**8. Orthotic gait training with hybrid system (bracing combined with FES) in SCI**

High level of energy demand and high effort and loads on the upper limb joints announced the main complication of the orthotics gait rehabilitation with mechanical orthoses. Combination of the mechanical orthoses and FES innovated to improve gait parameters and reduce the loads and energy demand in SCI subjects. The main concept of the using this type of approach announced trunk and hip stability and facilitate forward progression.

Different studies in this field evaluated the hybrid systems on the walking capacity in SCI subjects [38, 40, 48, 49]. Distance walked was announced as 180–1400 m in these studies [38, 40, 48, 49]. Although there was no significant improvement in the walking speed, but improvement in the distance walked was observed in trails in this field. The rate of the distance walked was announced between 3 and 400 m when the FES or orthoses were trained alone [38, 40, 48]. In subjects with incomplete level of spinal cord injury, the gait training with hybrid systems provided improvement in ambulation capacity compared to bracing or FES using alone [50].
