RGO

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Questions and Answers

What is the primary function of a caster cart?

  • To prevent hip and knee contractures.
  • To provide sitting mobility. (correct)
  • To facilitate standing balance practice.
  • To control involuntary muscle spasms.

What is the primary purpose of using a standing frame?

  • To increase the user's speed and agility.
  • To improve upper extremity strength.
  • To eliminate the need for orthoses.
  • To prevent hip, knee, and ankle contractures. (correct)

A parapodium is designed to achieve which of the following?

  • Limit range of motion.
  • Increase muscle power in lower extremities.
  • Facilitate ambulation and standing without crutches. (correct)
  • Allow sitting only.

The Orlau Swivel Walker is most appropriate for individuals with spinal lesions located where?

<p>L1-C6 (B)</p>
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What is the primary mechanism by which the Orlau Swivel Walker facilitates movement?

<p>Swiveling footplates that inject propulsive forces. (B)</p>
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The Parawalker is characterized by which feature?

<p>It utilizes a rigid body brace to maintain relative legs abduction during swing. (C)</p>
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In Reciprocating Gait Orthoses (RGOs), what mechanical principle prevents both hips from flexing simultaneously?

<p>A cable or other mechanism interconnecting the hip joints. (C)</p>
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Which of the following best describes the primary biomechanical function of the LSU Dual Looped Cable RGO?

<p>Coupling of hip joint motion through Bowden cables, enabling reciprocal gait. (A)</p>
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What distinguishes the Isocentric RGO (IRGO) from other RGO designs?

<p>The absence of a cable system and reliance on a pivoting bar and tie rod arrangement. (B)</p>
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Which of the following is a primary indication for prescribing an RGO?

<p>Flexible hips with no contractures. (D)</p>
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Which of the following conditions is a contraindication for RGO use?

<p>Severe irreducible contractures. (A)</p>
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Before initiating RGO training, what type of exercise is MOST important?

<p>Passive stretching exercises. (A)</p>
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Following donning of an RGO, what is typically the next step in training?

<p>Practice balance while standing. (C)</p>
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During gait training in parallel bars with an RGO, what action initiates forward movement of the opposite leg?

<p>Shifting weight by leaning forward and to the contralateral side. (D)</p>
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During gait training with parallel bars, a client is instructed to "TUCK bottom in by extending trunk." What is the primary purpose of this instruction?

<p>To enhance trunk stability and balance. (C)</p>
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In the context of RGO walking mechanics, what immediately follows right crutch strike?

<p>Early to mid-swing of left foot (D)</p>
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What is a defining characteristic of a Walkabout orthosis compared to traditional HKAFOs?

<p>Laterally placed external hip joints. (D)</p>
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A primary disadvantage of the 'Walkabout' orthosis is described as:

<p>Misalignment of hip and orthotic joints, leading to short steps and energy-expensive gait. (D)</p>
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What is the unique design feature of the Primewalk orthosis?

<p>It incorporates a sliding mechanism to bring the orthotic and anatomical hip joint closer. (B)</p>
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Following gait analysis, a prosthetist determines that a patient ambulating with a Walkabout orthosis exhibits excessive hip abduction during swing phase. What modification would MOST effectively address this gait deviation?

<p>Implementing a sliding mechanism to bring the anatomical and mechanical hip joints into closer alignment. (A)</p>
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According to the gait outcome data presented, which gait parameter is significantly improved with the use of the Primewalk orthosis compared to other devices?

<p>Gait speed (C)</p>
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A physical therapist is working with a child who has paraplegia and is using a Rochester Parapodium. What is the PRIMARY advantage of this device for the child's functional development?

<p>It enables the child to stand, sit, and bend over to grab objects from the floor. (A)</p>
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Which of the following best explains how swinging the arms in opposite directions contributes to propulsion when using a swivel walker?

<p>It produces an inertial torque, increasing the rotational effect produced. (A)</p>
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A 10-year-old child with spina bifida (L3-L4) presents with hip flexion contractures of 15 degrees bilaterally. Which ambulation device would be LEAST appropriate?

