Ambulation study of a woman with paraplegia using a reciprocating gait orthosis with functional electrical stimulation in Taiwan: a case report.
OBJECTIVE
Many patients who suffer from spinal cord injuries with paraplegia cannot recover to walk independently. They need to use a special walking orthoses to support their body to walk properly. Traditionally, long leg braces (LLB) were fitted to patients for walking. Unfortunately, the results were not satisfactory as this device supplies adequate support with less than optimum mobility. This study used the latest reciprocating gait orthosis (RGO) combined with functional electrical stimulation (FES). This combination provides a greater support range while applying assistant mechanical walking structures. The FES co-ordination helps restore natural walking abilities that the paralysed patient has lost.


METHODS
This study developed a walking orthosis with FES, using FES to stimulate specific muscles (quadriceps, hamstring) in the paralysed patients' lower limbs. The proposed method can achieve the benefits of physical therapeutics while paralysed patients can achieve the purpose of walking. The FES is designed with control buttons on the walking orthosis. A patient can control the left or right leg in walking and speed control via the control buttons.


RESULTS
Several practical tests were conducted on the new walking orthosis. A 25-year-old female paralysed patient (L1 complete spinal cord injury) used traditional LLB, RGO and RGO with FES to proceed with walking rehabilitation and clinical assessment. Heart rate difference (HRdifference), mean blood pressure (MBPdifference), walking speed, length of steps, number of steps and oxygen consumption comparisons were made before and after walking. The results show that RGO and RGO with FES were both better than LLB. However, the differences between RGO and RGO with FES in HRdifference, MBPdifference, and walking speed were not significant. This is because the patient's right leg reaction to the electrical stimulation was relatively low.


CONCLUSIONS
In general, RGO can help the patient achieve quicker and more independent walking. The combination of RGO and FES can increase the effectiveness of RGO for more mobile aid. These two walking orthoses are better than traditional LLB. Both methods provide patients who suffer from paraplegia with better choices.
Chen
Woei-Luen
WL
Department of Electrical Engineering, Chang Gung University, Tao-Yuan, Taiwan.
Chang
Walter H
WH
Chen
Chih-Chen
CC
Hsieh
Jung-Chai
JC
Shih
Ying-Ying
YY
Chen
Yu-Luen
YL
D000328:Adult; D000704:Analysis of Variance; D051341:Dependent Ambulation; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006801:Humans; D010101:Oxygen Consumption; D010264:Paraplegia / Q000534:rehabilitation*; D013624:Taiwan; D016138:Walking