WorldWideScience

Sample records for stance-control knee-ankle-foot orthosis

  1. The effect of a knee ankle foot orthosis incorporating an active knee mechanism on gait of a person with poliomyelitis.

    Science.gov (United States)

    Arazpour, Mokhtar; Chitsazan, Ahmad; Bani, Monireh Ahmadi; Rouhi, Gholamreza; Ghomshe, Farhad Tabatabai; Hutchins, Stephen W

    2013-10-01

    The aim of this case study was to identify the effect of a powered stance control knee ankle foot orthosis on the kinematics and temporospatial parameters of walking by a person with poliomyelitis when compared to a knee ankle foot orthosis. A knee ankle foot orthosis was initially manufactured by incorporating drop lock knee joints and custom molded ankle foot orthoses and fitted to a person with poliomyelitis. The orthosis was then adapted by adding electrically activated powered knee joints to provide knee extension torque during stance and also flexion torque in swing phase. Lower limb kinematic and kinetic data plus data for temporospatial parameters were acquired from three test walks using each orthosis. Walking speed, step length, and vertical and horizontal displacement of the pelvis decreased when walking with the powered stance control knee ankle foot orthosis compared to the knee ankle foot orthosis. When using the powered stance control knee ankle foot orthosis, the knee flexion achieved during swing and also the overall pattern of walking more closely matched that of normal human walking. The reduced walking speed may have caused the smaller compensatory motions detected when the powered stance control knee ankle foot orthosis was used. The new powered SCKAFO facilitated controlled knee flexion and extension during ambulation for a volunteer poliomyelitis person.

  2. Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis.

    Science.gov (United States)

    Arazpour, Mokhtar; Ahmadi, Fardin; Bahramizadeh, Mahmood; Samadian, Mohammad; Mousavi, Mohammad Ebrahim; Bani, Monireh Ahmadi; Hutchins, Stephen W

    2016-12-01

    Compared to able-bodied subjects, subjects with post-polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry. The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop-locked knee-ankle-foot orthosis or a newly developed powered knee-ankle-foot orthosis. Quasi experimental study. Seven subjects with poliomyelitis who routinely wore conventional knee-ankle-foot orthoses participated in this study and received training to enable them to ambulate with the powered knee-ankle-foot orthosis on level ground, prior to gait analysis. There were no significant differences in the gait symmetry index of step length (p = 0.085), stance time (p = 0.082), double-limb support time (p = 0.929), or speed of walking (p = 0.325) between the two test conditions. However, using the new powered knee-ankle-foot orthosis improved the symmetry index in step width (p = 0.037), swing time (p = 0.014), stance phase percentage (p = 0.008), and knee flexion during swing phase (p ⩽ 0.001) compared to wearing the drop-locked knee-ankle-foot orthosis. The use of a powered knee-ankle-foot orthosis for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage, and knee flexion during swing phase. A new powered knee-ankle-foot orthosis can improve gait symmetry for poliomyelitis subjects by influencing step width, swing time, stance time percentage, and knee flexion during swing phase when compared to ambulating with a drop-locked knee-ankle-foot orthosis. © The International Society for Prosthetics and Orthotics 2015.

  3. The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study.

    Science.gov (United States)

    Arazpour, Mokhtar; Moradi, Alireza; Samadian, Mohammad; Bahramizadeh, Mahmood; Joghtaei, Mahmoud; Ahmadi Bani, Monireh; Hutchins, Stephen W; Mardani, Mohammad A

    2016-06-01

    Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. Quasi-experimental design. Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities. © The International Society for Prosthetics and Orthotics 2015.

  4. The physiological cost index of walking with a powered knee-ankle-foot orthosis in subjects with poliomyelitis: A pilot study.

    Science.gov (United States)

    Arazpour, Mokhtar; Ahmadi Bani, Monireh; Samadian, Mohammad; Mousavi, Mohammad E; Hutchins, Stephen W; Bahramizadeh, Mahmood; Curran, Sarah; Mardani, Mohammad A

    2016-08-01

    A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee-ankle-foot orthosis with drop lock knee joints. Quasi experimental study. Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee-ankle-foot orthosis. Walking with the powered knee-ankle-foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee-ankle-foot orthosis. Using a powered knee-ankle-foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. This powered knee-ankle-foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee-ankle-foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted. © The International Society for Prosthetics and Orthotics 2015.

  5. A pneumatically powered knee-ankle-foot orthosis (KAFO) with myoelectric activation and inhibition

    Science.gov (United States)

    Sawicki, Gregory S; Ferris, Daniel P

    2009-01-01

    Background The goal of this study was to test the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO) powered by artificial pneumatic muscles during human walking. We had previously built a powered ankle-foot orthosis (AFO) and used it effectively in studies on human motor adaptation, locomotion energetics, and gait rehabilitation. Extending the previous AFO to a KAFO presented additional challenges related to the force-length properties of the artificial pneumatic muscles and the presence of multiple antagonistic artificial pneumatic muscle pairs. Methods Three healthy males were fitted with custom KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. Subjects walked over ground at 1.25 m/s under four conditions without extensive practice: 1) without wearing the orthosis, 2) wearing the orthosis with artificial muscles turned off, 3) wearing the orthosis activated under direct proportional myoelectric control, and 4) wearing the orthosis activated under proportional myoelectric control with flexor inhibition produced by leg extensor muscle activation. We collected joint kinematics, ground reaction forces, electromyography, and orthosis kinetics. Results The KAFO produced ~22%–33% of the peak knee flexor moment, ~15%–33% of the peak extensor moment, ~42%–46% of the peak plantar flexor moment, and ~83%–129% of the peak dorsiflexor moment during normal walking. With flexor inhibition produced by leg extensor muscle activation, ankle (Pearson r-value = 0.74 ± 0.04) and knee ( r = 0.95 ± 0.04) joint kinematic profiles were more similar to the without orthosis condition compared to when there was no flexor inhibition (r = 0.49 ± 0.13 for ankle, p = 0.05, and r = 0.90 ± 0.03 for knee, p = 0.17). Conclusion The proportional myoelectric control with flexor inhibition allowed for a more normal gait than direct proportional myoelectric control. The current orthosis design

  6. A pneumatically powered knee-ankle-foot orthosis (KAFO with myoelectric activation and inhibition

    Directory of Open Access Journals (Sweden)

    Ferris Daniel P

    2009-06-01

    Full Text Available Abstract Background The goal of this study was to test the mechanical performance of a prototype knee-ankle-foot orthosis (KAFO powered by artificial pneumatic muscles during human walking. We had previously built a powered ankle-foot orthosis (AFO and used it effectively in studies on human motor adaptation, locomotion energetics, and gait rehabilitation. Extending the previous AFO to a KAFO presented additional challenges related to the force-length properties of the artificial pneumatic muscles and the presence of multiple antagonistic artificial pneumatic muscle pairs. Methods Three healthy males were fitted with custom KAFOs equipped with artificial pneumatic muscles to power ankle plantar flexion/dorsiflexion and knee extension/flexion. Subjects walked over ground at 1.25 m/s under four conditions without extensive practice: 1 without wearing the orthosis, 2 wearing the orthosis with artificial muscles turned off, 3 wearing the orthosis activated under direct proportional myoelectric control, and 4 wearing the orthosis activated under proportional myoelectric control with flexor inhibition produced by leg extensor muscle activation. We collected joint kinematics, ground reaction forces, electromyography, and orthosis kinetics. Results The KAFO produced ~22%–33% of the peak knee flexor moment, ~15%–33% of the peak extensor moment, ~42%–46% of the peak plantar flexor moment, and ~83%–129% of the peak dorsiflexor moment during normal walking. With flexor inhibition produced by leg extensor muscle activation, ankle (Pearson r-value = 0.74 ± 0.04 and knee ( r = 0.95 ± 0.04 joint kinematic profiles were more similar to the without orthosis condition compared to when there was no flexor inhibition (r = 0.49 ± 0.13 for ankle, p = 0.05, and r = 0.90 ± 0.03 for knee, p = 0.17. Conclusion The proportional myoelectric control with flexor inhibition allowed for a more normal gait than direct proportional myoelectric control. The current

