The influence of the reciprocal hip joint link in the advanced reciprocating gait orthosis on standing performance in paraplegia

The effect of reciprocally linking the hip hinges of a hip-knee-ankle-foot orthosis on standing performance was studied in a comparative trial of the Advanced Reciprocating Gait Orthosis (ARGO) and an ARGO in which the Bowden cable was removed (A_GO). Six male subjects with spinal cord injury (SCI) at T4 to T12 level participated in the study, which was conducted using a single case experimental design. Standing balance, the ability to handle balance disturbances (standing stability), and the performance of a functional hand task during standing were assessed in both orthosis configurations in the order A_GO-ARGO-A_GO-ARGO. No significant differences with respect to standing performance were found for the two orthosis configurations. However, the results indicate that the crutch force needed for maintaining balance during various tasks, especially for quiet standing with two crutches, may be much higher in the orthosis without Bowden cable. Therefore, it is very likely that the reciprocal hip joint link in the ARGO provides a substantial and clinically relevant reduction of upper body effort required for standing under functional conditions.