The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients: a literature review.

OBJECTIVE The most simple and common approach in providing standing and walking by subjects with spinal cord injury (SCI) is the use of mechanical orthoses. These include traditional orthoses, medial linkage orthoses (MLOs) and reciprocating gait orthoses (RGOs). Independence, energy expenditure, gait parameters, system reliability and cosmesis are important factors in orthotic design. The aim of this review was to compare the evidence of existing mechanical orthoses to that of other types regarding these factors. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) method was used by an experience researcher based on selected keywords and their composition and an electronic search was performed in well-known databases. RESULTS Twenty articles were selected for final evaluation. Many were case studies, and also had limited and heterogeneous sample sizes with different instruments used for evaluation. The results of the analysis demonstrated that independence and cosmesis are improved when using MLOs, but gait parameters, energy expenditure and stability are all improved when using RGOs. CONCLUSION Those mechanical orthoses which have reciprocal motion and congruency between the anatomical and orthotic joints have been shown to provide positive effects on patient lifestyles. However, further improvement is needed to more effectively meet the needs of SCI patients. IMPLICATIONS FOR REHABILITATION The most simple and traditional approach to enable standing and walking by people with SCI is use of purely mechanical orthoses. The most important factors that increase rejection rates of orthoses in paraplegia patients are excessive energy expenditure and increased applied force on upper limb joints. Improvement of the structure of mechanical orthoses is needed to improve independence, energy expenditure, and gait parameters, and is an important approach to improve ambulatory function in subjects with paraplegia.