A Review of the Literature Pertaining to KAFOs and HKAFOs for Ambulation

The purpose of this review is to evaluate the scientific literature regarding the clinical use of knee-ankle-foot orthoses (KAFOs) and hip-knee-ankle-foot orthoses (HKAFOs) for ambulation to establish what is known and what requires further research to optimize the application of these orthoses. A search of the literature was carried out using a number of computerized databases. Based on their abstracts, publications were included and ranked when they were written in English and evaluated some aspect of ambulation with [H]KAFOs (KAFO and HKAFO). A total of 240 articles were identified that met the inclusion and exclusion criteria; however, there were only two systematic reviews and two randomized control trials located. A selection of recent cross-sectional studies and non-systematic reviews were also considered. The results of this review indicate that, while a reasonable amount of literature has been written regarding [H]KAFOs, the level of evidence regarding the use of [H]KAFOs for ambulation is generally low. There was some evidence (grade C recommendation) that use of HKAFOs diminishes with time in both adults and children with paraplegia and that when orthoses are used they are used mostly for therapeutic purposes. There was also some evidence that regardless of orthotic device used walking speed is slow and energy cost high in people with paraplegia. The main limitation of most studies of [H]KAFOs for ambulation was small sample size and inadequate study design.

[1]  J W GERSTEN,et al.  ENERGY COST OF AMBULATION IN THE TRAUMATIC PARAPLEGIC , 1964, American journal of physical medicine.

[2]  R. McCall,et al.  Clinical Experience with the Reciprocal Gait Orthosis in Myelodysplasia , 1986, Journal of pediatric orthopedics.

[3]  P. Meyer,et al.  Lower limb orthotics. , 1974, Clinical orthopaedics and related research.

[4]  Ross S. Chafetz,et al.  Outcomes in Upright Mobility in Individuals with a Spinal Cord Injury , 2005 .

[5]  G. Fenichel,et al.  Prolongation of Ambulation in Children with Duchenne Muscular Dystrophy by Subcutaneous Lower Limb Tenotomy , 1993, Journal of pediatric orthopedics.

[6]  A swivel walker for paraplegics: medical and technical considerations. , 1972, Biomedical engineering.

[7]  V. Dubowitz,et al.  Prolongation of ambulation in Duchenne muscular dystrophy by appropriate orthoses. , 1982, Physiotherapy.

[8]  L Rocca,et al.  Swivel walkers. , 1978, Physiotherapy.

[9]  M. Granat.  Functional electrical stimulation and rehabilitation , 1994 .

[10]  R. Waters,et al.  Energy cost of walking of amputees: the influence of level of amputation. , 1976, The Journal of bone and joint surgery. American volume.

[11]  G. Obinata,et al.  An electrical knee lock system for functional electrical stimulation. , 1996, Archives of physical medicine and rehabilitation.

[12]  B. Katirji,et al.  Evaluation of a Program for Long-Term Treatment of Duchenne Muscular Dystrophy. Experience at the University Hospitals of Cleveland* , 1996, The Journal of bone and joint surgery. American volume.

[13]  A review of 42 patients of 16 years and over using the ORLAU Parawalker , 1997, Prosthetics and orthotics international.

[14]  Orthotic Options for Standing and Walking , 2000 .

[15]  L. Blanch,et al.  Clinical evaluation of a new orthosis, the `Walkabout', for restoration of functional standing and short distance mobility in spinal paralysed individuals , 1997, Spinal Cord.

[16]  A G Cresswell,et al.  Upper body movement during walking in children with lumbo-sacral myelomeningocele. , 2002, Gait & posture.

[17]  R. Douglas,et al.  Ambulation using the reciprocating gait orthosis and functional electrical stimulation , 1992, Paraplegia.

[18]  G. Scivoletto,et al.  One year follow up of spinal cord injury patients using a reciprocating gait orthosis: Preliminary report , 2000, Spinal Cord.

[19]  J. S. Kaplan,et al.  Predicting the success of reambulation in patients with Duchenne muscular dystrophy. , 1983, The Journal of bone and joint surgery. American volume.

[20]  Rose Gk,et al.  A swivel walker for paraplegics: medical and technical considerations. , 1972 .

[21]  A Pedotti,et al.  Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study , 2003, Spinal Cord.