<p>Reciprocating Gait Orthosis (RGO) (D)</p>
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A patient with paraplegia is learning to use an RGO with crutches. They are having difficulty advancing their left leg after shifting their weight to the right. What adjustment or cue would be MOST helpful?

<p>Ensuring adequate trunk extension and posterior pelvic tilt. (A)</p>
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A patient with a T10 spinal cord injury is using a Walkabout orthosis. They report feeling unstable and notice that their steps are very short and require significant effort. What is the MOST likely reason for these issues?

<p>There is excessive horizontal rotation of the hip joint in the orthosis. (A)</p>
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A patient with paraplegia who has been using a KAFO expresses interest in progressing towards a more energy-efficient gait pattern. The therapist is considering both Walkabout and Primewalk orthoses. Which of the following statements MOST accurately guides the decision-making process?

<p>The Primewalk, with its sliding joint mechanism, aims to minimize the distance between anatomical and mechanical hip joints, potentially leading to improved energy efficiency compared to the Walkabout. (D)</p>
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What factor would CONTRAINDICATE the use of a swivel walker?

<p>Contractures. (A)</p>
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A 7-year-old child with myelomeningocele (L3) is being considered for a reciprocal gait orthosis (RGO). Which assessment finding would be MOST critical in determining the child's suitability for this device?

<p>The presence of full passive range of motion in the hips and knees. (C)</p>
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A patient with a T4 complete spinal cord injury has been using an RGO for community ambulation. Over time, they report increasing fatigue and difficulty maintaining an upright posture. What intervention would be MOST appropriate?

<p>Re-evaluating the fit and alignment of the RGO and assessing upper extremity strength and endurance. (C)</p>
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A patient with paraplegia is being fitted with a Walkabout orthosis. During the fitting, the therapist notes that the mechanical hip joint center is positioned significantly posterior to the patient's anatomical hip joint center. What is the MOST likely consequence of this misalignment?

<p>Reduced hip extension and increased energy expenditure during gait. (D)</p>
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A physical therapist is comparing the Primewalk and Walkabout orthoses for a patient with mid-thoracic paraplegia. While both devices provide reciprocal gait, what key biomechanical advantage does the Primewalk offer?

<p>Closer approximation of the mechanical and anatomical hip joint centers, potentially improving gait efficiency. (B)</p>
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A researcher is designing a study to compare the energy expenditure of ambulation using KAFOs versus an RGO in individuals with paraplegia. What would be the MOST appropriate primary outcome measure?

<p>Oxygen consumption (VO2) during a six-minute walk test. (C)</p>
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What is the MOST pivotal difference between a standard KAFO and a Walkabout orthosis in terms of design and biomechanical function?

<p>The Walkabout incorporates laterally placed external hip joints to facilitate reciprocal gait, whereas a standard KAFO primarily provides knee and ankle stability. (B)</p>
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A caster cart is primarily used for sitting mobility.

<p>True (A)</p>
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Standing frames are only used to prevent hip contractures.

<p>False (B)</p>
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Parapodiums have joints specifically at the ankles and elbows.

<p>False (B)</p>
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A parapodium allows a patient to ambulate and stand without crutches, but this feature is mandatory.

<p>False (B)</p>
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The Orlau Swivel Walker is designed for individuals with spinal lesions between L1 and C6.

<p>True (A)</p>
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The Orlau Swivel Walker requires additional walking aids for proper use.

<p>False (B)</p>
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Swiveling footplates are used to inject propulsive forces during ambulation.

<p>True (A)</p>
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Inertial torque is produced by swinging arms in the same direction.

<p>False (B)</p>
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A parawalker uses a rigid body brace that only maintains relative legs adduction during swing.

<p>False (B)</p>
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RGO stands for Rehabilitation Gait Orthosis.

<p>False (B)</p>
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In an RGO, both hips can flex simultaneously to allow for sitting.

<p>False (B)</p>
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The reciprocal motion in an RGO is achieved because reciprocal orthotic hip joints are interconnected, usually with a cable.

<p>True (A)</p>
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An Isocentric RGO (IRGO) uses a cable system to provide reciprocal movement.

<p>False (B)</p>
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Severe, but reducible contractures are a contraindication for RGO use.

