Paraplegic use of the Orlau swivel walker: case report.

This case report describes the characteristics, biomechanics, fitting, training, advantages, and disadvantages of the Orlau swivel walker. Advantages of the walker include stability, easy mobility, and the ability of the wearer to ambulate with free hands. Disadvantages include slow velocity of locomotion, comparative metabolic inefficiency, awkwardness of getting into and from the standing position, and inability to be used on uneven surfaces. In a comparison of the metabolic costs and efficiency of the Orlau swivel walker, bilateral knee-ankle-foot orthoses, and a wheelchair, the swivel walker was least efficient (1.9ml O2/kg/m) in comparison to the knee-ankle-foot orthoses (0.9ml O2/kg/m) and the wheelchair (0.18ml O2/kg/m). However, in evaluating a means of locomotion, various factors besides metabolic costs need to be considered; these include efficiency, velocity, the physiologic and psychologic benefits of standing, and the patient's needs. When considering all these factors for an individual patient, the swivel walker may be an effective device for meeting the needs of many individuals with spinal cord injury.