[22]  J Stallard,et al.  The ORLAU VCG (variable centre of gravity) swivel walker for muscular dystrophy patients , 1992, Prosthetics and orthotics international.

[23]  C A Phillips.  Electrical muscle stimulation in combination with a reciprocating gait orthosis for ambulation by paraplegics. , 1989, Journal of biomedical engineering.

[24]  J Stallard,et al.  A review of reciprocal walking systems for paraplegic patients: Factors affecting choice and economic justification , 1998, Prosthetics and orthotics international.

[25]  Ambulation without wheelchairs for paraplegics with complete lesions , 1978, Paraplegia.

[26]  J Stallard,et al.  A clinical review of the orthotic treatment of myelomeningocele patients. , 1983, The Journal of bone and joint surgery. British volume.

[27]  Myrtice B. Atrice.  Lower Extremity Orthotic Management for the Spinal-Cord-Injured Client , 2000 .

[28]  M. Azaria,et al.  A pilot study to determine the efficiency of lightweight carbon fibre orthoses in the management of patients suffering from post-poliomyelitis syndrome , 1997, Clinical rehabilitation.

[29]  M. Weinstein,et al.  Infections of the spine in patients with human immunodeficiency virus. , 2005, The Journal of bone and joint surgery. American volume.

[30]  S Lotta,et al.  Restoration of gait with orthoses in thoracic paraplegia: a multicentric investigation , 1994, Paraplegia.

[31]  B N Summers,et al.  A clinical review of the adult hip guidance orthosis (ParaWalker) in traumatic paraplegics , 1988, Paraplegia.

[32]  G M Davis,et al.  A medial linkage orthosis to assist ambulation after spinal cord injury , 1998, Prosthetics and orthotics international.

[33]  V. Dietz,et al.  Driven gait orthosis for improvement of locomotor training in paraplegic patients , 2001, Spinal Cord.

[34]  J. Lehmann,et al.  Restraining forces in various designs of knee ankle orthoses: their placement and effect on the anatomical knee joint. , 1976, Archives of physical medicine and rehabilitation.

[35]  Follow-up study on the use of leg braces issued to spinal cord injury patients , 1990, Paraplegia.

[36]  H. Hahn,et al.  Follow-up usage of the Scott-Craig Orthosis in paraplegia , 1981, Paraplegia.

[37]  J L Merritt,et al.  Energy expenditure of paraplegic patients standing and walking with two knee-ankle-foot orthoses. , 1984, Archives of physical medicine and rehabilitation.

[38]  R. Waters,et al.  Energy cost of paraplegic locomotion. , 1985, The Journal of bone and joint surgery. American volume.

[39]  Pneumatic orthosis PILOT STUDY;. , 1975, Archives of physical medicine and rehabilitation.

[40]  R. Brissot,et al.  Restoration of gait by functional electrical stimulation for spinal cord injured patients , 1995, Paraplegia.

[41]  Outcome Study: The Progression of Spinal Deformity in Paraplegic Children Fitted with Reciprocating Gait Orthoses , 1999 .

[42]  Trisha Greenhalgh,et al.  How to read a paper: Papers that summarise other papers (systematic reviews and meta-analyses) , 1997 .

[43]  M Molinari,et al.  A prototype of an adjustable advanced reciprocating gait orthosis (ARGO) for spinal cord injury (SCI) , 2003, Spinal Cord.

[44]  A Chantraine,et al.  Energy expenditure of ambulation in paraplegics: effects of long term use of bracing , 1984, Paraplegia.

[45]  Maarten J. IJzerman,et al.  Validity and reproducibility of crutch force and heart rate measurements to assess energy expenditure of paraplegic gait. , 1999, Archives of physical medicine and rehabilitation.

[46]  D I Rowley,et al.  Energetics of paraplegic walking. , 1992, Journal of biomedical engineering.

[47]  R Waters,et al.  Walking and wheelchair energetics in persons with paraplegia. , 1980, Physical therapy.

[48]  R. D'ambrosia,et al.  Standing and Walking After Spinal Cord Injury: Experience with the Reciprocating Gait Orthosis Powered by Electrical Muscle Stimulation , 2000 .

[49]  ENERGY COST OF WALKING AND OF WHEELCHAIR PROPULSION BY CHILDREN WITH MYELODYSPLASIA: COMPARISON WITH NORMAL CHILDREN , 1983, Developmental medicine and child neurology.

