Paraplegia is a form of paralysis affecting the lower half of the body, often resulting from a spinal cord injury in the thoracic, lumbar, or sacral regions. This injury disrupts nerve signals between the brain and lower body, causing a loss of motor and sensory function below the injury level. To regain the ability to stand and potentially walk, many individuals with paraplegia use leg braces, known medically as orthoses. These external devices are engineered to provide stability to the lower limbs, compensating for the lack of muscle control and enabling an upright posture.
Common Types of Leg Braces
The Knee-Ankle-Foot Orthosis (KAFO) is a common device that encases the leg to provide stability across the knee, ankle, and foot. Its rigid structure, often made from thermoplastics and metal, prevents the joints from buckling under the user’s weight. Many KAFOs have a locking knee mechanism that can be manually engaged to create a straight leg support for standing. The user can manually unlock the joint to bend the knee for sitting.
Reciprocating Gait Orthoses (RGOs) are extensive braces that include a pelvic girdle and a cable system connecting both legs. This design facilitates a step-over-step walking pattern by using the movement of one leg to assist the other. When the user shifts their weight and pushes off with one leg, the cable system automatically helps swing the opposite leg forward. This creates a gait that more closely mimics natural walking than standard KAFOs.
Stance Control Orthoses (SCOs) are a more dynamic advancement over traditional KAFOs. These devices use sensors that detect when a user’s foot is on the ground, automatically locking the knee for stability during the stance phase of walking. The knee unlocks during the swing phase, allowing for a more fluid and energy-efficient gait. For a higher level of assistance, powered exoskeletons are wearable robotic suits that use motors at the hip and knee joints to power the user’s walking movements.
The Custom Fitting Process
Obtaining leg braces starts with a physician’s prescription, which initiates a process with a specialized team including an orthotist and a physical therapist. The orthotist, who designs and fits the braces, first conducts a thorough evaluation. They assess muscle function, joint range of motion, and limb shape, and discuss the individual’s mobility goals to determine the most appropriate orthotic design.
After the evaluation, a precise model of the user’s lower limbs is created. Traditionally, this involved wrapping the legs in plaster bandages to make a physical cast to serve as a mold. Today, the process often uses digital technology, where a handheld 3D scanner captures the exact contours of the legs to create a detailed digital model. This method is faster and provides highly accurate data for fabrication.
Using the cast or digital scan, the orthotist fabricates the braces from materials like high-temperature thermoplastics, carbon fiber composites, and lightweight metal alloys. The components are custom-molded and assembled to match the individual’s anatomy. During the initial fitting appointment, the user tries on the orthoses. The orthotist then makes adjustments to ensure a proper fit, correct joint alignment, and maximize comfort and function.
Rehabilitation and Training
After receiving custom-fitted leg braces, a period of rehabilitation and training begins. Using the devices safely and effectively is a learned skill requiring guidance from a physical therapist. Initial training focuses on mastering putting on and taking off the braces, known as donning and doffing. This involves developing a sequence of movements that can be performed independently, often from a wheelchair.
Once donning and doffing are managed, physical therapy shifts to upright activities. Training focuses on safely transitioning from a seated position to standing with the braces locked, which involves using upper body strength to lift the body while maintaining balance. Therapists help individuals build the core and upper body strength needed to control the braces and use a walking aid, such as a walker or forearm crutches.
The final phase of rehabilitation focuses on the mechanics of walking. Users with KAFOs learn a swing-to or swing-through gait pattern with a walker. For those with RGOs, therapy focuses on initiating reciprocal leg movement through subtle shifts in body weight. This repetitive training aims to develop a safe and energy-efficient walking pattern for navigating different surfaces and maximizing independent mobility.
Physiological and Daily Living Considerations
Using leg braces for standing and walking provides several physiological health benefits. Bearing weight through the long bones of the legs helps combat the loss of bone mineral density that often accompanies paralysis, reducing fracture risk. Standing and moving also promote better circulatory function in the lower limbs and can improve respiratory capacity. These activities can also aid in more regular bladder and bowel function.
Using braces also impacts daily life and well-being. Standing changes an individual’s interaction with their environment, allowing for face-to-face conversations and access to surfaces out of reach from a wheelchair. This can foster greater independence and social integration. The reduction of prolonged sitting also helps decrease the risk of developing pressure sores.
Ambulation with braces is physically demanding and requires more energy than wheelchair mobility. An individual’s motivation and physical condition are large factors in how often the braces are used. The psychological benefits can be substantial, as the ability to stand upright and see the world from a different perspective can positively affect mood and self-esteem. This reinforces the value of the effort required for training and daily use.