The Use of the Reciprocating Gait Orthosis in Myelodysplasia
KENNETH J. GUIDERA, M.D., ELLEN RANEY, M.D., JOHN A. OGDEN, M.D., LINDA PUGH, R.N., JACKIE FROST, R.N., SANDY SMITH, R.P.T, AND DANIEL GRINER, C.P.O.
There are physical and psychological advantages to an upright posture and ambulation in myelodysplasia. The reciprocating gait orthosis (RGO) allows this activity by passively extending the hip as the contralateral side flexes. Thoracic level patients shift their trunk weight in order to motor the RGO. This orthosis has been available since 1969, with multiple authors reporting high success rates of ambulation. This review was undertaken to retrospectively evaluate the long term usage patterns at this institution. Twenty-one myelodysplastic patients having the RGO prescribed were recalled for evaluation. There were 13 males and 8 females. The average age was 8 years, 9 months. Nine had thoracic level lesions and 12 lumbar. The average usage time of the RGO was 25.8 months. All required surgical correction of lower limb or spine deformities prior to or during the bracing period. Seventeen exhibited residual contractures. Eleven required additional spinal orthotic support. All patients reported problems with donning and doffing, clothing, heat, other orthoses, multiple repairs, and down time. Ten of the twenty-one patients persisted with the RGO usage, but only four were community ambulators. The majority of usage was at school compared to home ambulation. The energy efficiency of three patients was evaluated. All were more energy efficient and two were faster with a swing through gait pattern as compared to the reciprocating pattern. However, each preferred to reciprocate. Various factors were evaluated which may contribute to the long term success or failure of this orthosis. Based on this review it was clear that there should be careful patient selection for RGO prescription. Negative variables included a thoracic lesion, obesity, lack of patient or family support, spinal deformity, mental retardation, knee flexion contracture over 30°, hip flexion contracture over 45°, spasticity, trunk and upper extremity weakness, asymmetrical hip dislocation or motor function, and lack of prior standing or walking in a parapodium or other orthosis. Presence of these factors adversely affected long term usage and ambulation. However, in carefully selected myelodysplastic patients this orthosis is an effective tool for ambulation and the prescribing physician should be aware of the pitfalls and negative patient variables.
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