[50]  Dejan B. Popovic.  Dynamics of the self-fitting modular orthosis , 1990, IEEE Trans. Robotics Autom..

[51]  M. D. Lynn.  Orthopaedic Management of High-Level Spina Bifida. Early Walking Compared With Early Use of a Wheelchair. , 1989, The Journal of bone and joint surgery. American volume.

[52]  Maarten J. IJzerman,et al.  Comparative trials on hybrid walking systems for people with paraplegia: An analysis of study methodology , 1999, Prosthetics and orthotics international.

[53]  M. Granat,et al.  The effects of knee and ankle flexion on ground clearance in paraplegic gait. , 2000, Clinical biomechanics.

[54]  E. Marsolais,et al.  Energy costs of walking and standing with functional neuromuscular stimulation and long leg braces. , 1988, Archives of physical medicine and rehabilitation.

[55]  T. Greenhalgh,et al.  Papers that summarise other papers (systematic reviews and meta-analyses). , 1997, BMJ.

[56]  M. Franceschini,et al.  Reciprocating gait orthoses: a multicenter study of their use by spinal cord injured patients. , 1997, Archives of physical medicine and rehabilitation.

[57]  D. Kohn,et al.  The function of the Thomas splint , 1991, Archives of Orthopaedic and Trauma Surgery.

[58]  Energy expenditure and fatiguability in paraplegic ambulation using reciprocating gait orthosis and electric stimulation. , 1996, Disability and rehabilitation.

[59]  C. Phillips.  Functional electrical stimulation and lower extremity bracing for ambulation exercise of the spinal cord injured individual: a medically prescribed system. , 1989, Physical therapy.

[60]  Robert A. Bangham.  Technical Note: Two in One KAFO , 1990 .

[61]  B. Guida,et al.  Body Composition , 2003, International Journal of Obesity.

[62]  A V Nene,et al.  Energy cost of paraplegic locomotion with the ORLAU ParaWalker , 1989, Paraplegia.

[63]  R. Jaeger,et al.  Lower extremity applications of functional neuromuscular stimulation. , 1992, Assistive technology : the official journal of RESNA.

[64]  G M Davis,et al.  Energy expenditure during gait using the walkabout and isocentric reciprocal gait orthoses in persons with paraplegia. , 1998, Archives of physical medicine and rehabilitation.

[65]  J Perry,et al.  Effect of an unrestricted knee-ankle-foot orthosis on the stance phase of gait in healthy persons. , 1990, Orthopedics.

[66]  E Genda,et al.  A new walking orthosis for paraplegics: hip and ankle linkage system , 2004, Prosthetics and orthotics international.

[67]  P. Bowker,et al.  Lightweight, modular knee-ankle-foot orthosis for Duchenne muscular dystrophy: design, development, and evaluation. , 1995, Archives of physical medicine and rehabilitation.

[68]  Jacqueline S. Hebert,et al.  Gait evaluation of an automatic stance-control knee orthosis in a patient with postpoliomyelitis. , 2005, Archives of physical medicine and rehabilitation.

[69]  P J Nichols,et al.  Swivel walkers. Experiences in fitting swivel walkers to children with severe lower-limb deformities. , 1969, Annals of physical medicine.

[70]  J. Petrofsky,et al.  Physiologic costs of computer-controlled walking in persons with paraplegia using a reciprocating-gait orthosis. , 1991, Archives of physical medicine and rehabilitation.

[71]  E. Marsolais,et al.  Report on a conference on motor prostheses for workplace mobility of paraplegic patients in North America , 1993, Paraplegia.

[72]  R J Jaeger,et al.  Rehabilitation Technology for Standing and Walking after Spinal Cord Injury , 1989, American journal of physical medicine & rehabilitation.

[73]  C A Phillips,et al.  A systems approach to medically prescribed functional electrical stimulation. Ambulation after spinal cord injury , 1991, Paraplegia.

[74]  D. Fish,et al.  Lower extremity orthoses and applications for rehabilitation populations. , 2001, Foot and ankle clinics.

[75]  M Massucci,et al.  Walking with the Advanced Reciprocating Gait Orthosis (ARGO) in thoracic paraplegic patients: energy expenditure and cardiorespiratory performance , 1998, Spinal Cord.

[76]  S. Braverman.  Orthotics for the fighting force. , 2002, Physical medicine and rehabilitation clinics of North America.