  7. Design of a test bench to evaluate the dynamic performance of the actuation system of an active knee-ankle-foot orthosis

    OpenAIRE

    Callejo Goena, Daniel

    2014-01-01

    En este proyecto se presenta el diseño mecánico de un banco de pruebas para el sistema de actuación de una ortesis activa de rodilla-tobillo-pie (knee-ankle-foot orthosis en inglés) para lesionados medulares incompletos. El objetivo de dicho banco es caracterizar con precisión el comportamiento dinámico del sistema de actuación de la rodilla: estudiar su funcionamiento directo e inverso y la posibilidad de emplear materiales elásticos en alguna de las piezas que transmite el movimiento a l...

  8. Safety and walking ability of KAFO users with the C-Brace? Orthotronic Mobility System, a new microprocessor stance and swing control orthosis

    OpenAIRE

    Pr?bsting, Eva; Kannenberg, Andreas; Zacharias, Britta

    2016-01-01

    Background: There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. Objectives: The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Study design: Survey of lower limb orthosis user...

  9. Safety and walking ability of KAFO users with the C-Brace®Orthotronic Mobility System, a new microprocessor stance and swing control orthosis.

    Science.gov (United States)

    Pröbsting, Eva; Kannenberg, Andreas; Zacharias, Britta

    2017-02-01

    There are clear indications for benefits of stance control orthoses compared to locked knee ankle foot orthoses. However, stance control orthoses still have limited function compared with a sound human leg. The aim of this study was to evaluate the potential benefits of a microprocessor stance and swing control orthosis compared to stance control orthoses and locked knee ankle foot orthoses in activities of daily living. Survey of lower limb orthosis users before and after fitting of a microprocessor stance and swing control orthosis. Thirteen patients with various lower limb pareses completed a baseline survey for their current orthotic device (locked knee ankle foot orthosis or stance control orthosis) and a follow-up for the microprocessor stance and swing control orthosis with the Orthosis Evaluation Questionnaire, a new self-reported outcome measure devised by modifying the Prosthesis Evaluation Questionnaire for use in lower limb orthotics and the Activities of Daily Living Questionnaire. The Orthosis Evaluation Questionnaire results demonstrated significant improvements by microprocessor stance and swing control orthosis use in the total score and the domains of ambulation ( p = .001), paretic limb health ( p = .04), sounds ( p = .02), and well-being ( p = .01). Activities of Daily Living Questionnaire results showed significant improvements with the microprocessor stance and swing control orthosis with regard to perceived safety and difficulty of activities of daily living. The microprocessor stance and swing control orthosis may facilitate an easier, more physiological, and safer execution of many activities of daily living compared to traditional leg orthosis technologies. Clinical relevance This study compared patient-reported outcomes of a microprocessor stance and swing control orthosis (C-Brace) to those with traditional knee ankle foot orthosis and stance control orthosis devices. The C-Brace offers new functions including controlled

  10. Effect of carbon-composite knee-ankle-foot orthoses on walking efficiency and gait in former polio patients

    NARCIS (Netherlands)

    Brehm, Merel-Anne; Beelen, Anita; Doorenbosch, Caroline A. M.; Harlaar, Jaap; Nollet, Frans

    2007-01-01

    Objective: To investigate the effects of total-contact fitted carbon-composite knee-ankle-foot orthoses (KAFOs) on energy cost of walking in patients with former polio who normally wear a conventional leather/metal KAFO or plastic/metal KAFO. Design: A prospective uncontrolled study with a multiple

  11. Measuring wearing time of knee-ankle-foot orthoses in children with cerebral palsy: comparison of parent-report and objective measurement.

    Science.gov (United States)

    Maas, Josina C; Dallmeijer, Annet J; Oudshoorn, Bodil Y; Bolster, Eline A M; Huijing, Peter A; Jaspers, Richard T; Becher, Jules G

    2018-02-01

    Purpose state: Orthotic wearing time may be an important confounder in efficacy studies of treatment in children with spastic cerebral palsy (SCP). Most studies measure parent-reported wearing time (WT parent ) with questionnaires, but it is questionable whether this yields valid results. This study aims to compare WT parent with objectively measured wearing time (WT obj ) in children with SCP receiving orthotic treatment. Eight children with SCP participated in this observational study. For one year, they received knee-ankle-foot orthosis (KAFO) treatment. WT parent was measured using questionnaires. WT obj was measured using temperature sensor-data-loggers that were attached to the KAFOs. The 2.5th and 97.5th percentiles and median of differences between methods (per participant) were used to calculate limits of agreement and systematic differences. There was no systematic difference between WT parent and WT obj (0.1 h per week), but high inter-individual variation of the difference was found, as reflected by large limits of agreement (lower limit/2.5th percentile: -1.7 h/week; upper limit/97.5th percentile: 11.1 h/week). Parent-reported wearing time (WTparent) of a KAFO differs largely from objectively measured wearing time (WT obj ) using temperature sensors. Therefore, parent-reported wearing time (WT parent ) of KAFOs should be interpreted with utmost care. Implications for Rehabilitation Low wearing time of orthoses may be a cause of inefficacy of orthotic treatment and incorrect reported wearing time may bias results of efficacy studies. Results of this study show that parent-reported wearing time is not in agreement with objectively measured wearing time. Parent-reported wearing time of KAFOs should be interpreted with utmost care. Objective methods are recommended for measuring orthotic wearing time.

  12. Comparison of energy efficiency between Wearable Power-Assist Locomotor (WPAL) and two types of knee-ankle-foot orthoses with a medial single hip joint (MSH-KAFO).

    Science.gov (United States)

    Yatsuya, Kanan; Hirano, Satoshi; Saitoh, Eiichi; Tanabe, Shigeo; Tanaka, Hirotaka; Eguchi, Masayuki; Katoh, Masaki; Shimizu, Yasuhiro; Uno, Akito; Kagaya, Hitoshi

    2018-01-01

    To compare the energy efficiency of Wearable Power-Assist Locomotor (WPAL) with conventional knee-ankle-foot orthoses (MSH-KAFO) such as Hip and Ankle Linked Orthosis (HALO) or Primewalk. Cross over case-series. Chubu Rosai Hospital, Aichi, Japan, which is affiliated with the Japan Organization of Occupational Health and Safety. Six patients were trained with MSH-KAFO (either HALO or Primewalk) and WPAL. They underwent 6-minute walk tests with each orthosis. Energy efficiency was estimated using physiological cost index (PCI) as well as heart rate (HR) and modified Borg score. Trial energy efficiency with MSH-KAFO was compared with WPAL to assess if differences in PCI became greater between MSH-KAFO and WPAL as time goes on during the 6-minute walk. Spearman correlation coefficient of time (range: 0.5-6.0 minutes) with the difference was calculated. The same statistical procedures were repeated for HR and modified Borg score. Greater energy efficiency, representing a lower gait demand, was observed in trials with WPAL compared with MSH-KAFO (Spearman correlation coefficients for PCI, HR and modified Borg were 0.93, 0.90 and 0.97, respectively, all P energy efficient type of robotics that may be used by patients with paraplegia.

