Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia.
METHODS
Cross-sectional, experimental research.


OBJECTIVE
To clarify the effect of lesion level on cardio-respiratory responses and biomechanical characteristics of walking with a reciprocating gait orthosis in complete paraplegia with spinal cord injury (SCI).


METHODS
National Rehabilitation Center for Persons with Disabilities, Japan.


METHODS
Ten SCI individuals (age: 20-34 years, injured level: Th5-12) who experienced orthotic gait training at least for 10 weeks participated in two experiments: (1) measurement of the cardiorespiratory responses during 20 min of orthotic gait exercise; and (2) three-dimensional motion analysis and ground reaction force measurement using the VICON system. We calculated the following parameters: pulmonary ventilation, oxygen consumption (VO(2)), heart rate (HR), gait speed, cadence, stride length, crutch force (CF), hip range of motion (ROM), and hip angular velocity (VEL). Further, energy consumption and energy cost were calculated using the steady-state value of VO(2) and gait speed.


RESULTS
The steady-state value of the VO(2) (18.2 +/- 3.80 ml/kg) and HR (133.0 +/- 21.63 b/min) tended to be larger in higher thoracic SCI subjects. There were strong positive correlations between the lesion level and walking speed (r = 0.74), energy cost (r = 0.85), and hip ROM (r = 0.78). On the other hand, negative correlation between the lesion level and peak CF (r = -0.78) was clarified.


CONCLUSIONS
The physiological intensity of the orthotic gait strongly depended on the level of lesion. It seems likely that a limited hip range of motion and excess upper limb load result in the low energy cost of orthotic gait for the higher thoracic level of paraplegic patients.
Kawashima
N
N
Department of Rehabilitation for the Movement Functions, Research Institute of the National Rehabilitation Center for Persons with Disabilities, Tokorozawa, Saitama, Japan.
Taguchi
D
D
Nakazawa
K
K
Akai
M
M
D000328:Adult; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D006339:Heart Rate; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D010101:Oxygen Consumption; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D016896:Treatment Outcome