A patient with T10 AIS A paraplegia has completed a strengthening program and can perform 75 dips in the parallel bars. The therapist is planning compensatory gait training. Which orthotic and gait pattern combination is MOST appropriate for this patient?

A patient with T10 AIS A paraplegia has completed a strengthening program and can perform 75 dips in the parallel bars. The therapist is planning compensatory gait training. Which orthotic and gait pattern combination is MOST appropriate for this patient?

• A. Bilateral AFOs with a reciprocal gait pattern using Lofstrand crutches
• B. Bilateral KAFOs with a swing-through gait pattern using Lofstrand crutches or a walker
• C. An RGO with a four-point gait pattern
• D. No orthotic with a step-to gait pattern using a rolling walker

Answer: (B)

When a person has a complete T10 spinal cord injury (AIS A), the legs are paralyzed below the level of injury, so any walking plan must include an orthosis that stabilizes the knee and ankle during stance while the arms and upper body provide the forward force. Bilateral knee-ankle-foot orthoses give the necessary knee stability in stance, which is essential because the knee would otherwise buckle without control. With this stabilization, a swing-through gait pattern lets the patient progress the legs past the crutches or walkers in a controlled sequence, leveraging strong upper-extremity function to advance the body safely. The other options don’t fit as well. An ankle-foot orthosis alone won’t control knee instability. An RGO relies on hip flexion and knee control that are typically not available with a complete injury at this level, making it unreliable here. Walking with no orthosis using a rolling walker would leave the knee unsupported and risk collapse during stance. Given the patient’s good upper-body strength (able to perform many dips), KAFOs with a swing-through gait using crutches or a walker is the most appropriate choice.

When a person has a complete T10 spinal cord injury (AIS A), the legs are paralyzed below the level of injury, so any walking plan must include an orthosis that stabilizes the knee and ankle during stance while the arms and upper body provide the forward force. Bilateral knee-ankle-foot orthoses give the necessary knee stability in stance, which is essential because the knee would otherwise buckle without control. With this stabilization, a swing-through gait pattern lets the patient progress the legs past the crutches or walkers in a controlled sequence, leveraging strong upper-extremity function to advance the body safely.

The other options don’t fit as well. An ankle-foot orthosis alone won’t control knee instability. An RGO relies on hip flexion and knee control that are typically not available with a complete injury at this level, making it unreliable here. Walking with no orthosis using a rolling walker would leave the knee unsupported and risk collapse during stance. Given the patient’s good upper-body strength (able to perform many dips), KAFOs with a swing-through gait using crutches or a walker is the most appropriate choice.