  13. The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study.

    Science.gov (United States)

    Mojaver, Ali; Arazpour, Mokhtar; Aminian, Gholamreza; Ahmadi Bani, Monireh; Bahramizadeh, Mahmood; Sharifi, Guive; Sherafatvaziri, Arash

    2017-10-01

    Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait. The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs. Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters. Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence. A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs. Implications for Rehabilitation The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using. Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis. In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion

  14. Bi-articular Knee-Ankle-Foot Exoskeleton Produces Higher Metabolic Cost Reduction than Weight-Matched Mono-articular Exoskeleton

    Science.gov (United States)

    Malcolm, Philippe; Galle, Samuel; Derave, Wim; De Clercq, Dirk

    2018-01-01

    The bi-articular m. gastrocnemius and the mono-articular m. soleus have different and complementary functions during walking. Several groups are starting to use these biological functions as inspiration to design prostheses with bi-articular actuation components to replace the function of the m. gastrocnemius. Simulation studies indicate that a bi-articular configuration and spring that mimic the m. gastrocnemius could be beneficial for orthoses or exoskeletons. Our aim was to test the effect of a bi-articular and spring configuration that mimics the m. gastrocnemius and compare this to a no-spring and mono-articular configuration. We tested nine participants during walking with knee-ankle-foot exoskeletons with dorsally mounted pneumatic muscle actuators. In the bi-articular plus spring condition the pneumatic muscles were attached to the thigh segment with an elastic cord. In the bi-articular no-spring condition the pneumatic muscles were also attached to the thigh segment but with a non-elastic cord. In the mono-articular condition the pneumatic muscles were attached to the shank segment. We found the highest reduction in metabolic cost of 13% compared to walking with the exoskeleton powered-off in the bi-articular plus spring condition. Possible explanations for this could be that the exoskeleton delivered the highest total positive work in this condition at the ankle and the knee and provided more assistance during the isometric phase of the biological plantarflexors. As expected we found that the bi-articular conditions reduced m. gastrocnemius EMG more than the mono-articular condition but this difference was not significant. We did not find that the mono-articular condition reduces the m. soleus EMG more than the bi-articular conditions. Knowledge of specific effects of different exoskeleton configurations on metabolic cost and muscle activation could be useful for providing customized assistance for specific gait impairments. PMID:29551959

  15. Bi-articular Knee-Ankle-Foot Exoskeleton Produces Higher Metabolic Cost Reduction than Weight-Matched Mono-articular Exoskeleton

    Directory of Open Access Journals (Sweden)

    Philippe Malcolm

    2018-03-01

    Full Text Available The bi-articular m. gastrocnemius and the mono-articular m. soleus have different and complementary functions during walking. Several groups are starting to use these biological functions as inspiration to design prostheses with bi-articular actuation components to replace the function of the m. gastrocnemius. Simulation studies indicate that a bi-articular configuration and spring that mimic the m. gastrocnemius could be beneficial for orthoses or exoskeletons. Our aim was to test the effect of a bi-articular and spring configuration that mimics the m. gastrocnemius and compare this to a no-spring and mono-articular configuration. We tested nine participants during walking with knee-ankle-foot exoskeletons with dorsally mounted pneumatic muscle actuators. In the bi-articular plus spring condition the pneumatic muscles were attached to the thigh segment with an elastic cord. In the bi-articular no-spring condition the pneumatic muscles were also attached to the thigh segment but with a non-elastic cord. In the mono-articular condition the pneumatic muscles were attached to the shank segment. We found the highest reduction in metabolic cost of 13% compared to walking with the exoskeleton powered-off in the bi-articular plus spring condition. Possible explanations for this could be that the exoskeleton delivered the highest total positive work in this condition at the ankle and the knee and provided more assistance during the isometric phase of the biological plantarflexors. As expected we found that the bi-articular conditions reduced m. gastrocnemius EMG more than the mono-articular condition but this difference was not significant. We did not find that the mono-articular condition reduces the m. soleus EMG more than the bi-articular conditions. Knowledge of specific effects of different exoskeleton configurations on metabolic cost and muscle activation could be useful for providing customized assistance for specific gait impairments.

  16. Bi-articular Knee-Ankle-Foot Exoskeleton Produces Higher Metabolic Cost Reduction than Weight-Matched Mono-articular Exoskeleton.

    Science.gov (United States)

    Malcolm, Philippe; Galle, Samuel; Derave, Wim; De Clercq, Dirk

    2018-01-01

    The bi-articular m. gastrocnemius and the mono-articular m. soleus have different and complementary functions during walking. Several groups are starting to use these biological functions as inspiration to design prostheses with bi-articular actuation components to replace the function of the m. gastrocnemius. Simulation studies indicate that a bi-articular configuration and spring that mimic the m. gastrocnemius could be beneficial for orthoses or exoskeletons. Our aim was to test the effect of a bi-articular and spring configuration that mimics the m. gastrocnemius and compare this to a no-spring and mono-articular configuration. We tested nine participants during walking with knee-ankle-foot exoskeletons with dorsally mounted pneumatic muscle actuators. In the bi-articular plus spring condition the pneumatic muscles were attached to the thigh segment with an elastic cord. In the bi-articular no-spring condition the pneumatic muscles were also attached to the thigh segment but with a non-elastic cord. In the mono-articular condition the pneumatic muscles were attached to the shank segment. We found the highest reduction in metabolic cost of 13% compared to walking with the exoskeleton powered-off in the bi-articular plus spring condition . Possible explanations for this could be that the exoskeleton delivered the highest total positive work in this condition at the ankle and the knee and provided more assistance during the isometric phase of the biological plantarflexors. As expected we found that the bi-articular conditions reduced m. gastrocnemius EMG more than the mono-articular condition but this difference was not significant. We did not find that the mono-articular condition reduces the m. soleus EMG more than the bi-articular conditions . Knowledge of specific effects of different exoskeleton configurations on metabolic cost and muscle activation could be useful for providing customized assistance for specific gait impairments.

  17. Carbon fibre reinforced plastic knee-ankle-foot orthosis with a partially flexible thigh cuff: a modification for comfort while sitting on a toilet seat.

    Science.gov (United States)

    Hachisuka, K; Arai, K; Arai, M

    2007-06-01

    At the request of a polio survivor, a partially flexible thigh cuff made of leather and canvas for a carbon KAFO was devised to allow the wearer to feel more comfortable while sitting on a toilet seat. The original, acrylic resin, thigh cuff was partially excised to make an opening (15x10 cm), which was stuffed with rubber sponge, and was sealed with leather and canvas. The opening's surround was vertically and horizontally reinforced with carbon fibres. This modification provided relief to the polio survivor from the discomfort previously experienced while sitting on a toilet seat, and satisfied her needs in daily life.