<p>False (B)</p>
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Spasticity and poor upper extremity strength are both contraindications for RGO.

<p>True (A)</p>
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Calf stretches are a pre-brace treatment.

<p>True (A)</p>
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The first step in training for RGO use is typically walking long distances unassisted.

<p>False (B)</p>
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During gait training in parallel bars, the correct sequence involves moving the right hand forward first.

<p>True (A)</p>
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During the early to mid-swing phase of gait, lateral tilt and trunk rotation in the sagittal plane do not occur.

<p>False (B)</p>
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Walkabout devices are made up of 3 KAFOs.

<p>False (B)</p>
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The Walkabout device is heavier than most traditional RGOs.

<p>False (B)</p>
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Primewalk increases gait speed, cadence, and stride length compared to other RGOs.

<p>True (A)</p>
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The Walkabout uses a sliding mechanism to bring the orthotic and anatomical hip joints closer together.

<p>False (B)</p>
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The LSU Dual Looped Cable RGO has one Bowden cable.

<p>False (B)</p>
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The 'KICK' action during RGO gait training refers to the activation of the cable mechanism.

<p>True (A)</p>
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The primary benefit of the Rochester Parapodium is to restrict movement and ensure complete stability.

<p>False (B)</p>
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A significant knee contracture of greater than 20 degrees is generally acceptable for RGO fitting.

<p>False (B)</p>
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In the gait cycle with an RGO, the right crutch strike always precedes the right heel strike.

<p>True (A)</p>
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A key advantage of the Walkabout orthosis is that it completely eliminates horizontal hip rotation during gait.

<p>False (B)</p>
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One advantage of the single looped cable RGO (ARGO) is that it is more difficult to stand up.

<p>False (B)</p>
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If all other indications are met, obesity will not effect RGO use.

<p>False (B)</p>
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The 'TUCK bottom in by extending trunk' cue ensures the patients extends at the knee to not drag their foot.

<p>False (B)</p>
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The Dual Cable LSU-RGO uses Bowden cables so that one cable can facilitate flexion in hip and the other facilitates shoulder abduction.

<p>False (B)</p>
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Parawalkers use hinge joints with friction to limit both flexion and extension.

<p>True (A)</p>
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Lateral rockers on a parawalker are designed to help lateral truck movement.

<p>True (A)</p>
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Flashcards

Caster Cart Purpose

A cart with casters used for sitting mobility.

Standing Frame Purpose

A device used when a person is ready for standing, providing support.

Standing Frame Benefits

Aids in preventing contractures, maintaining joint ROM, controlling muscle spasms, and facilitating nervous system development.

Parapodium

An orthotic device with joints at the knees/hips that facilitates ambulation and standing without crutches, and allows sitting.

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Rochester Parapodium Function

Allows paraplegic children to stand, sit, and bend over.

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Orlau Swivel Walker

A device for individuals with spinal lesions between L1 and C6, allowing ambulation in an upright position without additional walking aids.

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Swivel Walker Mechanics

Utilizes swiveling footplates to inject propulsive forces, allowing the user to turn and face another direction.

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Inertial Torque in Swivel Walker

Active patients swing arms in opposite direction, which produces an inertial torque, increasing the rotational effect produced.

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Parawalker

A rigid body brace that helps maintain relative legs abduction during swing and stabilizes knees and ankles.

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Reciprocating Gait Orthosis (RGO)

Bilateral HKAFOs or KAFOs with a trunk stabilizing or a pelvic band, interconnected by a cable or other mechanisms.

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RGO Movement Principle

When one leg is flexed, the other leg is extended by the coupled hip mechanism.

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RGO Prevents Jackknifing

This prevents both hips from flexing simultaneously.

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LSU Dual Looped Cable RGO

Two Bowden cables, one attaching anterior and the other attaching posterior to the hip joint; cables transmit forces that enables coupling of flexion of one hip joint and extension of another hip joint.

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Advanced RGO (ARGO)

A modification of LSU-RGO, single push-pull cable that links hip joints; also has a cable that connects hip and knee joints and a pneumatic assist to aid knee extension

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Isocentric RGO (IRGO)

No cable; using a specially designed pelvic band; centrally located pivoting bar and tie rod arrangement.

