2. There is limited evidence that a combined approach of bracing and FES results in additional benefit to functional ambulation in paraplegic patients with complete SCI.
There are several devices available for bracing the legs in persons with complete SCI to support standing and walking. SCIRE foundlimited level 4 evidence that bracing alone results in significant gains in functional ambulation for people with complete SCI. However, this patient does not have a complete lesion and it must be noted that for people with incomplete SCI, bracing (Ankle Foot Orthosis (AFO)-use) alone during walking can enhance gait speed and endurance when compared with walking without an AFO.
Bracing Combined with FES in SCI
Hybrid systems combine conventional bracing with FES to activate large lower extremity muscles in the hopes of improving the gait pattern, reduce upper extremity exertion and improve trunk and hip stability. Regarding this case, there is some indication that a combination of bracing and FES provides greater ambulatory function than either approach alone in incomplete SCI.
Figure 10a. Modular ankle-foot orthosis.
Figure 10b. Knee ankle foot orthosis.