Clinical experience with a new hip-knee-ankle-foot orthotic system using a medial single hip joint for paraplegic standing and walking.

The Walkabout is a new hip-knee-ankle-foot orthotic (HKAFO) system with a medial single hip joint (MSH-KAFO) invented by S. McKay in 1992. Compared with other HKAFO systems, the hip joint part is compact and removable, so it has distinguishable, real merits: ease in donning and doffing the device, compatibility with a wheelchair, and cosmesis. We clinically tested five patients, paraplegic because of spinal cord injury, using the MSH-KAFO system. All were males, aged 26-36 yr old. Their functional levels were L-1 (2 cases), T-10 (2 cases), and T-5 (1 case). All patients could stand stably without crutches and walk in parallel bars immediately the first time they wore the braces. After a few hours of crutch-walking exercises, all could walk independently with Lofstrand crutches. Their walking velocities ranged from 10 to 37.5 (mean, 19.9) m/min at the follow-up points (mean, 7.1 mo). With four cases, we measured oxygen uptake for predictions of energy consumption. At comfortable walking, predicted energy consumptions were from 1.31 to 3.89 (mean, 2.75) METs. Compared with the data in literature, these seemed to be at the same level with normal walking and lower than the KAFOs walking level. Our results suggest that MSH-KAFO is a very convenient standing and walking device for paraplegics and is compatible with wheelchair use.