A special HKAFO, which uses a mechanical linkage to couple flexion of one hip with extension of the other, which enables a reciprocal step-over-step gait. Also allow swing through and swing to gaits

1. Reciprocating Gait Orthosis
DR JOE ANTONY
MD (PHYSICAL MEDICINE AND REHABILITATION)
KGMU,LUCKNOW
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2. Reciprocating Gait Orthosis
A special HKAFO, which uses a mechanical linkage
to couple flexion of one hip with extension of the
other, which enables a reciprocal step-over-step
gait.
Also allow swing through and swing to gaits
AAOS ATLAS OF ORTHOSIS AND ASSISTIVE DEVICES
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3. Parts
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Reciprocating mechanism
Custom moulded pelvic shell
Hip joints
Thigh pieces
Off set knee joint with drop
locks
Plastic AFO

4. Types of Reciprocating mechanisms
Cord and Pully design
Gear box cable ( Bowden cables)
Single Cable
Dual Cable
Isocentric RGO
Latest design
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5. Isocentric RGO
Constructed according to lower limb casting
Includes a thoracic shell also
Reciprocating mechanism is a Pivot bar
reciprocating link
ARAZPOUR M, GHOLAMI M, BAHRAMIZADEH M, SHARIFI G, BANI MA. INFLUENCE OF RECIPROCATING LINK WHEN USING AN ISOCENTRIC RECIPROCATING GAIT ORTHOSIS (IRGO) ON WALKING IN PATIENTS WITH
SPINAL CORD INJURY: A PILOT STUDY. TOP SPINAL CORD INJ REHABIL. 2017 SUMMER;23(3):256-262. DOI: 10.1310/SCI16-00016. EPUB 2017 MAY 4. PMID: 29339901; PMCID: PMC5562033.
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6. Pre requisites
At least grade 3 power of hip flexors
Upper trunk balance
Adequate Cognitive function
Adequate upper limb function for assistive devices
AAOS ATLAS OF ORTHOSIS AND ASSISTIVE DEVICES
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7. Indication
Paraplegia with at least 3/5 power in hip flexors and lesser power in hip extensors
Traumatic paraplegia
MMC sequel
Transverse myelitis
SOL of Spinal canal
Potts spine
AAOS ATLAS OF ORTHOSIS AND ASSISTIVE DEVICES
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8. Contra indications
Hip Flexion Contractures
Spasticity in hip flexors
Orthostatic hypotension
Poor cardiopulmonary endurance
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9. Advantages
Decreases energy expenditure
Can achieve four point gait with two crutches
Improve confidence and balance in new
paraplegics
Can gradually wean out to KAFOs
ADVANTAGE OF IRGO OVER OTHER RGO
 No protruding wires/cables over back
More cost efficient than other RGOs
No energy loss due to friction between
cables- hence more energy efficient.
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10. Evidence for
RGOs
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11. Thank you
REFERENCES
1. The HELP guide to cerebral palsy
2. AAOS Atlas of orthosis and Assistive devices
3. Braddoms textbook of PMR
4. Böhm H, Matthias H, Braatz F, Döderlein L. Effect of floor reaction ankle-foot orthosis on crouch
gait in patients with cerebral palsy: What can be expected? Prosthet Orthot Int. 2018 Jun;42(3):245-253.
doi: 10.1177/0309364617716240. Epub 2017 Jul 11. PMID: 28693377.
5. Arazpour M, Gholami M, Bahramizadeh M, Sharifi G, Bani MA. Influence of Reciprocating Link
When Using an Isocentric Reciprocating Gait Orthosis (IRGO) on Walking in Patients with Spinal Cord
Injury: A Pilot Study. Top Spinal Cord Inj Rehabil. 2017 Summer;23(3):256-262. doi: 10.1310/sci16-00016.
Epub 2017 May 4. PMID: 29339901; PMCID: PMC5562033.
6. Campbells textbook of operative orthopedics
7. Mueller M.J, Diamond J.E, Sinacore D.R, et al. Total contact casting in treatment of diabetic
plantar ulcers. Controlled clinical trial. Diabetes Care . 1989;12(6):384–388. PMID: 2659299
8. Armstrong DG, Nguyen HC, Lavery LA, van Schie CH, Boulton AJ, Harkless LB: Off-loading the
diabetic foot wound: a randomized clinical trial. Diabetes Care. 2001;24(6):1019–1022.
9. Messenger G, Masoetsa R, Hussain I. A Narrative Review of the Benefits and Risks of Total
Contact Casts in the Management of Diabetic Foot Ulcers. J Am Coll Clin Wound Spec. 2018 Jun 7;9(1-
3):19-23. doi: 10.1016/j.jccw.2018.05.002. PMID: 30591897; PMCID: PMC6304285.
10. Cakar E, Durmus O, Tekin L, Dincer U, Kiralp MZ. The ankle-foot orthosis improves balance and
reduces fall risk of chronic spastic hemiparetic patients. Eur J Phys Rehabil Med. 2010 Sep;46(3):363-8.
Epub 2010 Jul 1. PMID: 20927002.
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