The reciprocating gait orthosis in myelomeningocele.

Seventeen patients with myelomeningocele were fitted with a device that reciprocally controls hip flexion and extension in an attempt to improve ambulatory ability. To evaluate the function of the reciprocating mechanism, the orthosis was tested in three configurations. With the reciprocating mechanism functioning at the hips, five of eight patients ambulated faster than in other configurations. With the mechanism released for free hip joint motion, five of eight patients ambulated slower or not at all. With the hip joints locked, six of eight patients ambulated more slowly than with the reciprocating mechanism functioning. Two were faster with a swing-through gait. However, 11 of 12 independent ambulators spontaneously chose the reciprocating gait pattern over the swing-through pattern. The reciprocating gait orthosis was used by patients with meningomyelocele from 18 months to 15 years of age. The device was most successful if strong hip flexors were present, although ambulation in a reciprocal pattern was possible for some with no active hip musculature. We believe that this orthosis is the most effective ambulatory aid for children handicapped by hip extensor weakness.