[77]  K V Kuhlemeier,et al.  Energy cost of ambulation in paraplegic patients using Craig-Scott braces. , 1979, Archives of physical medicine and rehabilitation.

[78]  N. Rosman,et al.  Paraplegic use of walking braces: a survey. , 1974, Archives of physical medicine and rehabilitation.

[79]  T. Bajd,et al.  The use of a four-channel electrical stimulator as an ambulatory aid for paraplegic patients. , 1983, Physical therapy.

[80]  H. Yano,et al.  A new concept of dynamic orthosis for paraplegia: The weight bearing control (WBC) orthosis , 1997, Prosthetics and orthotics international.

[81]  R. D'ambrosia,et al.  Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part II: Medical evaluation of 70 paraplegic patients. , 1997, Orthopedics.

[82]  B. Andrews,et al.  Augmentation of the Oswestry Parawalker orthosis by means of surface electrical stimulation: gait analysis of three patients , 1987, Paraplegia.

[83]  V. Dubowitz,et al.  Prevention of Rapidly Progressive Scoliosis in Duchenne Muscular Dystrophy by Prolongation of Walking with Orthoses , 1988, Journal of child neurology.

[84]  D. Cherry,et al.  Childhood progressive muscular dystrophy and the role of physical therapy. , 1974, Physical Therapy.

[85]  A V Nene,et al.  Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis. , 1990, Archives of physical medicine and rehabilitation.

[86]  F. Ziter,et al.  The value of orthoses for patients with Duchenne muscular dystrophy. , 1979, Physical therapy.

[87]  C. Carstens,et al.  Results of orthotic treatment in children with myelomeningocele. , 1991, European journal of pediatric surgery.

[88]  K R Kaufman,et al.  Optimization and application of a wrap-spring clutch to a dynamic knee-ankle-foot orthosis. , 1999, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[89]  R. Major,et al.  The technique of reciprocal walking using the hip guidance orthosis (hgo) with crutches , 1984, Prosthetics and orthotics international.

[90]  Glen M Davis,et al.  A comparison of the attitude of paraplegic individuals to the Walkabout Orthosis and the Isocentric Reciprocal Gait Orthosis , 1997, Spinal Cord.

[91]  Pelvic band use in orthotics for adult paraplegic patients. , 1975, Archives of physical medicine and rehabilitation.

[92]  Para Walker ambulation for adult tetraplegic patients: Two case reports , 2001 .

[93]  Brian T. Smith,et al.  Three-Year Follow-Up Of An Implanted Functional Electrical Stimulation System For Upright Mobility In A Child With A Thoracic Level Spinal Cord Injury , 2002, The journal of spinal cord medicine.

[94]  Noritaka Kawashima,et al.  Induction of locomotor-like EMG activity in paraplegic persons by orthotic gait training , 2004, Experimental Brain Research.

[95]  The orthotic ambulation performance of paraplegic myelomeningocele children using the ORLAU ParaWalker treatment system , 1991 .

[96]  A Pedotti,et al.  Paraplegic adaptation to assisted-walking: energy expenditure during wheelchair versus orthosis use , 2000, Spinal Cord.

[97]  J K Coghlan,et al.  Lower extremity bracing in paraplegia—A follow-up study , 1980, Paraplegia.

[98]  J. Stallard,et al.  New technical advances in swivel walkers , 2003, Prosthetics and orthotics international.

[99]  Seymour Rj,et al.  Paraplegic use of the Orlau swivel walker: case report. , 1982 .

[100]  R. J. Jefferson,et al.  Performance of three walking orthoses for the paralysed: a case study using gait analysis , 1990, Prosthetics and orthotics international.

[101]  A V Nene,et al.  Physiological cost index of paraplegic locomotion using the ORLAU ParaWalker , 1992, Paraplegia.

[102]  A reciprocating brace with polyplanar hip hinges used on spina bifida children. , 1971, Physiotherapy.

[103]  Nene Av,et al.  Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis. , 1990 .

[104]  P. Åstrand,et al.  Textbook of Work Physiology , 1970 .

[105]  J Stallard,et al.  The influence of orthosis stiffness on paraplegic ambulation and its implications for functional electrical stimulation (FES) walking systems , 1995, Prosthetics and orthotics international.

[106]  E. Marsolais,et al.  Walking with a hybrid orthosis system , 1999, Spinal Cord.