  18. A new approach to implement a customized anatomic insole in orthopaedic footwear of lower limb orthosis

    Science.gov (United States)

    Peixoto, J.; Flores, P.; Souto, A. P.

    2017-10-01

    This paper concerns the development of a new approach for orthopaedic footwear to apply in KAFO orthosis (acronym for Knee Ankle Foot Orthosis). This procedure starts with full characterization of the problem with the purpose to characterize a plantar of a patient’s foot with polio. A 3D Scanner was used to collect their feet’s data to produce an anatomic insole. After this step, the patient performs a study of his gait using a static and dynamic study with the aim of characterizing the parameters to improve quality in the footwear. The insole was produced using a 3D printing technology. It was essential to optimize manufacturing processes and it was developed a footwear prototype with innovative characteristics, which is 25% lighter, allowing the user to consume less energy in daily routines.

  19. Performance of spinal cord injury individuals while standing with the Mohammad Taghi Karimi reciprocal gait orthosis (MTK-RGO)

    International Nuclear Information System (INIS)

    Karimi, Mohammad Taghi; Amiri, Pouya; Esrafilian, Amir; Sedigh, Jafar; Fatoye, Francis

    2013-01-01

    Most patients with spinal cord injury use a wheelchair to transfer from place to place, however they need to stand and walk with orthosis to improve their health status. Although many orthoses have been designed for paraplegic patients, they have experienced various problems while in use. A new type of reciprocal gait orthosis was designed in the Bioengineering Unit of Strathclyde University to solve the problems of the available orthoses. Since there was no research undertaken regarding testing of the new orthosis on paraplegic subjects, this study was aimed to evaluate the new orthosis during standing of paraplegic subjects. Five paraplegic patients with lesion level between T12 and L1 and aged matched normal subjects were recruited into this study. The stability of subjects was evaluated during quiet standing and while undertaking hand tasks during standing with the new orthosis and the knee ankle foot orthosis (KAFO). The difference between the performances of paraplegic subjects while standing with both orthoses, and between the function of normal and paraplegic subjects were compared using the paired t test and independent sample t test, respectively. The stability of paraplegic subjects in standing with the new orthosis was better than that of the KAFO orthosis (p < 0.05). Moreover, the force applied on the crutch differed between the orthoses. The functional performance of paraplegic subjects was better with the new orthosis compared with normal subjects. The performance of paraplegic subjects while standing with the new orthosis was better than the KAFO. Therefore, the new orthosis may be useful to improve standing and walking in patients with paraplegia.

  20. Effect of pneumatic compressing powered orthosis in stroke patients: preliminary study.

    Science.gov (United States)

    Kim, Eun Sil; Yoon, Yong-Soon; Sohn, Min Kyun; Kwak, Soo-Hyun; Choi, Jong Ho; Oh, Ji Sun

    2015-04-01

    To evaluate the feasibility and effectiveness of a knee-ankle-foot orthosis powered by artificial pneumatic muscles (PKAFO). Twenty-three hemiplegic patients (age, 59.6±13.7 years) were assessed 19.7±36.6 months after brain lesion. The 10-m walking time was measured as a gait parameter while the individual walked on a treadmill. Walking speed (m/s), step cycle (cycle/s), and step length (m) were also measured on a treadmill with and without PKAFO, and before and after gait training. Clinical parameters measured before and after gait training included Korean version of Modified Bathel Index (K-MBI), manual muscle test (MMT), and Modified Ashworth Scale (MAS) of hemiplegic ankle. Gait training comprised treadmill walking for 20 minutes, 5 days a week for 3 weeks at a comfortable speed. The 10-m walking time, walking speed, step length, and step cycle were significantly greater with PKAFO than without PKAFO, and after gait training (both p<0.05). K-MBI was improved after gait training (p<0.05), but MMT and MAS were not. PKAFO may improve gait function in hemiplegic patients. It can be a useful orthosis for gait training in hemiplegic patients.

  1. Orthosis Effects on the Gait of a Child with Infantile Tibia Vara

    Directory of Open Access Journals (Sweden)

    Serap Alsancak

    2015-01-01

    Full Text Available Infantile tibia vara (ITV is an acquired form of tibial deformity associated with tibial varus and internal torsion. As there is currently insufficient data available on the effects of orthotics on gait parameters, this study aimed to document the influence of orthosis on walking. A male infant with bilateral tibia vara used orthoses for five months. Gait evaluations were performed pre- and posttreatment for both legs. The kinematic parameters were collected by using a motion analysis system. The orthotic design principle was used to correct the femur and tibia. Posttreatment gait parameters were improved compared to pretreatment parameters. After 5 months, there was remarkable change in the stance-phase degrees of frontal plane hip joint abduction and knee joint varus. We found that orthoses were an effective treatment for the infantile tibia vara gait characteristics in this patient. Full-time use of single, upright knee-ankle-foot orthosis with a drop lock knee joint and application of corrective forces at five points along the full length of the limb were effective.

  2. Charcot-Marie-Tooth and Related Diseases

    Science.gov (United States)

    ... find they can overcome them just by wearing boots or high-top shoes to support the ankles. ... people with more proximal weak- ness, there’s the knee-ankle-foot orthosis (KAFO), which extends up the ...

  3. A multisensory integration model of human stance control.

    Science.gov (United States)

    van der Kooij, H; Jacobs, R; Koopman, B; Grootenboer, H

    1999-05-01

    A model is presented to study and quantify the contribution of all available sensory information to human standing based on optimal estimation theory. In the model, delayed sensory information is integrated in such a way that a best estimate of body orientation is obtained. The model approach agrees with the present theory of the goal of human balance control. The model is not based on purely inverted pendulum body dynamics, but rather on a three-link segment model of a standing human on a movable support base. In addition, the model is non-linear and explicitly addresses the problem of multisensory integration and neural time delays. A predictive element is included in the controller to compensate for time delays, necessary to maintain erect body orientation. Model results of sensory perturbations on total body sway closely resemble experimental results. Despite internal and external perturbations, the controller is able to stabilise the model of an inherently unstable standing human with neural time delays of 100 ms. It is concluded, that the model is capable of studying and quantifying multisensory integration in human stance control. We aim to apply the model in (1) the design and development of prostheses and orthoses and (2) the diagnosis of neurological balance disorders.

  4. Active Elbow Orthosis

    Directory of Open Access Journals (Sweden)

    Tomas Ripel

    2014-09-01

    Full Text Available This paper presents a novel approach to the design of a motorized rehabilitation device – active elbow orthosis (AEO – inspired by the principles of robotic exoskeletons. The device is currently designed for the elbow joint, but can be easily modified for other joints as well. AEO determines the motion activity of the patient using a strain gauge and utilizes this measurement to control the actuator that drives the forearm part of the orthosis. Patient activity level is related to a free arm measurement obtained via a calibration procedure prior to the exercise. A high-level control module offers several types of exercises mimicking the physiotherapist. The device was successfully verified by tests on a number of patients, resulting in extended range of elbow-joint motion.

  5. 21 CFR 890.3475 - Limb orthosis.

