title: 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).
abstract: To compare the energy efficiency of Wearable Power-Assist Locomotor (WPAL) with conventional knee-ankle-foot orthoses (MSH-KAFO) such as Hip and Ankle Linked Orthosis (HALO) or Primewalk.
  
  
  
  Cross over case-series.
  
  
  
  Chubu Rosai Hospital, Aichi, Japan, which is affiliated with the Japan Organization of Occupational Health and Safety.
  
  
  
  Six patients were trained with MSH-KAFO (either HALO or Primewalk) and WPAL. They underwent 6-minute walk tests with each orthosis. Energy efficiency was estimated using physiological cost index (PCI) as well as heart rate (HR) and modified Borg score. Trial energy efficiency with MSH-KAFO was compared with WPAL to assess if differences in PCI became greater between MSH-KAFO and WPAL as time goes on during the 6-minute walk. Spearman correlation coefficient of time (range: 0.5-6.0 minutes) with the difference was calculated. The same statistical procedures were repeated for HR and modified Borg score.
  
  
  
  Greater energy efficiency, representing a lower gait demand, was observed in trials with WPAL compared with MSH-KAFO (Spearman correlation coefficients for PCI, HR and modified Borg were 0.93, 0.90 and 0.97, respectively, all P < 0.0001).
  
  
  
  WPAL is a practical and energy efficient type of robotics that may be used by patients with paraplegia.
authors.affiliation: a Department of Rehabilitation Medicine I, School of Medicine , Fujita Health University , Toyoake , Aichi , Japan.|b Department of Rehabilitation , Japan Organization of Occupational Health and Safety Chubu Rosai Hospital , Nagoya , Aichi , Japan.
authors.forename: Kanan
authors.initials: K
authors.lastname: Yatsuya
authors.affiliation: a Department of Rehabilitation Medicine I, School of Medicine , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.affiliation: a Department of Rehabilitation Medicine I, School of Medicine , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Saitoh
authors.affiliation: c Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Tanabe
authors.affiliation: b Department of Rehabilitation , Japan Organization of Occupational Health and Safety Chubu Rosai Hospital , Nagoya , Aichi , Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: b Department of Rehabilitation , Japan Organization of Occupational Health and Safety Chubu Rosai Hospital , Nagoya , Aichi , Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Eguchi
authors.affiliation: d Department of Rehabilitation , Fujita Health University Hospital , Toyoake , Aichi , Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Katoh
authors.affiliation: e Rehabilitation Center , Kizankai Memorial Hospital , Iida , Nagano , Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: f Orthopedic Services Division , Tomei Brace Co., Ltd. , Seto , Aichi , Japan.
authors.forename: Akito
authors.initials: A
authors.lastname: Uno
authors.affiliation: a Department of Rehabilitation Medicine I, School of Medicine , Fujita Health University , Toyoake , Aichi , Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kagaya
mesh_terms: D000328:Adult; D004734:Energy Metabolism; D000067190:Exoskeleton Device / Q000009:adverse effects* / Q000592:standards; D005260:Female; D005684:Gait; D006339:Heart Rate; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D035002:Lower Extremity / Q000503:physiopathology; D008297:Male; D000066530:Neurological Rehabilitation / Q000295:instrumentation* / Q000379:methods; D009989:Orthotic Devices / Q000009:adverse effects* / Q000592:standards; D013119:Spinal Cord Injuries / Q000534:rehabilitation*
keywords: Energy efficiency; Orthosis; Physiological cost index; Rehabilitation; Spinal cord injury; Wearable power-assist locomotor