The Journal of Bone and Joint Surgery, Vol 67, Issue 8 1245-1250, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
Energy cost of paraplegic locomotion
RL Waters and BR Lunsford
We measured the physiological energy expenditure that was associated with
several modes of mobility in 151 individuals with paraplegia that resulted
from spinal cord injury. The relationship of the neurological level of the
spinal lesion, extent of paralysis, orthotic requirement, and type of gait
pattern was evaluated. The patients who required a bilateral
knee-ankle-foot orthosis in order to walk with a swing-through
crutch-assisted gait had an average rate of oxygen consumption that was 43
per cent greater than that of the patients who used a wheelchair and 38 per
cent greater than was required for normal walking. Their average walking
speed was slow in comparison with wheelchair propulsion or normal walking.
Furthermore, the paraplegics in whom the hip flexor and knee extensor
muscles were intact bilaterally and who were able to walk with a reciprocal
crutch-assisted gait, but did not require knee-ankle-foot orthoses, did no
better. They had a rate of oxygen consumption that was 20 per cent greater
than that required for wheelchair use and 15 per cent greater than that
required for normal walking. In addition, their mean walking speed was the
slowest of all of the groups. These findings account for the common
clinical experience that most paraplegics who require a knee-foot-ankle
orthosis bilaterally and use a swing-through crutch-assisted gait prefer to
use a wheelchair, and discontinue walking as the primary means of
mobilization after gait-training.(ABSTRACT TRUNCATED AT 250 WORDS)
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