    Science.gov (United States)

    2010-04-01

    ... PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3475 Limb orthosis. (a) Identification. A limb orthosis (brace) is a device intended for medical purposes that is worn on the upper or lower... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Limb orthosis. 890.3475 Section 890.3475 Food and...

  6. Characteristics of multiple sclerosis patient stance control disorders, measured by means of posturography and related to brainstem lesions

    Directory of Open Access Journals (Sweden)

    Dario Alpini

    2012-01-01

    Full Text Available Balance disorders are commonly observed during the course of multiple sclerosis (MS. The aim of this study is to report characteristics of MS patient stance control disorders, measured by means of posturography and related to the brainstem lesions. Thirty-eight patients affected by MS, mildly to moderately disable according to Kurtzke’s Expanded Disability Status Scale, underwent a complete clinical neurological and vestibular evaluation and brain MRI scanning. All patients were then tested on a static posturography platform (Tetrax, Israel in four conditions: eyes open and eyes closed standing on a firm surface and on a foam pad. Clinical and/or magnetic resonance imaging evidence of brainstem involvement was observed in 55.3% of patients. When brainstem lesion was detected, Fourier analysis showed a typical pattern characterized by inversion of the 0- 0.1 Hz and 0.1-0.25 Hz frequency bands. In conclusion, MS leads to pervasive postural disturbances in the majority of subjects, including the visuo-vestibular loops and proprioception involving vestibulospinal pathways in at least 55.3% of patients. Our results may also suggest the presence of Fourier inversion in patients with brainstem lesions.

  7. An ankle-foot orthosis powered by artificial pneumatic muscles.

    Science.gov (United States)

    Ferris, Daniel P; Czerniecki, Joseph M; Hannaford, Blake

    2005-05-01

    We developed a pneumatically powered orthosis for the human ankle joint. The orthosis consisted of a carbon fiber shell, hinge joint, and two artificial pneumatic muscles. One artificial pneumatic muscle provided plantar flexion torque and the second one provided dorsiflexion torque. Computer software adjusted air pressure in each artificial muscle independently so that artificial muscle force was proportional to rectified low-pass-filtered electromyography (EMG) amplitude (i.e., proportional myoelectric control). Tibialis anterior EMG activated the artificial dorsiflexor and soleus EMG activated the artificial plantar flexor. We collected joint kinematic and artificial muscle force data as one healthy participant walked on a treadmill with the orthosis. Peak plantar flexor torque provided by the orthosis was 70 Nm, and peak dorsiflexor torque provided by the orthosis was 38 Nm. The orthosis could be useful for basic science studies on human locomotion or possibly for gait rehabilitation after neurological injury.

  8. Comparison of effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy.

    Science.gov (United States)

    Caliskan Uckun, Asli; Celik, Canan; Ucan, Halil; Ordu Gokkaya, Nilufer Kutay

    2014-12-01

    The aim of the study was to compare the effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy (CP). We included 48 children with CP using lower extremity orthosis. Energy expenditures determined based on heart rate, yielded an energy expenditure index (EEI) with and without orthosis during walking. RESULTS were compared statistically between orthosis groups (solid polyethylene ankle foot orthosis (PAFO), articulated PAFO, ground reaction foot orthosis (GRAFO), plastic and metallic knee-ankle-foot-orthosis (KAFO), and metallic AFO). It was found that an advancement in energy expenditure was seen with plastic orthoses which is more prominent by solid PAFO (p = 0.008). It was concluded that especially solid PAFO can be more beneficial in terms of energy consumption in CP patients. In rehabilitation phase, the EEI measurement was seen to be a useful and practical method for choosing the proper orthosis type.

  9. Non-linear stimulus-response behavior of the human stance control system is predicted by optimization of a system with sensory and motor noise.

    Science.gov (United States)

    van der Kooij, Herman; Peterka, Robert J

    2011-06-01

    We developed a theory of human stance control that predicted (1) how subjects re-weight their utilization of proprioceptive and graviceptive orientation information in experiments where eyes closed stance was perturbed by surface-tilt stimuli with different amplitudes, (2) the experimentally observed increase in body sway variability (i.e. the "remnant" body sway that could not be attributed to the stimulus) with increasing surface-tilt amplitude, (3) neural controller feedback gains that determine the amount of corrective torque generated in relation to sensory cues signaling body orientation, and (4) the magnitude and structure of spontaneous body sway. Responses to surface-tilt perturbations with different amplitudes were interpreted using a feedback control model to determine control parameters and changes in these parameters with stimulus amplitude. Different combinations of internal sensory and/or motor noise sources were added to the model to identify the properties of noise sources that were able to account for the experimental remnant sway characteristics. Various behavioral criteria were investigated to determine if optimization of these criteria could predict the identified model parameters and amplitude-dependent parameter changes. Robust findings were that remnant sway characteristics were best predicted by models that included both sensory and motor noise, the graviceptive noise magnitude was about ten times larger than the proprioceptive noise, and noise sources with signal-dependent properties provided better explanations of remnant sway. Overall results indicate that humans dynamically weight sensory system contributions to stance control and tune their corrective responses to minimize the energetic effects of sensory noise and external stimuli.

  10. Prototyping of Individual Ankle Orthosis Using Additive Manufacturing Technologies

    Directory of Open Access Journals (Sweden)

    Natalia Wierzbicka

    2017-09-01

    Full Text Available The paper presents design and manufacturing process of an individualized ankle orthosis using additive manufacturing technologies and reverse engineering. Conventional processes of manufacturing of orthosesareexpensive and time consuming -an alternative method was proposed. The patient’s leg was 3D scanned and the orthosis was designed using a CAD system. It was then manufactured using the Fused Deposition Modelling technology, assembled and fully tested. Positive results were obtained.

  11. User experience of lower-limb orthosis.

    Science.gov (United States)

    Yang, Bing-Shiang; Chen, Yen-Wan; Tong, Ji-Rou

    2017-06-09

    If an assistive device is not acceptable to the user, it will not achieve efficacy and would be resource-wasting. This study employed in-depth interviews to understand what users' individual activities of daily living, problems of using orthoses, and considerations for selecting orthoses are. We conducted qualitative interviews with 35 lower-limb orthosis users, and semi-structured interviews were applied in this study. We analyzed the interview data from transcripts, through coding and concepts, to theories based on grounded theory. The results showed that problems of using orthoses are mostly related to activities of daily living of the user and user's expectation. Therefore, in order to enhance its efficacy and use intention, the design and prescribing process of orthoses need to address the problems in the light of activities of daily living and user education.

