Functional walking ability of paraplegic patients: comparison of functional electrical stimulation versus mechanical orthoses

Abstract

Spinal cord injury (SCI) can cause partial or complete paralysis of the lower extremities, impairing the ability of individuals to stand and walk. Various types of mechanical orthoses, functional electrical stimulation (FES) systems and hybrid orthoses that incorporate FES have been designed to restore the ability of individuals with SCI to stand and walk. Standing and ambulation performance of SCI subjects using these different systems have been previously evaluated using energy consumption analysis, stability analysis and by quantitative gait analysis. Though FES-based systems are technologically more complex than passive mechanical systems, it is not apparent whether user performance is substantially improved with FES and hybrid orthoses compared to purely mechanical orthoses. An electronic search was performed via the Pubmed, Embase and ISI Web of Knowledge data base from 1960 to 2010. The abstracts, titles and full details of each individual study were assessed by the authors. The findings that were indicative of users' performance with the FES systems and hybrid systems were compared with that of mechanical orthoses. Moreover, the effects of using these different systems on physiological health were evaluated. Twelve original articles and 5 review articles were selected by the author. However, most of the original articles were case studies. The results of previous investigations indicate that user performance with the mechanical orthoses was generally better than that of the hybrid and FES systems based on subject's stability and energy consumption while walking. Moreover, subject reportedly experienced a higher incidence of problems with the use of hybrid orthoses and FES systems compared with mechanical orthoses. FES and hybrid orthoses offer considerable potential for restoring standing and walking abilities in persons with SCI. However, improvements in their designs and operation with subsequent objective evaluations are required to demonstrate that these systems enable users to improve their performance over that currently possible with passive, mechanical orthoses.