A long-term review of severely disabled spina bifida patients using a reciprocal walking system.

Purpose: The purpose of the study was to establish long-term compliance of paediatric spina bifida patients using a reciprocal walking orthosis, prescribed to enhance function and long-term therapeutic benefit.

Methods: Data from current clinical notes of 28 spina bifida patients prescribed with the Parawalker reciprocal walking orthosis between 1973 and 1984 were compared with those established for the purposes of research at the time of original prescription. Patients were supplied via an on-going treatment regime by a specialist multi-disciplinary team. Regular follow-up was an essential element of the clinical policy. This enabled effective monitoring of patient performance and requirements. It also ensured that accurate data was maintained. Clinical and walking performance details were recorded at the time of supply. Current clinical notes from routine follow-up reviews for patients in the study were scrutinized to establish present status, ambulation performance and medical history.

Results: Fourteen patients had thoracic lesions the remainder having high, mid lumbar or variably diagnosed lesions. The period of use ranged from 4.6 to 18.1 years (average = 9.71 years) The orthosis was first prescribed at 3.6 years to 13.9 years. Discontinuation occurred at between 11.2 and 23.9 years. None of the patients suffered a pressure sore or bone fracture.

Conclusions: Long-term continuation of reciprocal walking within a controlled treatment regime was established. This enabled confirmation that comprehensive health care systems can achieve improvements in patient function, together with overall cost savings because of the reductions in pressure sores and bone fractures identified for such activity.