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Reciprocating Gait Orthosis - when is it the right direction for your patient? 

RECIPROCATING GAIT ORTHOSIS EXPLAINED

A big advancement in the field of orthotics came into the picture around the 1980s when what we knew of a Hip-Knee-Ankle-Foot-Orthosis (HKAFO) was transformed and taken to a new level by replacing the hip belt with a different pelvic section and hip joint to assist in mimicking a reciprocating gait pattern. When these braces began to be used, they were first fit on children diagnosed with spina bifida. Advancements in technology have since led to patients of varying ages, as well as varying diagnoses being fit with an HKAFO or as we now know them as a Reciprocating Gait Orthosis (RGO). In the past, the RGO was heavy weight and difficult to don (especially for parents and caretakers) and made up of uncomfortable materials. Today, advancements with carbon fiber bracing have made the RGO a lighter weight orthosis and it is now made of more comfortable and moveable materials.  

 “An RGO is a specific type of HKAFO that provides a reciprocating action. A posterior pivot joint and a spring-loaded hip hinged creates a hip flexion force for the swing limb, while the trailing, weight-bearing limb is brought into extension, thus loading the hip hinge in preparation for the next cycle of flexion.” (Lunsford, 2019). To break it down into more general terms an RGO consists of bilateral HKAFOs attached through hinges to a rigid pelvic band with a thoracic extension. A cable system couples hip flexion on one side to hip extension on the contralateral side and thus compensates for a lack of extensor power (Kelly, 2019). In comparison to a statically locked HKAFO, an RGO provides a faster, more energy-efficient gait. The video below shows all the moving parts in action. 

DETERMINING IF YOUR PATIENT IS THE RIGHT CANDIDATE FOR AN RGO   

While an RGO can offer some benefits over other HKAFOs, not everyone is a candidate. There are a wide variety of diagnoses that an RGO can be beneficial for, however it heavily depends on how the patient presents, degree of diagnosis/disability, and what their goals, strengths and weaknesses are. Some diagnoses frequently fit with RGO’s include spinal cord injury, spina bifida, and cerebral palsy.  

Factors and/or presentations to consider when determining if a patient is a candidate for an RGO is overall body weight, neurosegmental level, good head and neck control, minimal lower limb contractures, minimal lower limb deformities, good upper limb strength, motivated and compliant patient and a strong support system.

Other indications include T4-L4 paraplegia, feet should be plantar grade (minor deviations can be corrected with modifications to the shoes such as wedges), knees should be free from significant contractures of <10 degrees, hips should be free of contracture and flexible, not rigid or spastic, and ability to use walking aids, such as crutches or walker (Fillauer, 2018). If a patient lacks in one of the indications listed above, it does not mean they are automatically ruled unable to be fit with an RGO. Some modifications can be made to an RGO to accommodate certain presentations or conditions. It is best to be evaluated by an experienced practitioner to determine if your conditions can be accommodated for. 

Contraindications for an RGO include severe flexed hip and knee contractures that prevent the establishment of normal alignment, spasticity or other involuntary muscle activity that prevents free and coordinated mobility, marked obesity, poor upper body strength, and contractures greater than 30 degrees in the hips, knee or ankles (Fillauer, 2018). Depending on the severity, some contraindications (such as upper extremity strength and contractures/tightness) listed can be corrected with extensive physical therapy involving stretching and strengthening exercises.  

See a Reciprocating Gait Orthosis in action!

CHOOSING AND FABRICATING THE RIGHT RGO FOR YOUR PATIENT 

There are multiple moving parts with an RGO. Once a thorough exam is completed and it’s determined the patient is a candidate, the practitioner will have to decide on the design and type of componentry used to make the patient most successful with overall fit and function. Component selection will include the pelvic section design and componentry, hip joint type, knee joint type, AFO design, and material selection. These complicated devices can be very difficult to fabricate which is why many offices tend to shy away from evaluating and fitting them. The team at Tillges has evaluated, fabricated, and fit many RGOs for varying ages and the patients have had great success with their devices!

If you are currently wearing an HKAFO and are looking at potentially progressing to a Reciprocating Gait Orthosis device, or you are a new patient looking for more information, please contact Tillges today to schedule a consultation with one of our experienced practitioners!  

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RESOURCES 

  1. https://fillauer.com/wp-content/uploads/2020/03/m009b-rgo-selection-1.pdf
  2. https://www.sciencedirect.com/science/article/abs/pii/B9780323483230000342
  3. https://www.sciencedirect.com/science/article/abs/pii/B9780323483230000317 https://www.oandplibrary.org/cpo/pdf/1987_02_079.pdf

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