The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients: A pilot study

Background: Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users. Objectives: To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. Study design: Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses. Methods: Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed. Results: Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation. Conclusion: Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk. Clinical relevance Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.