title: Speed and efficiency in walking and wheeling with novel stimulation and bracing systems after spinal cord injury: a case study.
abstract: To compare various novel and conventional systems for locomotion, a 25-year-old man was studied with motor complete spinal cord injury at the T4/5 level. He used various devices in the community, and changes in speed, physiological cost index (PCI), and oxygen consumption were measured periodically. Speed was fastest with a conventional manual wheelchair (nearly 120 m/min in a 4-min test). Speed was about 30% less, but the PCI was lowest (highest efficiency) using functional electrical stimulation (FES) of the quadriceps and hamstring muscles to propel a novel wheelchair. He walked with knee-ankle-foot orthoses (KAFO) at much lower speed (8.8 m/min) and higher PCI. He walked with an alternating gait using a new stance-control KAFO with FES. The speed was still slow (5 m/min), but he prefers the more normal-looking gait and uses it daily. Walking with FES and ankle-foot orthoses (AFO) was slowest (3.5 m/min) and had the highest PCI. In conclusion, the leg-propelled wheelchair provides a more efficient method of locomotion. A new stance-controlled KAFO with FES may provide a more acceptable walking system, but must be tested on other subjects.
authors.affiliation: Centre for Neuroscience, University of Alberta;              Karl Hager Limb and Brace, Edmonton, Alberta, and              Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Stein
authors.forename: Frank
authors.initials: F
authors.lastname: Hayday
authors.forename: Suling
authors.initials: S
authors.lastname: Chong
authors.forename: Aiko K
authors.initials: AK
authors.lastname: Thompson
authors.forename: Robert
authors.initials: R
authors.lastname: Rolf
authors.forename: Kelvin B
authors.initials: KB
authors.lastname: James
authors.forename: Gordon
authors.initials: G
authors.lastname: Bell