[107]  R. Mikelberg,et al.  Spinal cord lesions and lower extremity bracing: an overview and follow-up study , 1981, Paraplegia.

[108]  J. Lubicky,et al.  Ambulation in children and adolescents with spinal cord injuries. , 1995, Journal of pediatric orthopedics.

[109]  Clinical application of the modified medially-mounted motor-driven hip gear joint for paraplegics , 2000, Disability and rehabilitation.

[110]  Comparative study of conventional hip-knee-ankle-foot orthoses versus reciprocating-gait orthoses for children with high-level paraparesis. , 1997, Journal of pediatric orthopedics.

[111]  L Sykes,et al.  The reciprocating gait orthosis: long-term usage patterns. , 1995, Archives of physical medicine and rehabilitation.

[112]  The potential for ambulation by severely handicapped cerebral palsy patients , 1996, Prosthetics and orthotics international.

[113]  R E Major,et al.  Dynamics of reciprocal gait of adult paraplegics using the Para Walker (Hip Guidance Orthosis) , 1987, Prosthetics and orthotics international.

[114]  A. Nene,et al.  Hybrid paraplegic locomotion with the ParaWalker using intramuscular stimulation: a single subject study , 1989, Paraplegia.

[115]  A V Nene,et al.  Relationship between heart rate and oxygen uptake in thoracic level paraplegics , 1990, Paraplegia.

[116]  L Sykes,et al.  Objective measurement of use of the reciprocating gait orthosis (RGO) and the electrically augmented RGO in adult patients with spinal cord lesions , 1996, Prosthetics and orthotics international.

[117]  Development of Orthoses for People with Paraplegia , 1997 .

[118]  R. D'ambrosia,et al.  Energy consumption in paraplegic ambulation using the reciprocating gait orthosis and electric stimulation of the thigh muscles. , 1990, Archives of physical medicine and rehabilitation.

[119]  C L Gerritsma-Bleeker,et al.  Ambulation with the reciprocating-gait orthosis. Experience in 15 children with myelomeningocele or paraplegia. , 1997, Acta orthopaedica Scandinavica.

[120]  V. Castellano,et al.  Rehabilitation of walking for paraplegic patients by means of a treadmill , 1997, Spinal Cord.

[121]  P. Shekelle,et al.  Clinical guidelines: developing guidelines. , 1999, BMJ.

[122]  Energy expenditure in patients with low-, mid-, or high-thoracic paraplegia using Scott-Craig knee-ankle-foot orthoses. , 1985, Mayo Clinic proceedings.

[123]  The function of the reciprocal link in paraplegic orthotic gait , 2001 .

[124]  S. E. Irby,et al.  Gait of stance control orthosis users: The Dynamic Knee Brace System , 2005, Prosthetics and orthotics international.

[125]  R Ofir,et al.  Orthoses and ambulation in hemiplegia: a ten year retrospective study. , 1980, Archives of physical medicine and rehabilitation.

[126]  B. T. Smith,et al.  Comparison of functional electrical stimulation to long leg braces for upright mobility for children with complete thoracic level spinal injuries. , 1999, Archives of physical medicine and rehabilitation.

[127]  Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicentre controlled study. I. Clinical evaluation , 1995, Paraplegia.

[128]  D. A. Gibson,et al.  Pseudohypertrophic muscular dystrophy and its surgical management: review of 30 patients. , 1970, Canadian journal of surgery. Journal canadien de chirurgie.

[129]  O. Kameyama,et al.  Newly designed computer controlled knee-ankle-foot orthosis (Intelligent Orthosis) , 1998, Prosthetics and orthotics international.

[130]  F. Maynard,et al.  Influence of appropriate lower extremity orthotic management on ambulation, pain, and fatigue in a postpolio population. , 1989, Archives of physical medicine and rehabilitation.

[131]  Maarten J. IJzerman,et al.  The influence of frontal alignment in the advanced reciprocating gait orthosis on energy cost and crutch force requirements during paraplegic gait , 1997 .

[132]  A. Cormerais,et al.  Energy consumption of paraplegic locomotion using reciprocating gait orthosis , 2006, European Journal of Applied Physiology and Occupational Physiology.

