Restoration of gait with orthoses in thoracic paraplegia: a multicentric investigation

Twenty-eight patients with complete T3-12 traumatic paraplegia were fitted with hip guidance orthosis (HGO, four cases), reciprocating gait orthosis (RGO, 13 cases) or advanced reciprocating gait orthosis (ARGO, 11 cases). Patients were enrolled for 2 months-6 years (median 5 months) in six Italian rehabilitation centres engaged in a common prospective protocol, including a 6 month follow up. After 12-84 (median 20) rehabilitation sessions over a 3-16 week (median 7) period of specific training all of the patients could perform don-doff manoeuvres autonomously in 2.5-15 min (median 6.4), and could walk at least 30 m with a walker (15 cases) or forearm crutches (13 cases) at 10-50 cm/s (median 16.6). HGO patients tended to walk more slowly than the others. None of them could walk upstairs, while three out of 13 RGO patients and seven out of 11 ARGO patients could. Six months later, 21 patients still used the orthosis for 0.5-3 h daily (median 2). Only four patients used the orthosis to walk outdoors. As a median they could still attain the speed recorded at discharge. Six patients had decided to abandon the device, while one was wheelchair bound due to a recent spinal intervention. Neither clinical, demographic or locomotor variables, nor centre and type of orthosis appeared to be predictive of abandonment of the device. During either the training or the follow up periods, six out of 13 RGO and seven out of 11 ARGO had to be repaired by the orthotist 1-10 times (median 3). Thus, in our sample of paraplegics, walking with these orthoses appeared to be a promising form of exercise rather than an alternative to wheelchair locomotion.