Conventional Versus Reciprocating Braces:Effect on Gait and Spinal Posture
MARY L. MORDEN, MD AND EDWARD HERMAN, CO*Baltimore, Maryland
Bracing myelodysplastic children with thoracic or upper-lumbar lesions with trunk-hip-knee-ankle- foot orthotic systems, using standard drop-lock hips and knees, enabled most to walk. In therapy children could demonstrate a reciprocal gait, but most relied on a swing-to or swing-through gait. Most children who used such a system assumed an excessively lordotic posture with persistent low-back pain from facet degeneration and risk of spinal decompensation and scoliosis. Standard orthoses are heavy and hinder walking and sitting; it is usually impossible for the child to stand with hands free.
Four years' experience with the system consisting of polypropylene floor-reaction ankle-foot orthoses with lateral uprights and two forms of the Louisiana State University reciprocator hip section have been satisfactory. The system weighs a fourth of the former braces. Hips are easy to unlock, especially with a newly designed lock. Children often balance independently. The incidence and degree of lumbar lordosis appear decreased, because a lordotic posture would tense the cable keeping both hips locked so the leg could not swing forward.
*Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21205