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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Europa Medicophysica 1998 September;34(3):145-57

language: English

Gait in spi­nal ­cord ­injured ­patients

Franceschini M.

Unità Organica di Riabilitazione Intensiva Neuromotoria, Trevi (Perugia), Italy, Azienda USL n 3, Regione Umbria


This ­review of the lit­er­a­ture ­begins by out­lin­ing the ­main indi­ca­tions and con­tra­in­di­ca­tions for the use of orthos­es in spi­nal ­cord ­injured ­patients. It ­goes on to exam­ine the resid­u­al mus­cle activ­ity to ­call ­into ­play in reac­ti­vat­ing ambu­la­tion in the para­ple­gic sub­ject, and sec­ond­ly the ­lost mus­cle com­po­nents ­which are fun­da­men­tal to effec­tive pos­tu­ral con­trol. The ­review ­then address­es the ­joints to stab­il­ise in ­order to com­pen­sate for the ­loss of neu­ro­mus­cu­lar ­strength fol­low­ing the ­lesion and to ­restore pos­tu­ral stabil­ity. There ­then fol­lows a descrip­tion of the mechan­i­cal ­systems ­used in ­recent ­years for ­that pur­pose. Their dif­fer­ent struc­tu­ral and func­tion­al char­ac­ter­is­tics are ­described. Details are giv­en ­about the advan­tag­es and dis­ad­van­tag­es of the ­hybrid ­systems, ­which fea­ture func­tion­al electri­cal stim­u­la­tion. Data is pre­sent­ed on the use and non­use of the var­i­ous orthos­es in every­daily ­life, ­with atten­tion ­drawn to the ­high inci­dence of dis­con­tin­u­ance of the ­KAFO ­systems in sub­jects ­with ­lesions ­above D10, and to the find­ing ­that recip­roca­t­ing ­systems con­tin­ue to be ­used ­over ­time ­even in sub­jects ­with ­high spi­nal inju­ries. An anal­y­sis of the pur­poses for ­which ­these ­systems are ­used indi­cates ­that the prev­a­lent use is for ther­a­peu­tic exer­cise as ­opposed to an alter­na­tive to wheel­chair loco­mo­tion. There is ­some ­debate in the lit­er­a­ture con­cern­ing the gen­er­al phys­i­cal ben­e­fits of ­being ­able to main­tain the ­upright posi­tion. The con­clu­sion ­reached fol­low­ing the anal­y­sis of the ener­gy ­costs asso­ciat­ed ­with the dif­fer­ent orthos­es is ­that under­ly­ing the ­high inci­dence of dis­con­tin­u­ance ­over ­time is the exces­sive ­effort cou­pled ­with the ­slow ­speed of ­gait—the for­mer ­being con­sid­er­ably high­er and the lat­ter far low­er ­than ­that asso­ciat­ed ­with use of the wheel­chair. In ­fact ­this is why sub­jects ­find it nec­es­sary to use the wheel­chair dur­ing the per­for­mance of ­their dai­ly acti­vit­ies. This lit­er­a­ture ­review con­cludes ­with an explo­ra­tion of the poten­tial of FES and tread­mill train­ing to ­improve ­gait in SCI ­patients.

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