Reciprocating Gait Orthosis

A special HKAFO, which uses a mechanical linkage to couple flexion of one hip with extension of the other, which enables a reciprocal step-over-step gait.

Also allow swing through and swing to gaits

1. Reciprocating Gait Orthosis Dr joe antony Md (Physical medicine and rehabilitation) kgmu,lucknow 1

2. Reciprocating Gait Orthosis A special HKAFO, which uses a mechanical linkage to couple flexion of one hip with extension of the other, which enable s a reciprocal step-over-step gait. Also allow swing through and swing to gaits AAOS Atlas of orthosis and Assistive devices 2

3. Parts 3 Reciprocating mechanism Custom moulded pelvic shell Hip joints Thigh pieces Off set knee joint with drop locks Plastic AFO

4. Types of Reciprocating mechanisms Cord and Pully design Gear box cable ( Bowden cables) Single Cable Dual Cable Isocentric RGO Latest design 4

5. Isocentric RGO Constructed according to lower limb casting Includes a thoracic shell also Reciprocating mechanism is a Pivot bar reciprocating link Arazpour M, Gholami M, Bahramizadeh M, Sharifi G, Bani MA. Influence of Reciprocating Link When Using an Isocentric Reciprocating Gait Orthosis (IRGO) on Walking in Patients with Spinal Cord Injury: A Pilot Study. Top Spinal Cord Inj Rehabil. 2017 Summer;23(3):256-262. doi: 10.1310/sci16-00016. Epub 2017 May 4. PMID: 29339901; PMCID: PMC5562033. 5

6. Pre requisites At least grade 3 power of hip flexors Upper trunk balance Adequate Cognitive function Adequate upper limb function for assistive devices AAOS Atlas of orthosis and Assistive devices 6

7. Indication Paraplegia with at least 3/5 power in hip flexors and lesser power in hip extensors Traumatic paraplegia MMC sequel Transverse myelitis SOL of Spinal canal Potts spine AAOS Atlas of orthosis and Assistive devices 7

8. Contra indications Hip Flexion Contractures Spasticity in hip flexors Orthostatic hypotension Poor cardiopulmonary endurance 8

9. Advantages Decreases energy expenditure Can achieve four point gait with two crutches Improve confidence and balance in new paraplegics Can gradually wean out to KAFOs Advantage of irgo over other rgo No protruding wires/cables over back More cost efficient than other RGOs No energy loss due to friction between cables- hence more energy efficient. 9

10. Evidence for RGOs 10

11. Thank you REFERENCES The HELP guide to cerebral palsy AAOS Atlas of orthosis and Assistive devices Braddoms textbook of PMR Böhm H, Matthias H, Braatz F, Döderlein L. Effect of floor reaction ankle-foot orthosis on crouch gait in patients with cerebral palsy: What can be expected? Prosthet Orthot Int. 2018 Jun;42(3):245-253. doi : 10.1177/0309364617716240. Epub 2017 Jul 11. PMID: 28693377. Arazpour M, Gholami M, Bahramizadeh M, Sharifi G, Bani MA. Influence of Reciprocating Link When Using an Isocentric Reciprocating Gait Orthosis (IRGO) on Walking in Patients with Spinal Cord Injury: A Pilot Study. Top Spinal Cord Inj Rehabil . 2017 Summer;23(3):256-262. doi : 10.1310/sci16-00016. Epub 2017 May 4. PMID: 29339901; PMCID: PMC5562033. Campbells textbook of operative orthopedics Mueller M.J, Diamond J.E,  Sinacore  D.R, et al. Total contact casting in treatment of diabetic plantar ulcers. Controlled clinical trial.  Diabetes Care . 1989;12(6):384–388. PMID: 2659299 Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB: Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24(6):1019–1022. Messenger G, Masoetsa R, Hussain I. A Narrative Review of the Benefits and Risks of Total Contact Casts in the Management of Diabetic Foot Ulcers. J Am Coll Clin Wound Spec. 2018 Jun 7;9(1-3):19-23. doi : 10.1016/j.jccw.2018.05.002. PMID: 30591897; PMCID: PMC6304285. Cakar E, Durmus O, Tekin L, Dincer U, Kiralp MZ. The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. Eur J Phys Rehabil Med. 2010 Sep;46(3):363-8. Epub 2010 Jul 1. PMID: 20927002. 11