[133]  R. Kobetic,et al.  Simulation of a functional neuromuscular stimulation powered mechanical gait orthosis with coordinated joint locking , 2005, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[134]  M. Bernardi,et al.  Ergonomy of paraplegic patients working with a reciprocating gait orthosis , 1995, Paraplegia.

[135]  Harry R Hahn.  Lower extremity bracing in paraplegics with usage follow-up , 1970, Paraplegia.

[136]  A Pedotti,et al.  Estimation of deformation in a walking orthosis for paraplegic patients. , 1993, Clinical biomechanics.

[137]  A. Ohry,et al.  Prosthetic fitting and ambulation in a paraplegic patient with an above-knee amputation. , 1995, Archives of physical medicine and rehabilitation.

[138]  Evaluation of functional electrical stimulation for an incomplete spinal cord injured patient , 1992 .

[139]  Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation , 1995, Paraplegia.

[140]  O. Bar-or,et al.  Growth, Maturation and Physical Activity , 1992 .

[141]  G. Scivoletto,et al.  Urodynamics in spinal cord injured patients walking with reciprocating gait orthosis. , 2000, The Journal of urology.

[142]  J. P. Paul,et al.  Further development of hybrid functional electrical stimulation orthoses , 1996, Spinal Cord.

[143]  J. Halbertsma,et al.  An automatic hinge system for leg orthoses , 2004, Prosthetics and orthotics international.

[144]  J. Lubicky,et al.  AMBULATION WITH PARAPODIA AND RECIPROCATING GAIT ORTHOSES IN PEDIATRIC SPINAL CORD INJURY , 1995 .

[145]  G K Rose.  The principles and practice of hip guidance articulations∗ , 1979, Prosthetics and orthotics international.

[146]  J J Carollo,et al.  A comparison of paraplegic gait performance using two types of reciprocating gait orthoses , 1993, Prosthetics and orthotics international.

[147]  H. Hermens,et al.  Paraplegic locomotion: a review , 1996, Spinal Cord.

[148]  L. Schwirtlich,et al.  Hybrid assistive system-the motor neuroprosthesis , 1989, IEEE Transactions on Biomedical Engineering.

[149]  F. L. Christensen.  Pain in spinal cord injured patients , 1988 .

[150]  An infant reciprocal walking orthosis: Engineering development , 2001, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[151]  Y Morinaka,et al.  Biomechanical study of a knee-ankle-foot-orthosis for hemiplegic patients , 1984, Prosthetics and orthotics international.

[152]  J Stallard,et al.  A long-term review of severely disabled spina bifida patients using a reciprocal walking system. , 2001, Disability and rehabilitation.

[153]  H. Beckerman,et al.  The effects of knee-ankle-foot orthoses in the treatment of Duchenne muscular dystrophy: review of the literature , 2000, Clinical rehabilitation.

[154]  J Stallard,et al.  Clinical Evaluation of Spina Bifida Patients Using Hip Guidance Orthosis , 1981, Developmental medicine and child neurology.

[155]  J. Stallard,et al.  A review of the fundamental design problems of providing ambulation for paraplegic patients , 1989, Paraplegia.

[156]  P. M. Dall,et al.  The functional use of the reciprocal hip mechanism during gait for paraplegic patients walking in the Louisiana State University reciprocating gait orthosis , 1999, Prosthetics and orthotics international.

[157]  The Royal Salop Infirmary "clicking splint". , 1970, Physiotherapy.

[158]  J L Merritt,et al.  Paraplegic energy expenditure during negotiation of architectural barriers. , 1984, Archives of physical medicine and rehabilitation.

[159]  M. Goldfarb,et al.  Preliminary evaluation of a controlled-brake orthosis for FES-aided gait , 2003, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[160]  C A Phillips,et al.  Functional electrical stimulation and reciprocating gait orthosis for ambulation exercise in a tetraplegic patient: a case study , 1991, Paraplegia.

[161]  Patricia A. Deuster,et al.  Exercise Physiology: Energy, Nutrition and Human Performance , 1991 .

[162]  Lehmann Jf,et al.  Restraining forces in various designs of knee ankle orthoses: their placement and effect on the anatomical knee joint. , 1976 .

[163]  The Reciprocating Gait Orthosis in Myelomeningocele , 1984, Journal of pediatric orthopedics.

[164]  V. Dubowitz,et al.  PROLONGATIÓN OF WALKING IN DUCHENNE MUSCULAR DYSTROPHY WITH LIGHTWEIGHT ORTHOSES; REVIEW OF 57 CASES , 1985, Developmental medicine and child neurology.

