Mobility Devices for Upright Support Post SCI

Q14. What evidence is there regarding the efficiency of brace/orthotic devices for upright support and mobility?
1. In persons with complete spinal cord injuries, the limited available evidence does not support that bracing alone will enable significant gains in functional ambulation. The advantages of bracing in such cases appear largely restricted to the general health and well-being benefits related to the practice of standing and the ability to ambulate short-distances in the home or indoor settings. The benefits of bracing alone on functional ambulation primarily involve people with incomplete spinal lesions.
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.
Bracing (alone) in 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.

For more information, please see:Bracing and Bracing with FES


Figure 10a.
Modular ankle-foot orthosis.           

Figure 10b.
Knee ankle foot orthosis.