  12. EFFECTIVENESS OF INTRINSIC MUSCLE STRENGTHENING WITH ORTHOSIS OVER CONVENTIONAL PHYSIOTHERAPY WITH ORTHOSIS FOR NAVICULAR DROP IN PROLONG STANDING WORKERS

    Directory of Open Access Journals (Sweden)

    Pooja Saikia

    2015-08-01

    Full Text Available Background: Foot pronation is a series of movements which is intended to absorb shock by decelerating and cushioning the foot as it comes in contact with surface. When this motion is exaggerated, the ankle rolls too far inward and the arch is flattened causing overpronation. It is seen that with an abnormal pronation, navicular drop occurs. Navicular drop causes pain in ankle and knee, fatigue, difficulty in walking. The purpose of the study was to determine the effect of intrinsic muscle strengthening with orthosis over conventional physiotherapy exercises with orthosis for correction of navicular drop and Pain Disability in prolong standing workers. Method: An Experimental study design, seventy industrial workers were tested for navicular drop test out of which fifty tested positive. The subjects were divided into two groups Group A (N=25 and Group B (N=25. Group-A subjects received intrinsic muscle strengthening exercises with orthosis and Group-B received conventional physiotherapy exercises with orthosis. The duration of treatment continued was given for 8 weeks and outcome measurements were measured at 0 day, 4th week and 8th week using the Navicular drop (ND test and Pain Disability Questionnaire (PDQ. Results: Comparative analysis using Independent t-test was carried out separately for ND and PDQ. For ND, t =-5.01 which is highly significant (p=0.00. It has been inferred that ND decreases more when intrinsic muscle strengthening with orthosis was applied. To see the difference of means of PDQ, t = -1.97 which is significant (p = 0.049 implying that PDQ decrease more when intrinsic muscle strengthening was applied as compared to conventional physiotherapy with orthosis. Conclusion: It is concluded that 8 weeks of intrinsic muscle strengthening exercise with orthosis is more effective than conventional physiotherapy exercises with orthosis in reducing navicular drop and improving Pain Disability in prolong standing workers.

  13. Voluntary driven elbow orthosis with speed controlled tremor suppression

    Directory of Open Access Journals (Sweden)

    Gil eHerrnstadt

    2016-03-01

    Full Text Available Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is such one example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions such as eating and drinking.We have developed a one degree-of-freedom (DOF elbow orthosis that could be worn by an individual with tremor. A speed controlled voluntary driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach, instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal while simultaneously rejecting the tremorous motion.In this work, we tested the suppressive orthosis using a 1 DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of nonlinear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system.The electromechanical design of the orthosis is presented, and data from an Essential Tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of

  14. Effect of New Kypho-Remainder Orthosis on Curve Intensity in Adults With Postural Hyper Kyphosis

    Directory of Open Access Journals (Sweden)

    Omid Torkaman

    2017-10-01

    Conclusion Considering the importance of maintaining a proper posture to optimize the muscles activity in preventing deformity and orthosis with a bio-feedback mechanism may be the solution. The long-term effect of using a bio-feedback orthosis indicated that kypho-remainder orthosis can significantly improve the kyphosis curve in individuals with postural hyper-kyphosis. 

  15. Internal Models Support Specific Gaits in Orthotic Devices

    DEFF Research Database (Denmark)

    Matthias Braun, Jan; Wörgötter, Florentin; Manoonpong, Poramate

    2014-01-01

    such limitations is to supply the patient—via the orthosis—with situation-dependent gait models. To achieve this, we present a method for gait recognition using model invalidation. We show that these models are capable to predict the individual patient's movements and supply the correct gait. We investigate...... the system's accuracy and robustness on a Knee-Ankle-Foot-Orthosis, introducing behaviour changes depending on the patient's current walking situation. We conclude that the here presented model-based support of different gaits has the power to enhance the patient's mobility....

  16. Modelling of the Human Knee Joint Supported by Active Orthosis

    Science.gov (United States)

    Musalimov, V.; Monahov, Y.; Tamre, M.; Rõbak, D.; Sivitski, A.; Aryassov, G.; Penkov, I.

    2018-02-01

    The article discusses motion of a healthy knee joint in the sagittal plane and motion of an injured knee joint supported by an active orthosis. A kinematic scheme of a mechanism for the simulation of a knee joint motion is developed and motion of healthy and injured knee joints are modelled in Matlab. Angles between links, which simulate the femur and tibia are controlled by Simulink block of Model predictive control (MPC). The results of simulation have been compared with several samples of real motion of the human knee joint obtained from motion capture systems. On the basis of these analyses and also of the analysis of the forces in human lower limbs created at motion, an active smart orthosis is developed. The orthosis design was optimized to achieve an energy saving system with sufficient anatomy, necessary reliability, easy exploitation and low cost. With the orthosis it is possible to unload the knee joint, and also partially or fully compensate muscle forces required for the bending of the lower limb.

  17. Modelling of the Human Knee Joint Supported by Active Orthosis

    Directory of Open Access Journals (Sweden)

    Musalimov V.

    2018-02-01

    Full Text Available The article discusses motion of a healthy knee joint in the sagittal plane and motion of an injured knee joint supported by an active orthosis. A kinematic scheme of a mechanism for the simulation of a knee joint motion is developed and motion of healthy and injured knee joints are modelled in Matlab. Angles between links, which simulate the femur and tibia are controlled by Simulink block of Model predictive control (MPC. The results of simulation have been compared with several samples of real motion of the human knee joint obtained from motion capture systems. On the basis of these analyses and also of the analysis of the forces in human lower limbs created at motion, an active smart orthosis is developed. The orthosis design was optimized to achieve an energy saving system with sufficient anatomy, necessary reliability, easy exploitation and low cost. With the orthosis it is possible to unload the knee joint, and also partially or fully compensate muscle forces required for the bending of the lower limb.

  18. Hip orthosis powered by pneumatic artificial muscle: voluntary activation in absence of myoelectrical signal.

    Science.gov (United States)

    do Nascimento, Breno Gontijo; Vimieiro, Claysson Bruno Santos; Nagem, Danilo Alves Pinto; Pinotti, Marcos

    2008-04-01

    Powered orthosis is a special class of gait assist device that employs a mechanical or electromechanical actuator to enhance movement of hip, knee, or ankle articulations. Pneumatic artificial muscle (PAM) has been suggested as a pneumatic actuator because its performance is similar to biological muscle. The electromyography (EMG) signal interpretation is the most popular and simplest method to establish the patient voluntary control of the orthosis. However, this technique is not suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. For those cases, an alternative control strategy should be provided. The aim of the present study is to develop a gait assistance orthosis for lower limb powered by PAMs controlled by a voluntary activation method based on the angular behavior of hip joint. In the present study, an orthosis that has been molded in a patient was employed and, by taking her anthropometric parameters and movement constraints, the adaptation of the existing orthosis to the powered orthosis was planned. A control system was devised allowing voluntary control of a powered orthosis suitable for patients presenting neurological lesions causing absence or very low quality of EMG signal. A pilot clinical study was reported where a patient, victim of poliovirus, successfully tested a hip orthosis especially modified for the gait test evaluation in the parallel bar system. The hip orthosis design and the control circuitry parameters were able to be set to provide satisfactory and comfortable use of the orthosis during the gait cycle.

  19. A Motor Learning Oriented, Compliant and Mobile Gait Orthosis

    Directory of Open Access Journals (Sweden)

    A. Calanca

    2012-01-01

    Full Text Available People affected by Cerebral Palsy suffer from physical disabilities due to irreversible neural impairment since the very beginning of their life. Difficulties in motor control and coordination often relegate these patients to the use of a wheelchair and to the unavoidable upcoming of disuse syndromes. As pointed out in recent literature Damiano [7] physical exercise, especially in young ages, can have a deep impact on the patient health and quality of life. For training purposes is very important to keep an upright position, although in some severe cases this is not trivial. Many commercial mobile orthoses are designed to facilitate the standing, but not all the patients are able to deploy them. ARGO, the Active Reciprocated Gait Orthosis we developed, is a device that overcomes some of the limitations of these devices. It is an active device that is realized starting from a commercial reciprocated Gait Orthosis applying sensors and actuators to it. With ARGO we aim to develop a device for helping limbs in a non-coercive way accordingly to user’s intention. In this way patients can drive the orthosis by themselves, deploying augmented biofeedback over movements. In fact Cerebral Palsy patients usually have weak biofeedback mechanisms and consequently are hardly inclined to learn movements. To achieve this behavior ARGO deploys a torque planning algorithm and a force control system. Data collected from a single case of study shows benefits of the orthosis. We will show that our test patient reaches complete autonomous walking after few hour of training with prototype.

