A reciprocating gait orthosis (RGO) is also a HKAFO however it allows one leg to be placed ahead of another – more like normal walking. This is achieved by linking the two KAFOs together by a band, two cables or a push-pull rod which transfers movement energy from one leg to the other. Therefore as one leg is flexed or brought forward, it causes a reciprocal extension of the other leg. This allows a much smoother gait and greatly reduces the amount of effort that is needed to walk. A walker can often be abandoned for forearm crutches.
RGOs tend to be most successfully used for children with spina bifida starting as young as 2.5 years old but have been used by children with other diagnoses. RGOs are sometimes used for adult paraplegics but often a wheelchair becomes the preferred mode of transportation for the adults.
The RGO is commonly used for individuals with a lesion level of T12 to L3 (although higher levels are possible) who lack adequate strength to maintain hip extension. Good upper extremity strength, high motivation levels, good family support and minimal contractures definately contribute to the successful use of the device.
ADVANTAGES OF THE RGO
There are two significant advantages to the RGO system over conventional orthoses for the paraplegic individual. The first advantage is that, the RGO is energy efficient. The wheelchair offers the advantages of speed and has the energy demands comparable to walking by normal individuals. Two point swing-to gait with crutches increases energy requirements 33% over normal walking, and a faster swing-through gait increases the energy consumption to 78%. Ambulation with the RGO system has energy demands significantly less than the use of standard HKAFO’s with crutches. Thus, ambulation with the RGO system is energy efficient without sacrificing speed when compared to using HKAFO’s.
A second major advantage of the RGQ, especially in the adult paraplegic, is the ability to stand unassisted with security and confidence. In standing, the orthotic device prevents bilateral flexion and extension from occurring simultaneously unless the hip joints are unlocked in preparation for sitting. As one hip tends to flex, as occurs when one falls forward, the other hip automatically extends with the same degree of force, thus preventing the fall. With practice, the paraplegic can learn to stand for long periods of time with no assistance, thus freeing the upper extremities for work or play activities. Therefore, the RGO system offers two distinct advantages over traditional HKAFO’s. First, it enables an energy efficient reciprocating gait, and second, allows the individual to stand comfortably and safely, freeing up the upper extremities for other activities.