[165]  Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients , 1996, Prosthetics and orthotics international.

[166]  E Byron Marsolais,et al.  Electronic Orthoses: Technology, Prototypes, and Practices , 1988 .

[167]  K R Kaufman,et al.  Automatic control design for a dynamic knee-brace system. , 1999, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[168]  R. J. Jefferson,et al.  A comparative trial of two walking systems for paralysed people , 1991, Paraplegia.

[169]  C. Phillips,et al.  Walking when utilizing a sensory feedback system and an electrical muscle stimulation gait orthosis. , 1995, Medical engineering & physics.

[170]  M. Menelaus,et al.  Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair. , 1989, The Journal of bone and joint surgery. American volume.

[171]  I Canale,et al.  The efficiency of walking of paraplegic patients using a reciprocating gait orthosis , 1995, Paraplegia.

[172]  S Boccardi,et al.  Biomechanical assessment of paraplegic locomotion with hip guidance orthosis (HGO) , 1993 .

[173]  Volker Dietz,et al.  Obstacle avoidance during human walking: effects of biomechanical constraints on performance. , 2004, Archives of physical medicine and rehabilitation.

[174]  R. Waters,et al.  Gait Performance After Spinal Cord Injury , 1993, Clinical orthopaedics and related research.

[175]  The reciprocation-gait orthosis for children with myelodysplasia. , 1989, Physical & occupational therapy in pediatrics.

[176]  R. D'ambrosia,et al.  The RGO Generation II: muscle stimulation powered orthosis as a practical walking system for thoracic paraplegics. , 1989, Orthopedics.

[177]  R E Major,et al.  Comparison of rocking edge spacing for two common designs of swivel walkers , 2004, Prosthetics and orthotics international.

[178]  Paraplegic locomotion , 1988 .

[179]  O B Luna-Reyes,et al.  Energy cost of ambulation in healthy and disabled Filipino children. , 1988, Archives of physical medicine and rehabilitation.

[180]  K. Siegel,et al.  Effects of withdrawal of bracing in matched pairs of children with osteogenesis imperfecta. , 1998, Archives of physical medicine and rehabilitation.

[181]  E. Ross,et al.  Energy expenditure of walking for adult patients with spinal cord lesions using the reciprocating gait orthosis and functional electrical stimulation , 1996, Spinal Cord.

[182]  J. Michael,et al.  Preliminary Evidence for Effectiveness of a Stance Control Orthosis , 2004 .

[183]  G. Lankhorst,et al.  Prescription pattern for orthoses in The Netherlands: use and experience in the ambulatory phase of Duchenne muscular dystrophy. , 1997, Disability and rehabilitation.

[184]  S. Tashman,et al.  The Case Western Reserve University Hybrid Gait Orthosis , 2000, The journal of spinal cord medicine.

[185]  C. Buckon,et al.  Longitudinal Assessment of Oxygen Cost and Velocity in Children With Myelomeningocele: Comparison of the Hip-Knee-Ankle-Foot Orthosis and the Reciprocating Gait Orthosis , 2001, Journal of pediatric orthopedics.

[186]  Maarten J. IJzerman,et al.  Speed dependence of crutch force and oxygen uptake: implications for design of comparative trials on orthoses for people with paraplegia. , 1998, Archives of physical medicine and rehabilitation.

[187]  B. Heller,et al.  A new hybrid spring brake orthosis for controlling hip and knee flexion in the swing phase , 2001, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[188]  W Van Petegem,et al.  The use of an advanced reciprocating gait orthosis by paraplegic individuals: a follow-up study , 1997, Spinal Cord.

[189]  F E Zajac,et al.  Modeling and simulation of paraplegic ambulation in a reciprocating gait orthosis. , 1995, Journal of biomechanical engineering.

[190]  F Felici,et al.  Cost of walking and locomotor impairment. , 1999, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[191]  Scott Tashman,et al.  Development Of A Hybrid Gait Orthosis: A Case Report , 2003, The journal of spinal cord medicine.

[192]  Frank I. Katch,et al.  Exercise Physiology: Energy, Nutrition, and Human Performance , 2006 .

[193]  G Barnes,et al.  Determinants of gait performance following spinal cord injury. , 1989, Archives of physical medicine and rehabilitation.

