An individual with a complete spinal cord injury at L2 who uses a wheelchair and seeks gait training: what is the primary realistic gait goal?

• A. Ambulate within home and community with KAFOs
• B. Stand daily in a standing frame for weight bearing
• C. Ambulate within home with KAFOs
• D. Ambulate within home and community with AFOs

Answer: (A)

In a complete spinal cord injury at L2, the goal for gait rehabilitation centers on enabling functional walking with devices that provide knee stability. Because function below the injury is lost, controlling the knee becomes the major challenge for standing and stepping. A knee-ankle-foot orthosis (KAFO) with assistive devices (like a walker or crutches) supplies the necessary knee stability during stance, allowing a person to generate a stepping pattern and safely advance in both home and community environments. An ankle-foot orthosis alone wouldn’t control the knee, making safe, functional ambulation unlikely. Standing in a frame achieves weight bearing but doesn’t produce walking. Limiting ambulation to the home with KAFOs is more restrictive than enabling movement in the community, so the primary realistic gait goal for this person is ambulation within home and community with KAFOs.