Clinical evaluation of spina bifida patients using hip guidance orthosis.

A hip guidance orthosis has been designed to provide the highest potential level of ambulation for the child with myelomeningocele. It permits low energy-cost ambulation at a reasonable speed, and independent transfer from chair to walking and vice versa. It also enables some patients to ascend or descend steps of up to 150mm, as well as gradients of up to one in 10. A review of 27 patients who had used the orthosis for periods of between six and 45 months was undertaken in order to establish the degree of benefit. 17 patients had no power in hips or below, the rest having some power in one or both hips. 17 patients had dorsal lesions and the remainder had lumbar lesions. Using Hoffer's (1973) classification, 13 patients had improved ambulation when using the hip guidance orthosis, and most of the remainder showed some measurable improvement in ambulation. 14 patients were tested for speed of ambulation and heart rate before and after use of the orthosis, and the mean increase in speed was 87.3 per cent, with a mean decrease in heart rate of 10bpm--a clear improvement in efficiency. The results indicate that the hip guidance orthosis can provide low-energy ambulation for spina bifida patients with dorsal and high lumbar lesions in a form acceptable both to patients and parents.