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Indications for RGO Use

Plantigrade foot, knees with no significant contractures, hips with no contracture and flexible, good upper extremity strength, well motivated, supportive family, necessary walking aids

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Contraindications for RGO Use

Severe irreducible contractures that prevent establishing normal alignment; spasticity or other involuntary muscle activities that prevent free and coordinated mobility; obesity, poor upper extremity strength

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Pre-Brace Stretching

Exercises include calf muscle stretches, hamstring stretches, and hip flexor stretches.

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Pre-Brace Balance Training

Balance training on a bed, chair and a standing frame.

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RGO Training Steps

Learning how to put on the RGO, Stand with orthosis, Sit down with it and balance yourself while standing and sitting; Walk with walking aids.

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Gait Training with RGOs - Right Side

Clear left foot off ground, TUCK bottom in by extending trunk; PUSH down with their arms; KICK – the action of mechanism; Swing left leg through

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Gait Training with RGOs - Left Side

Move left hand forward; SHIFT weight by leaning forward & Left; - Clear right foot off ground; TUCK bottom in by extending trunk; PUSH down with their arms; KICK – the action of the cable; Swing right leg through

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Walkabout Orthoses

Orthotic joint with bilateral KAFOs; Alternative to HKAFOs with laterally placed external hip joints

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Advantages of Walkabout

Light weight, easy to don and doff and easy to use with a wheel chair.

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Disadvantages of Walkabout

Due to misalignment of hip and orthotic joints; Step tends to be short and excessive horizontal rotation of the hip; Results in slow and energy expensive gait

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Primewalk Orthoses

Uses a sliding mechanism to make orthotic and anatomical hip joint closer

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Outcome of Primewalk Orthoses

Faster gait speed, higher cadence and longer stride

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RGO Gait Training

A structured program to practice using a reciprocal gait orthosis

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RGO Gait - Right leg

Move Right hand, shift weight forward and right whilst extending the trunk and pushing down with arms to swing left leg through

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RGO Gait - Left leg

Move Left hand, shift weight forward and left whilst extending the trunk and pushing down with arms to swing right leg through

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Walking mechanics

Right heel strike, right crutch strike, early to mid-swing of left foot, peak of right lateral tilt, left heel strike

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Study Notes

  • Reciprocal Gait Orthoses and other devices are designed for Paraplegic Walking

Caster Cart & Standing Frame

  • Caster carts facilitate sitting mobility.
  • Standing frames are introduced when the individual is ready for standing.

Standing Frame Use

  • Standing frames prevent hips, knees, and ankles contractures.
  • They maintain joint Range of Motion (ROM).
  • They help control involuntary muscle spasms.
  • Standing frames facilitate integrated nervous system development.
  • Orthoses can be used alongside standing frames.

Parapodium

  • Parapodiums feature joints at the knees and hips.
  • They are suitable for patients with insufficient muscle power in the lower extremities and trunk.
  • These devices facilitate ambulation and standing without crutches, though crutches are optional.
  • Parapodiums allow for sitting.
  • Individuals can flex their knees and hips within the parapodium to sit.

Rochester Parapodium

  • Rochester Parapodiums allow paraplegic children to stand, sit, and bend over.
  • These actions can be used to grab objects from the floor.

Orlau Swivel Walker

  • The Orlau Swivel Walker is designed for individuals with spinal lesions between L1 and C6.
  • It allows users to ambulate in an upright position without additional walking aids.
  • The rigid structure of the walker stabilizes the ankles, knees, and hips.

Ambulation mechanics of Swivel Walkers

  • Swiveling footplates inject propulsive forces.
  • Swivel is defined as turning around a central point to face another direction.

Inertial Torque

  • Active patients can swing their arms in opposite directions.
  • This produces an inertial torque, which increases the rotational effect produced.

Parawalker

  • The parawalker is a rigid body brace.
  • It maintains relative legs abduction during the swing phase of gait.
  • Lateral rockers on the brace help with lateral movement of the trunk.
  • Hip joint with limited Flexion / Extension ROM
  • Friction free operation.
  • No linkage.
  • The Parawalker Stabilizes knees and ankles.
  • Simple fastening arrangements allow for easy application and removal.