  20. FES-Assisted Walking with Spring Brake Orthosis: Simulation Studies

    Directory of Open Access Journals (Sweden)

    R. Jailani

    2011-01-01

    Full Text Available This paper presents a simulation of bipedal locomotion to generate stimulation pulses for activating muscles for paraplegic walking with wheel walker using functional electrical stimulation (FES with spring brake orthosis (SBO. A new methodology for paraplegic gait, based on exploiting natural dynamics of human gait, is introduced. The work is a first effort towards restoring natural like swing phase in paraplegic gait through a new hybrid orthosis, referred to as spring brake orthosis (SBO. This mechanism simplifies the control task and results in smooth motion and more-natural like trajectory produced by the flexion reflex for gait in spinal cord injured subjects. SBO can eliminate reliance on the withdrawal reflex and foot-ground clearance without extra upper body effort. The stored energy in the spring of SBO is used to replace stimulation pulses in knee flexion and reduce total required torque for the paraplegic walking with wheel walker. The study is carried out with a model of humanoid with wheel walker using the Visual Nastran (Vn4D dynamic simulation software. Stimulated muscle model of quadriceps is developed for knee extension. Fuzzy logic control (FLC is developed in Matlab/Simulink to regulate the muscle stimulation pulse-width required to drive FES-assisted walking gait and the computed motion is visualised in graphic animation from Vn4D. The simulation results show that SBO can be successfully used with FES for paraplegic walking with wheel walker with all the advantages discussed over the current hybrid orthoses available.

  1. Efficacy of a hybrid assistive limb in post-stroke hemiplegic patients: a preliminary report

    Directory of Open Access Journals (Sweden)

    Takeda Koji

    2011-09-01

    Full Text Available Abstract Background Robotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation. Methods The study group comprised 16 stroke patients with severe hemiplegia. All patients underwent gait training. Four patients required assistance, and 12 needed supervision while walking. The stride length, walking speed and physiological cost index on wearing the hybrid assistive limb suit and a knee-ankle-foot orthosis were compared. Results The hybrid assistive limb suit increased the stride length and walking speed in 4 of 16 patients. The patients whose walking speed decreased on wearing the hybrid assistive limb suit either had not received sufficient gait training or had an established gait pattern with a knee-ankle-foot orthosis using a quad cane. The physiological cost index increased after wearing the hybrid assistive limb suit in 12 patients, but removal of the suit led to a decrease in the physiological cost index values to equivalent levels prior to the use of the suit. Conclusions Although the hybrid assistive limb suit is not useful for all hemiplegic patients, it may increase the walking speed and affect the walking ability. Further investigation would clarify its indication for the possibility of gait training.

  2. Design a New Orthosis and Assessment of Its Effects on Knee Joint Kinetics and Kinematics During Gait

    Directory of Open Access Journals (Sweden)

    Mostafa Kamali

    2015-12-01

    Methods: Ten subjects without any neuromuscular disease participated in this study. New orhosis with the same structure of Scottish rite orthosis was designed. Qualysis system analyses with seven cameras as well as a Kistler force plate were used to measure the kinematics and kinetics variables during the gait with and without orthosis. For statistical analysis independent student-t test was used. The significance level was set at p0.05. There was significant difference between peak medio-lateral forces applied on knee during walking with and without orthosis (p<0.05. Conclusion: The new orthosis decreases the adductor moment on knee joint therefore, it can decrease the forces applied on medial compartment of the knee joint. This orthosis improves walking because it does not let inferior transition. This orthosis can improve femur alignment. It is recommended that physiotherapist prescribe this orthosis in order to decrease pain in patients with OA.

  3. Use and tolerability of a side pole static ankle foot orthosis in children with neurological disorders.

    Science.gov (United States)

    Delvert, Céline; Rippert, Pascal; Margirier, Françoise; Vadot, Jean-Pierre; Bérard, Carole; Poirot, Isabelle; Vuillerot, Carole

    2017-04-01

    Transverse-plane foot deformities are a frequently encountered issue in children with neurological disorders. They are the source of many symptoms, such as pain and walking difficulties, making their prevention very important. We aim to describe the use and tolerability of a side pole static ankle foot orthosis used to prevent transverse-plane foot deformities in children with neurologic disorders. Monocentric, retrospective, observational study. Medical data were collected from 103 children with transverse-plane foot deformities in one or both feet caused by a neurological impairment. All children were braced between 2001 and 2010. Unilateral orthosis was prescribed for 32 children and bilateral orthosis for 71. Transverse-plane foot deformities were varus in 66% of the cases and an equinus was associated in 59.2% of the cases. Mean age for the first prescription was 8.6 years. For the 23 patients present at the 4-year visit, 84.8% still wore the orthosis daily, and 64.7% wore the orthosis more than 6 h per day. The rate of permanent discontinuation of wearing the orthosis was 14.7%. The side pole static ankle foot orthosis is well tolerated with very few side effects, which promotes regular wearing and observance. Clinical relevance Side pole static ankle foot orthoses are well tolerated and can be safely used for children with foot abnormalities in the frontal plane that have a neurological pathology origin.

  4. The effects of a new designed forearm orthosis in treatment of lateral epicondylitis.

    Science.gov (United States)

    Forogh, Bijan; Khalighi, Mohsen; Javanshir, Mohammad Ali; Ghoseiri, Kamiar; Kamali, Mohammad; Raissi, Gholamreza

    2012-07-01

    This paper reports on the design and testing of a new designed forearm orthosis and explores its efficacious in comparison to the standard counterforce orthosis in patients with lateral epicondylitis. Twenty-four patients were enrolled in this assessor-blinded clinical trial and randomly assigned to two parallel treatment groups. The measures of pain and function, the pain threshold and grip strength were compared using patient rated tennis elbow evaluation (PRTEE) form, algometer and dynamometer respectively at baseline and 4 weeks after treatment. Paired and independent t-test statistical methods recruited for within and between groups comparisons respectively. The both orthoses, counterforce and new-designed, significantly relieved pain, and improved function, pain threshold and grip strength of all patients after 4 weeks application. The new-designed orthosis seemed to be more effective than the counterforce orthosis in pain relief, but there was not any significant difference in efficacious of two types of orthoses regarding function. The new-designed orthosis can significantly relieve pain, improve function, increase pain threshold and grip strength after application. This orthosis seemed to be more effective than counterforce orthosis in relieving pain and increasing the pain threshold probably due to the limitation of forearm supination.

  5. SCRIPT passive orthosis: design and technical evaluation of the wrist and hand orthosis for rehabilitation training at home.

