Sykes et al. 1996a; UK
Downs & Black = 13
Post-test
N=5

Population: 5 males and females; age 24-37 yrs; all subjects had a diagnosis of AIS A-C; C2 -T6 lesion level; 8-14 yrs post-injury.
Treatment: RGO and FES: 20-40 weeks of RGO use at home followed by RGO+FES bilaterally to quadriceps and hamstrings. 
Outcome measures: RGO pedometer measured number of steps over 18 months.

1. Number of steps taken per week varied between 306 and 1879 steps (99-845 m/week).
2. Use of the RGO was low and no increase in use or function after hybrid system supplied.
3. 1 subject (AIS C) was already a community ambulator and showed most frequent use of RGO but across all subjects, RGO-use was variable, intermittent and generally poor.

Solomonow et al. 1997; USA
Downs & Black = 12
Post-test
N=70

Population: 70 males and females; age 16-50 yrs; all subjects had a SCI; C6-T12 lesion level; 1-10 yrs post-injury
Treatment: RGO use and gait training 1-3 hr, 3x/wk, 6 wks followed by RGO+FES (bilateral quadriceps and  hamstrings) for another 6 wks.
Outcome measures: Walking ability, 180 m walk.

1. After training, 57 patients could walk at least 180 m (19 could walk > 450 m). 77% of patients could walk independently on different surfaces (grass, ramps, curbs).

Yang et al. 1996; UK
Downs & Black = 11
Post-test
N=3

Population: 3 subjects; age 28-42 yrs; subjects had a complete or incomplete SCI; C6 -T8 lesion level; 3-15 yrs post-injury.
Treatment: RGO ± FES. RGO with and without FES to common peroneal nerve stimulation.
Outcome measures: walking speed, stride length.

1. RGO + FES:  Modest (non-significant) increase in walking speed and stride length compared with RGO without FES.
2. When subjects walked with the RGO+FES, average walking speed was 13% faster and stride length was 5% longer.

Sykes et al. 1996b; UK
Downs & Black = 10
Post-test
N=5

Population: 5 males and females; age 24-37 yrs; all subjects had a diagnosis of AIS A-C; C2-T6 lesion level.
Treatment: Following conditioning program, RGO+FES bilaterally to quadriceps and hamstrings for home use.
Outcome measures: Walking speed over 40 m.

1. Without FES, subjects’ walking speeds ranged from 0.13 to 0.40 m/s. With RGO+FES, speeds ranged from 0.14 to 0.45 m/s, corresponding to changes ranging from -1% to 14%.

Marsolais et al. 2000; USA
Downs & Black = 9
Post-test
N=6

Population: 6 males and females; age 22-50 yrs; all subjects had a SCI; C7-T12 lesion level; 2.5-20.6 yrs post-injury.
Treatment: Case-Western Reserve University Hybrid Gait Orthosis (modification of IRGO) combined with FES to various muscles (combination of 8-16 muscles).
Outcome measures: walking speed and distance.

1. Subjects who were unable to use RGO alone could ambulate with hybrid system. 3 subjects who were previously ambulatory with either RGO or FES alone showed improvement in walking distance with the hybrid system (from 3-90 m to 200-350 m).
2. 2 of the subjects were capable of stair-climbing with the hybrid system.

Thoumie et al. 1995; France
Downs & Black = 8
Post-test
N=26

Population: 26 males and females; age 20-53 yrs; all subjects had a complete SCI; C8-T11 lesion level; 9-144 months post-injury
Treatment: RGO-II orthosis: long-leg brace with reciprocal hip joint combined with FES to the quadriceps and hamstrings. 4-6 weeks of gait training with orthosis alone followed by RGO-II+FES (hybrid) program (total program time: 2-5 months inpatients, 3-14 months outpatients).
Outcome measures:walking distance and speed with RGO and with RGO+FES.

21/26 completed the training program, 19 were able to stand up alone. Following program, walking distance ranged from 200-1400 m with hybrid orthosis, 150-400 m with RGO II.

1. Maximal walking speed with the hybrid orthosis (mean 0.32 m/s; SD 0.02; range 0.21-0.45 m/s) was not significantly different from that with orthosis alone (mean 0.29 m/s; SD 0.03; range 0.22-0.41 m/s)