RGO: Reciprocating Gait Orthosis

  • RGO consists of bilateral HKAFOs or KAFOs.
  • These have trunk stabilization or a pelvic band.
  • Reciprocal orthotic hip joints are interconnected by a cable or other mechanisms.
  • Flexion of one leg causes extension of the other through the coupled hip mechanism.
  • Both hips cannot flex simultaneously, which prevents "jackknifing".
  • Types includes Cord & Pulley, Gear box, Single cable, Dual cable and Isocentric.

LSU Dual Looped Cable RGO (LSU-RGO)

  • Employs two Bowden cables.
  • One cable attaches to the anterior of the hip joint.
  • The other attaches to the posterior.
  • The cables transmit forces.
  • These forces enable coupling of flexion in one hip joint and extension in the other.

Single Looped Cable RGO

  • An advanced RGO device (ARGO)
  • It is a modification of the LSU-RGO.
  • It utilizes a single push-pull cable that links hip joints.
  • The design also includes a cable that connects hip and knee joints.
  • It contains a pneumatic assist to aid knee extension.
  • It is easier to stand up with this RGO.

Isocentric RGO (IRGO)

  • Isocentric RGO does not use a cable.
  • It uses a specially designed pelvic band.
  • It features a centrally located pivoting bar and tie rod arrangement.

Indications for RGO

  • Plantigrade foot posture can be achieved with shoes modifications.
  • The knees should have no significant contracture (5~10°).
  • The hips should have no contracture and should be flexible.
  • Neither rigid nor spastic.
  • Good upper extremity strength is required.
  • The patient should be well-motivated.
  • A supportive, cooperative family environment is beneficial.
  • Walking aids are necessary.

Contraindications for RGO

  • Severe irreducible contractures that prevent establishing normal alignment.
  • Spasticity or other involuntary muscle activities that prevent free and coordinated mobility.
  • Obesity
  • Poor upper extremity strength

Pre-brace treatment for RGO

  • Passive stretching exercises for calf muscles, hamstrings, and hip flexors.
  • Balance training on bed, chair, and standing frame.
  • Standing practice

Training for RGO Use

  • Donning
  • Standing with the orthosis
  • Sitting down
  • Balance
  • Walking with aids

Gait Training in Parallel Bars

  • Move the right hand forward
  • Shift weight by leaning forward and to the right, clearing the left foot off the ground.
  • Tuck the bottom in by extending the trunk.
  • Push down with the arms.
  • Kick: the action of the mechanism involves swinging the left leg through.

Gait Training in Parallel Bars(2)

  • Move left hand forward
  • SHIFT weight by leaning forward & Left
  • Clear right foot off ground
  • TUCK bottom in by extending trunk
  • PUSH down with their arms
  • KICK – the action of the cable
  • Swing right leg through

Walking Mechanics

  • Right heel strike.
  • Right crutch strike coupled with lateral movement to the right commencing.
  • Early to mid-swing of the left foot, including:
  • Lateral tilt to the right
  • Trunk rotation in the sagittal plane.
  • Peak of right lateral tilt.
  • Left heel strike.

Walkabout

  • Orthotic joint with bilateral KAFOs
  • Alternative to HKAFOs with laterally placed external hip joints
  • Made up of 2 KAFOs
  • Connected at the proximal ends of medial uprights
  • The joint has a mechanism of reciprocal gait

Advantages & Disadvantages of Walkabout

  • Advantages: Light weight, easy to don and doff, and easy to use with a wheelchair.
  • Disadvantages: Misalignment of hip and orthotic joints can lead to short steps and excessive horizontal rotation of the hip, resulting in slow and energy-expensive gait.

Primewalk

  • Uses a sliding mechanism to make the orthotic and anatomical hip joint closer.

Walkabout VS Primewalk

  • Gait Outcome
  • Studies show 7 patients with paraplegia achieved:
  • Primewalk: Faster gait speed, higher cadence, and longer stride.

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