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The metabolic demands of ambulation in a reciprocation gait orthosis (RGO) were compared with those in conventional bracing (hip-knee-ankle-foot orthosis) and wheelchair use in eight myelodysplastic children. Heart rate was significantly increased during swing-through gait compared with that during wheelchair use (p < 0.01). Oxygen consumption studies showed a significant increase in swing-through gait over that in wheelchair use. These values for RGO use approximated wheelchair use. These results suggest a more favorable prognosis for long-term functional ambulation in higher-level myelodysplastic patients if they are fitted with an RGO.