Should External Powered Orthoses be Used by Paraplegic Subjects or Not?

Spinal cord injury (SCI) is a damage to spinal cord that results in loss of function, mobility and sensation below the level at which the spinal cord has been injured. The incidence of this disorder varies between 12.7 and 59 new cases per million each year (1). These subjects used various orthoses to improve their abilities to stand and walk, such as mechanical orthoses, functional electrical stimulation (FES), external powered orthoses (EPO) and hybrid system, which is a combination of FES and mechanical orthosis (2). However patients experience some problems such as high energy consumption during walking, high loads applied on upper limb and reduced walking speed (3). The external powered orthoses employ various kinds of power sources which include pneumatic, hydraulic and electrical power. Some orthoses such as pneumatic active gait orthosis (PAGO), powered gait orthosis (PGO), weight bearing control orthosis (WBCO), two degree of freedom orthosis (TDFO), driven gait orthosis (DGO), hybrid assistive limb (HAL) and lowered extremity powered exoskeleton (LEPE) have been designed to improve the performance of the subjects (4-10). However, the main questions posted here is how much the performance of paraplegic subjects is improved while walking with EPO in contrast to mechanical systems. Furthermore, it is not clear that how much is the willingness of subjects to use these orthoses (3). An electronic search was done via Pubmed, Embase and ISI web of knowledge data from 1960 to 2010. Some key words such as external power orthosis, spinal cord injury and rehabilitation were used. The abstracts and titles of each individual study were assessed by two reviewers based on whether the abstracts addressed the research question of interest, Figure 1. The quality of the studies was assessed by use of Black and Down tool. PubMed ISI Web of Knowledge Embase