Speed and Efficiency in Walking and Wheeling with Novel Stimulation and Bracing Systems After Spinal Cord Injury: A Case Study

To compare various novel and conventional systems for locomotion, a 25‐year‐old man was studied with motor complete spinal cord injury at the T4/5 level. He used various devices in the community, and changes in speed, physiological cost index (PCI), and oxygen consumption were measured periodically. Speed was fastest with a conventional manual wheelchair (nearly 120 m/min in a 4‐min test). Speed was about 30% less, but the PCI was lowest (highest efficiency) using functional electrical stimulation (FES) of the quadriceps and hamstring muscles to propel a novel wheelchair. He walked with knee‐ankle‐foot orthoses (KAFO) at much lower speed (8.8 m/min) and higher PCI. He walked with an alternating gait using a new stance‐control KAFO with FES. The speed was still slow (5 m/min), but he prefers the more normal‐looking gait and uses it daily. Walking with FES and ankle‐foot orthoses (AFO) was slowest (3.5 m/min) and had the highest PCI. In conclusion, the leg‐propelled wheelchair provides a more efficient method of locomotion. A new stance‐controlled KAFO with FES may provide a more acceptable walking system, but must be tested on other subjects.