A patient with L2 AIS A SCI has functional iliopsoas and quadratus lumborum bilaterally. The therapist is determining the most appropriate orthotic prescription for limited community ambulation. Which option is MOST appropriate?

A patient with L2 AIS A SCI has functional iliopsoas and quadratus lumborum bilaterally. The therapist is determining the most appropriate orthotic prescription for limited community ambulation. Which option is MOST appropriate?

• A. Bilateral KAFOs or ground reaction AFOs with ambulatory aids
• B. Bilateral HKAFOs with a standard walker
• C. No orthotic needed; the patient can ambulate with a single-point cane only
• D. An RGO with Lofstrand crutches

Answer: (A)

The key idea is to restore safe, limited community ambulation by providing knee stability while using hips and trunk to assist gait. At L2 with AIS A, there is no motor function below the level, but the patient has functional hip flexors (iliopsoas) and trunk control (quadratus lumborum). This means the knee is the main weakness that limits walking, so the orthosis should stabilize the knee and allow a secure, energy-efficient gait with an assistive device. Bilateral KAFOs or ground reaction AFOs are the most appropriate because they provide solid knee control during stance and aid forward progression with the help of ambulatory aids. KAFOs lock the knees to prevent buckling, giving a stable platform for stepping. Ground reaction AFOs can also support knee extension during stance by leveraging ground reaction forces, which can be advantageous if knee extensors are weak but hip and trunk function are preserved. Either option supports limited community ambulation with a cane or walker. High-level devices like HKAFOs are unnecessarily bulky for limited community walking and add substantial energy cost. An RGO with crutches is typically reserved for higher lesions where hip flexion is available and knee control is more challenging; it is more restrictive and not the first choice here. No orthosis is not appropriate for an L2 AIS A injury when knee stability is required for safe ambulation. So, the best choice is bilateral KAFOs or ground reaction AFOs with ambulatory aids.

The key idea is to restore safe, limited community ambulation by providing knee stability while using hips and trunk to assist gait. At L2 with AIS A, there is no motor function below the level, but the patient has functional hip flexors (iliopsoas) and trunk control (quadratus lumborum). This means the knee is the main weakness that limits walking, so the orthosis should stabilize the knee and allow a secure, energy-efficient gait with an assistive device.

Bilateral KAFOs or ground reaction AFOs are the most appropriate because they provide solid knee control during stance and aid forward progression with the help of ambulatory aids. KAFOs lock the knees to prevent buckling, giving a stable platform for stepping. Ground reaction AFOs can also support knee extension during stance by leveraging ground reaction forces, which can be advantageous if knee extensors are weak but hip and trunk function are preserved. Either option supports limited community ambulation with a cane or walker.

High-level devices like HKAFOs are unnecessarily bulky for limited community walking and add substantial energy cost. An RGO with crutches is typically reserved for higher lesions where hip flexion is available and knee control is more challenging; it is more restrictive and not the first choice here. No orthosis is not appropriate for an L2 AIS A injury when knee stability is required for safe ambulation.

So, the best choice is bilateral KAFOs or ground reaction AFOs with ambulatory aids.