[194]  L. Merlini,et al.  PROMOTION OF AMBULATION OF PATIENTS WITH SPINAL MUSCULAR ATROPHY BY EARLY FITTING OF KNEE‐ANKLE‐FOOT ORTHOSES , 1987, Developmental medicine and child neurology.

[195]  Restorative management of paraplegic patient. Philosophy and concept of bracing. , 1968, New York state journal of medicine.

[196]  R. W. Wirta,et al.  Energy‐Efficient Knee‐Ankle-Foot Orthosis: A Case Study , 1996 .

[197]  Kimitaka Nakazawa,et al.  Phase-dependent electromyographic activity of the lower-limb muscles of a patient with clinically complete spinal cord injury during orthotic gait , 1998, Experimental Brain Research.

[198]  R. D'ambrosia,et al.  Reciprocating gait orthosis powered with electrical muscle stimulation (RGO II). Part I: Performance evaluation of 70 paraplegic patients. , 1997, Orthopedics.

[199]  P. Vignos,et al.  Bracing for ambulation in childhood progressive muscular dystrophy. , 1962, The Journal of bone and joint surgery. American volume.

[200]  G M Davis,et al.  Functional outcomes attained by T9-12 paraplegic patients with the walkabout and the isocentric reciprocal gait orthoses. , 1997, Archives of physical medicine and rehabilitation.

[201]  P Bowker,et al.  The physiological benefits of paraplegic orthotically aided walking , 1993, Paraplegia.

[202]  Oxygen costs using a reciprocating gait orthosis in a paraplegic (T9) patient with a bilateral below-knee amputation: Case report , 1997, Spinal Cord.

[203]  R. Douglas,et al.  The LSU Reciprocation-Gait Orthosis. , 1983, Orthopedics.

[204]  J P Paul,et al.  Effects of joint motion constraints on the gait of normal subjects and their implications on the further development of hybrid FES orthosis for paraplegic persons. , 1996, Journal of biomechanics.

[205]  J Stallard,et al.  The dynamics of walking using the hip guidance orthosis (hgo) with crutches , 1981, Prosthetics and orthotics international.

[206]  Maarten J. IJzerman,et al.  The influence of the reciprocal cable linkage in the advanced reciprocating gait orthosis on paraplegic gait performance , 1997, Prosthetics and orthotics international.

[207]  J Stallard.  Walking for the severely disabled: research and development, experience and clinical outcomes. , 2005, The Journal of bone and joint surgery. British volume.

[208]  I. Siegel,et al.  Subcutaneous lower limb tenotomy in the treatment of pseudohypertrophic muscular dystrophy. Description of technique and presentation of twenty-one cases. , 1968, The Journal of bone and joint surgery. American volume.

[209]  Dejan B. Popovic,et al.  Design and evaluation of the self-fitting modular orthosis (SFMO) , 1993 .

[210]  N Chino,et al.  Clinical experience with a new hip-knee-ankle-foot orthotic system using a medial single hip joint for paraplegic standing and walking. , 1996, American journal of physical medicine & rehabilitation.

[211]  R. Waters,et al.  The energy expenditure of normal and pathologic gait. , 1999, Gait & posture.

[212]  A W Heinemann,et al.  Mobility for persons with spinal cord injury: an evaluation of two systems. , 1987, Archives of physical medicine and rehabilitation.

[213]  J. Sibert,et al.  Swivel walkers in Duchenne muscular dystrophy. , 1987, Archives of disease in childhood.

[214]  S. Thomas,et al.  Energy consumption in children with myelomeningocele: a comparison between reciprocating gait orthosis and hip–knee–ankle–foot orthosis ambulators , 1997, Developmental medicine and child neurology.

[215]  D. Guiraud.  Application of an artificial neural network to the control of an active external orthosis of the lower limb , 2006, Medical and Biological Engineering and Computing.

[216]  J Stallard,et al.  The Case for Lateral Stiffness in Walking Orthoses for Paraplegic Patients , 1993, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[217]  Luna-Reyes Ob,et al.  Energy cost of ambulation in healthy and disabled Filipino children. , 1988 .

[218]  Å. Bartonek,et al.  Heart rate and walking velocity during independent walking in children with low and midlumbar myelomeningocele. , 2002, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[219]  Reciprocal walking orthoses for paraplegic patients , 1996 .