Clinical evaluation of a new orthosis, the 'walkabout', for restoration of functional standing and short distance mobility in spinal paralysed individuals.

Abstract

The Walkabout orthosis is a relatively new device for assisted standing and mobility in spinal paralysed individuals. The design, with a medially-mounted single-axis hinge joint linking two knee-ankle-foot orthoses, is quite different to other currently available orthoses which have laterally positioned hip joints such as the Reciprocal Gait Orthosis or Hip Guidance Orthosis. Twenty-five spinal cord injured patients were fitted and trained with the Walkabout orthosis and followed up regularly for just under 2 years on average. Sixty percent of all the patients fitted have incorporated use of the Walkabout orthosis into their lifestyles. Maintenance of joint mobility and psychological benefits were the most important outcomes of Walkabout usage. Loss of thoraco-lumbar mobility was found to be a limiting factor in successful use of the Walkabout orthosis in patients without active hip flexion. Patient selection criteria should include demonstrated spinal stability without significant deformity, controlled muscle spasm, less than 5 degrees of hip or knee flexion contracture, achievable neutral ankle position, mobility of the thoraco-lumbar spine into lateral flexion, good upper limb strength, and motivation with realistic expectations.