk lean. A walker with 2 wheels was required to maintain balance.


CONCLUSIONS
The results point to the need for a hybrid system that allows for unencumbered hip and knee joint motion for stepping without excessive anterior trunk lean. Such a hybrid system could provide a reasonable speed in gait powered by muscle stimulation, without the usual joint motion constraints imposed by the bracing, while providing stability that is normally seen only with bracing. Further advantages would include reduction in required stimulation during standing and support phases of gait.
Motion Studies Laboratory, Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. walkwithfes@msn.com
Rudi
R
Kobetic
E Byron
EB
Marsolais
Ronald J
RJ
Triolo
Dwight T
DT
Davy
Richard
R
Gaudio
Scott
S
Tashman
D004558:Electric Stimulation; D004567:Electrodes, Implanted; D004867:Equipment Design; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D004856:Postural Balance / Q000502:physiology; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D014853:Walkers