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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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