S-3-10-03
A SINGLE BAR KAFO WITH "INTELLIGENT" KNEE HINGE (UTX-SWING)
Heleen B. Braak-Vcldsink (Roessingh Rehabilitation Center, Enschede, the Netherlands)
Purpose: To compare the useability of the classic KAFO and UTX-swing.
Method:
Patients: 22 patients with a flaccid paresis up to paralysis of the leg using a classic doublebar KAFO with or without locked knee hinges.
UTX-sing: The lightweight (750 gr) single (lateral) bar KAFO has a knee hinge which moves free at the swingphase, locks at heel strike and delocks at the end of the stance phase. The fitting of the UTX-swing with the leg occurs via 4 tilting pads.
Measurements: Measurement of energy consumption (O2), gate pattern (kinematically, using Giga and VICON-system) and subjective useability (questionnaire with VAS-score method).
Results/conclusion: Twelve patients prefer the UTX-swing especially because of the wearing comfort and in less measure the cosmetics. Both orthoses do not differ significally in energy consumption and gate pattern. Ten patients prefer their classic KAFO because of missing a tuber seat and problems with delocking the knee hinge. The latter happens in patients with a muscle force of hip- or knee extensors < grade 3, a knee flexion contracture and dorsi-plantar (flexion) of the ankle 10-15°.
S-3-10-04
DEVELOPMENT OF A HIP-KNEE-ANKLE-FOOT-ORTHOSIS FOR PARAPLEGICS
M.J. IJzerman, G. Baardman, H.J. Hermens, P.H. Veltink, H.B.K. Boom and G. Zilvold
Purpose: A high energy expenditure is often considered as a major limitation of walking systems for paraplegic individuals. A new HKAFO was developed aiming at improved userfriendliness and reduced energy expenditure.
Methods: Four comparative studies were conducted in which we investigated the influence of small alterations in the Advanced Reciprocating Gait Orthosis on energy expenditure. Energy expenditure was assessed by means of oxygen uptake and crutch force measurements. The results of the studies were used in order to optimise the new Hip-Knee-Ankle-Foot-Orthosis for energy expenditure.
Results: A reciprocal cable linkage was found to improve standing performance. Removal of the reciprocal linkage, aiming at a free ballistic swing phase, did not reduce energy expenditure. Alignment of the orthosis in abduction (frontal plane) was beneficial, because stance leg crutch peak forces were reduced. Knee flexion during swing phase was studied in an early prototype of the orthosis. Knee flexion in a mechanical orthosis is a passive mechanism due to hip flexion and inertia of the lower leg. No advantages with respect to energy expenditure were found.
Conclusion: Reduction of energy expenditure during paraplegic walking in mechanical orthoses is a difficult research objective. Only small improvements can be expected.
