HIP GUIDENCE ORTHOSIS (HGO)

 

A hip guidance orthosis (HGO), also known as the Orthotic Research
and Locomotor Assessment Unit (ORLAU) Parawalker, developed to overcome the
disadvantages of swivel walker

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•                   
A rigid body brace through which the
relative abduction of the legs can be maintained

•                   
HKAFO with free-moving hip joints that
allow a reciprocal gait pattern

•                   
To offer patients to walk reciprocally
with crutches

•                   
It consists of bilateral KAFOs with
all bearing hip joint along with body brace

•                   
Movement is preferred via trunck
motion transmitted to the lower legs with help of hip flexion and extension.

•                   
Hip Flexion – can be  restricted by stop

•                   
HIP Extension – can be limited or free

 

 

RECIPROCATION GAIT ORTHOSIS (RGO)

 

·        
These are often prescribed for the
patients with post Spinal Cord Injury paralysis or coordinates similer to the
post polio paralysis.

·        
In children from 2.5 yrs age with
spina bifida the RGOs are successfully being used. A majority of the adult
patients with paraplegics preferred to use wheel chair for transportation but
RGOs offer a better and attractive kind of freedom.

·        
RGO is a highly specialized orthotic
device which works on the reciprocating gait principle. 

·        
It means that when patient flexes his
right hip, the device provide the stability to the patient by providing the
extension of the left hip. This allows the patient to stand without support and
walk . With the time passing the technology has made it more comfortable for
patients to walk with RGOs.

·        
This is the only device that permits
the hands free standing without immobilizing the hips.

·        
The legs are linked with the torso
section.so the hip flexion and extension movements can freely occur while
standing to take steps. But the torso is restricted from forward flexion.

Benefits

•                   
Provides maximum stability at hip,
knee, foot and ankle joints

•                   
It can be manufactured from plastic ,
carbon somposites and hybrid variations

 

 

HIP JOINT
OPTIONS :      Free, Variable Range of
motion, Flexion , Extension , Abduction, Fixed, Locked, off –set

KNEE JOINT
OPTIONS:   Free, Drop Locak, Stance
Control , Off-set Knee, Extension assist, Electronic control , Variable range
of motion , Fixed range of motion

ANKLE JOINT
OPTIONS: Solid, Semi Rigid , Articulated,
Double Action, Variable range of motion, planter and dorsiflexion, assists and
stop.

 

 

COMMON DESIGNS OF RECIPROCATING ORTHOSES (RGO)

 

A reciprocating gait orthosis
(RGO) is an HKAFO that uses?a mechanical system that connects
the two sides of the brace ?by an

•                   
isocentric bar (IRGO),

•                   
double cable (LSU RGO from Louisiana
State University), or

•                   
single push/pull cable?system (advanced RGO ARGO developed
by Hugh             

 

•                   
ISOCENTRIC RGOs  The couple cables are replaced by the
centrally pivoted bar and tie rod arrangement. A study shows that the
Physiologic cost index is decreased in SCI patients while using the ISO Centric
RGOs.

 

•                   
MECHANICAL RGOs concists of bilateral
KAFOs , consists of licking knee joints, hip jointys, cutom molded pelvic
girdle and thoracic aextension. TO prevent the simultaneous hip flexion the hip
joints are coupled with cables. Through the cable the hip extension on one side
coupled with hip flexion on the other side.

 

•                   
MODERN RGOs are supported with
software and stepper motors.

 

 

COMPARING THE DESIGN CONCEPTS OF THE RGO & HGO

 

HGO

·        
HIP JOINT – with limited flextion
& Extension with  Friction free
option

·        
HKAFO with free-moving hip joints that
allow a reciprocal gait pattern

·        
Shoe Place incorporated with rocker
sole

·        
Simple fastening arrangements

RGO

·        
Consists of two HAFOs coupled together
through a system of gears at a certain level just above the hip.

·        
Advancement of one orthoses reacts
with the other .

RELATIVE ADVANTA GES & DISADVANTAGES OF EACH SYSTEM

a.       One
of the reported advantage of the HGOs are the provision of lateral stiffness.
This prevents the adduction during the swing phase of free limb.

b.      Second
is the broad foot plates that enhance stability during the double stance phase.

c.       A
study shows that HGOs produced extra efficient gait and better walking velocity
than RGOS in SCI patients with mid to high level of injuries

d.      In
another study it was found that patient felt more ease of donning and doffing
with HGOs while RGOs are given preference due to their appearance, and
provision of stability in standing.

e.      One
study found that users commented that the RGO manage was easy on rough area.

f.       
Energy consumption in IRGOs is less

g.       A
study presented that HGO required fewer repairs than RGOs

b)      It is
important to understand the one should be very careful when comparing the
outcomes of these braces in studies. Current researches have considerable
difference in orthotic designs, ages, assistive devices , age group,
professional caregiver support, and orthotic experience. The level of injury
also impact a lot.