Prescribing the reciprocal gait orthosis for myelomeningocele children: A different approach and clinical outcome

The reciprocal gait orthosis (RGO) is a recognized mobility aid for lower thoracic-upper lumbar paraplegia. However, criteria exist that limit prescription in the myelomeningocele (MMC) population. At the Alyn Rehabilitation Hospital, every child with MMC is offered a programme of ambulation with a used but adjusted RGO. Only those children with a positive outcome (those who achieve a minimum of 10 strides on repeated occasions) then receive their own RGO. Seventy patients with MMC, neurological level L3 and cephalad entered the programme over the period 1988-1998. Forty-nine (70%) of the children were successful and received their own RGO; success correlated inversely with the neurological level and correlated directly with parental cooperation (OR = 9.4). The period of use related positively with availability of a treatment centre. This pre-prescription clinical approach reveals those children who can achieve ambulation contrary to stated criteria, while saving unnecessary costs in those failing the test trial.