• Richard B Stein, Frank Hayday, Suling Chong, Aiko K Thompson, Robert Rolf, Kelvin B James, and Gordon Bell.
• Centre for Neuroscience, University of Alberta; Karl Hager Limb and Brace, Edmonton, Alberta, and Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
• Neuromodulation. 2005 Oct 1;8(4):264-71.

AbstractTo compare various novel and conventional systems for locomotion, a 25-year-old man was studied with motor complete spinal cord injury at the T4/5 level. He used various devices in the community, and changes in speed, physiological cost index (PCI), and oxygen consumption were measured periodically. Speed was fastest with a conventional manual wheelchair (nearly 120 m/min in a 4-min test). Speed was about 30% less, but the PCI was lowest (highest efficiency) using functional electrical stimulation (FES) of the quadriceps and hamstring muscles to propel a novel wheelchair. He walked with knee-ankle-foot orthoses (KAFO) at much lower speed (8.8 m/min) and higher PCI. He walked with an alternating gait using a new stance-control KAFO with FES. The speed was still slow (5 m/min), but he prefers the more normal-looking gait and uses it daily. Walking with FES and ankle-foot orthoses (AFO) was slowest (3.5 m/min) and had the highest PCI. In conclusion, the leg-propelled wheelchair provides a more efficient method of locomotion. A new stance-controlled KAFO with FES may provide a more acceptable walking system, but must be tested on other subjects.

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