**7. Orthotic gait training of SCI subjects with powered gait orthoses**

Providing gait training in different environments such as clinic, home, or community announced as the main benefit of wearing powered gait orthosis [3]. Only limited PGOs are currently commercially available to the public and therefore would be able to be used

in the field in SCI subjects. The concept of using PGOs is the reduction of energy demand

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The HAL-5 Type-C (hybrid assistive limb) (**Figure 8**), the ReWalk powered orthosis (Argo Medical Technologies) (**Figure 9** ), the wearable power assist locomotor (**Figure 10**), and the eLEGS-powered orthosis (Berkeley Bionics) (**Figure 11**) are commercially powered orthoses

In the evaluation of the gait training with the HAL-6LB on the SCI subject for 8 days, for 2 hours per day, Tsukahara et al*.* reported that walking speed and cadence were 0.11 m/s and

in uses and reduces loads on the upper limb joints.

**Figure 11.** The eLEGS-powered orthosis (Berkeley Bionics).

for ambulation in SCI subjects.

**Figure 10.** The wearable power assist locomotor.

**Figure 8.** The HAL-5 type-C (hybrid assistive limb).

**Figure 9.** The ReWalk powered orthosis (Argo Medical Technologies).

Role of Gait Training in Recovery of Standing and Walking in Subjects with Spinal Cord Injury http://dx.doi.org/10.5772/intechopen.71312 115

**Figure 10.** The wearable power assist locomotor.

in the field in SCI subjects. The concept of using PGOs is the reduction of energy demand in uses and reduces loads on the upper limb joints.

The HAL-5 Type-C (hybrid assistive limb) (**Figure 8**), the ReWalk powered orthosis (Argo Medical Technologies) (**Figure 9** ), the wearable power assist locomotor (**Figure 10**), and the eLEGS-powered orthosis (Berkeley Bionics) (**Figure 11**) are commercially powered orthoses for ambulation in SCI subjects.

In the evaluation of the gait training with the HAL-6LB on the SCI subject for 8 days, for 2 hours per day, Tsukahara et al*.* reported that walking speed and cadence were 0.11 m/s and

**Figure 11.** The eLEGS-powered orthosis (Berkeley Bionics).

**Figure 9.** The ReWalk powered orthosis (Argo Medical Technologies).

**Figure 8.** The HAL-5 type-C (hybrid assistive limb).

114 Essentials of Spinal Cord Injury Medicine

20 steps/minutes, respectively [44]. In the evaluation of Rewalk exoskeleton on safety and tolerance in SCI patients, Zeilig et al. reported that mean time to walk 10 m was 47 seconds following training when using the Rewalk [45]. In another study, distance walked for 50–100 m announced between 5 and 10 minutes continually. The mean walking speed was 0.25 m/s [46]. In the evaluation of the wearable power assist locomotor orthosis (WPAL) on walking, physiological cost index (PCI) and muscle activity of the upper extremities in SCI subjects, Tanabe et al. reported all patients walked independently with the new powered device. The increased walking duration and distance of walking and reduction of the PCI and muscle activity of upper limbs with the WPAL compared to that the Primewalk orthosis [47]. Based on the literature in this field, we can conclude that PGOs can enable safe walking and reduce energy expenditure compared to mechanical orthoses in SCI subjects.

Orthotic training in SCI subjects can be reduced fatigue and fear of falling and increased the stepping [61]. It was announced that after training program, SCI subjects had walking ability and performance of activity of daily living. The SCI subjects may have less energy demand during walking with orthoses compared to without orthotic gait training condition [32].

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Complications of SCI such as spasticity, joint contractures, pressure sores, osteoporosis, and urinary tract infections may be present in subjects with SCI [1, 2]. Standing and walking provides physiological and psychological benefits for individuals with SCI [3]. A reduction of bed sores, osteoporosis, spasticity, contractures, and improvement of bladder and bowel functions have all been announced after standing and walking in subjects with SCI [1, 4].

• The effect of orthotics gait training on the electromyography of the lower limb muscles

• Comparison between orthotics gait training with RGOs and powered orthosis on the walk-

1 Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation

2 Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[1] Eng JJ, Levins SM, Townson AF, Mah-Jones D, Bremner J, Huston G. Use of prolonged standing for individuals with spinal cord injuries. Physical Therapy. 2001;**81**(8):1392-1399

[2] Anson C, Shepherd C. Incidence of secondary complications in spinal cord injury.

[3] Walter SJ, Sola GP, Sacks J, Lucero Y, Langbein E, Weaver F. Indications for a home standing program for individuals with spinal cord injury. The Journal of Spinal Cord

International Journal of Rehabilitation Research. 1996;**19**(1):55-66

, Mohammad Ebrahim Mousavi<sup>1</sup>

and Maryam Maleki1

**10. Positive results of walking in SCI subjects**

Orthotic gait training is the intervention, which can help in SCI subjects.

• The effect of orthotics gait training on the quality of life in SCI subjects

Future study in this field must be focused on the following terms:

ing parameters and other related parameters

\*, Guive Sharifi2

\*Address all correspondence to: m.arazpour@yahoo.com

**Author details**

Mokhtar Arazpour1

Sciences, Tehran, Iran

Medicine. 1999;**22**(3):152-158

**References**