    Science.gov (United States)

    Ates, Serdar; Lobo-Prat, Joan; Lammertse, Piet; van der Kooij, Herman; Stienen, Arno H A

    2013-06-01

    In this paper, a new hand and wrist exoskeleton design, the SCRIPT Passive Orthosis (SPO), for the rehabilitation after stroke is presented. The SPO is a wrist, hand, and finger orthosis that assists individuals after stroke that suffer from impairments caused by spasticity and abnormal synergies. These impairments are characterized in the wrist and hand by excessive involuntary flexion torques that make the hand unable to be used for many activities in daily life. The SPO can passively offset these undesired torques, but it cannot actively generate or control movements. The user needs to use voluntary muscle activation to perform movements and thus needs to have some residual muscle control to successfully use the SPO. The SPO offsets the excessive internal flexion by applying external extension torques to the joints of the wrist and fingers. The SPO physically interacts with the users using the forearm shell, the hand plate and the digit caps from the Saebo Flex, but is otherwise a completely novel design. It applies the external extension torques via passive leaf springs and elastic tension cords. The amount of this support can be adjusted to provide more or less offset force to wrist, finger, or thumb extension, manually. The SPO is equipped with sensors that can give a rough estimate of the joint rotations and applied torques, sufficient to make the orthosis interact with our interactive gaming environment. Integrated inertial and gyroscopic sensors provide limited information on the user's forearm posture. The first home-based patient experiences have already let to several issues being resolved, but have also made it clear that many improvement are still to be made.

  6. Locomotor adaptation to a powered ankle-foot orthosis depends on control method

    Directory of Open Access Journals (Sweden)

    Gordon Keith E

    2007-12-01

    Full Text Available Abstract Background We studied human locomotor adaptation to powered ankle-foot orthoses with the intent of identifying differences between two different orthosis control methods. The first orthosis control method used a footswitch to provide bang-bang control (a kinematic control and the second orthosis control method used a proportional myoelectric signal from the soleus (a physiological control. Both controllers activated an artificial pneumatic muscle providing plantar flexion torque. Methods Subjects walked on a treadmill for two thirty-minute sessions spaced three days apart under either footswitch control (n = 6 or myoelectric control (n = 6. We recorded lower limb electromyography (EMG, joint kinematics, and orthosis kinetics. We compared stance phase EMG amplitudes, correlation of joint angle patterns, and mechanical work performed by the powered orthosis between the two controllers over time. Results During steady state at the end of the second session, subjects using proportional myoelectric control had much lower soleus and gastrocnemius activation than the subjects using footswitch control. The substantial decrease in triceps surae recruitment allowed the proportional myoelectric control subjects to walk with ankle kinematics close to normal and reduce negative work performed by the orthosis. The footswitch control subjects walked with substantially perturbed ankle kinematics and performed more negative work with the orthosis. Conclusion These results provide evidence that the choice of orthosis control method can greatly alter how humans adapt to powered orthosis assistance during walking. Specifically, proportional myoelectric control results in larger reductions in muscle activation and gait kinematics more similar to normal compared to footswitch control.

  7. Embracing additive manufacture: implications for foot and ankle orthosis design

    Directory of Open Access Journals (Sweden)

    Telfer Scott

    2012-05-01

    Full Text Available Abstract Background The design of foot and ankle orthoses is currently limited by the methods used to fabricate the devices, particularly in terms of geometric freedom and potential to include innovative new features. Additive manufacturing (AM technologies, where objects are constructed via a series of sub-millimetre layers of a substrate material, may present the opportunity to overcome these limitations and allow novel devices to be produced that are highly personalised for the individual, both in terms of fit and functionality. Two novel devices, a foot orthosis (FO designed to include adjustable elements to relieve pressure at the metatarsal heads, and an ankle foot orthosis (AFO designed to have adjustable stiffness levels in the sagittal plane, were developed and fabricated using AM. The devices were then tested on a healthy participant to determine if the intended biomechanical modes of action were achieved. Results The adjustable, pressure relieving FO was found to be able to significantly reduce pressure under the targeted metatarsal heads. The AFO was shown to have distinct effects on ankle kinematics which could be varied by adjusting the stiffness level of the device. Conclusions The results presented here demonstrate the potential design freedom made available by AM, and suggest that it may allow novel personalised orthotic devices to be produced which are beyond the current state of the art.

  8. Design of a quasi-passive 3 DOFs ankle-foot wearable rehabilitation orthosis.

    Science.gov (United States)

    Zhang, Chao; Zhu, Yanhe; Fan, Jizhuang; Zhao, Jie; Yu, Hongying

    2015-01-01

    Muscular rigidity and atrophy caused by long-term underactivity usually lead to foot drop, strephenopodia, foot extorsion or some other complications for the lower limb movement disorders or lower limb surgery sufferers. The ankle-foot orthosis can help patients conduct the right ankle motion mode training, inhibit spasm and prevent ankle complications. In this paper, a quasi-passive 3 DOFs ankle-foot wearable orthosis was designed on the basis of kinematics and dynamics analysis of the ankle joint. Ankle joint trajectory and dynamic characteristics similar to those of natural gait can be obtained by the combination of passive energy storage and additional power complement. In terms of function, the orthosis has shock absorption and low energy consumption. Given its excellent characteristics of comfortableness, lightweight, and anthropomorphic construction, the orthosis can be used in medical institutions for rehabilitation training or as a daily-walking auxiliary equipment for surgery sufferers.

  9. Mesh three-dimensional arm orthosis with built-in ultrasound physiotherapy system

    Science.gov (United States)

    Kashapova, R. M.; Kashapov, R. N.; Kashapova, R. S.

    2017-09-01

    The possibility of using the built-in ultrasound physiotherapy system of the hand orthosis is explored in the work. The individual mesh orthosis from nylon 12 was manufactured by the 3D prototyping method on the installation of selective laser sintering SLS SPro 60HD. The applied technology of three-dimensional scanning made it possible to obtain a model of the patient’s hand and on the basis of it to build a virtual model of the mesh frame. In the course of the research, the developed system of ultrasound exposure was installed on the orthosis and its tests were carried out. As a result, the acceleration of the healing process and the reduction in the time of wearing orthosis were found.

  10. Design and Evaluation of the AIRGAIT Exoskeleton: Leg Orthosis Control for Assistive Gait Rehabilitation

    Directory of Open Access Journals (Sweden)

    Mohd Azuwan Mat Dzahir

    2013-01-01

    Full Text Available This paper introduces the body weight support gait training system known as the AIRGAIT exoskeleton and delves into the design and evaluation of its leg orthosis control algorithm. The implementation of the mono- and biarticular pneumatic muscle actuators (PMAs as the actuation system was initiated to generate more power and precisely control the leg orthosis. This research proposes a simple paradigm for controlling the mono- and bi-articular actuator movements cocontractively by introducing a cocontraction model. Three tests were performed. The first test involved control of the orthosis with monoarticular actuators alone without a subject (WO/S; the second involved control of the orthosis with mono- and bi-articular actuators tested WO/S; and the third test involved control of the orthosis with mono- and bi-articular actuators tested with a subject (W/S. Full body weight support (BWS was implemented in this study during the test W/S as the load supported by the orthosis was at its maximum capacity. This assessment will optimize the control system strategy so that the system operates to its full capacity. The results revealed that the proposed control strategy was able to co-contractively actuate the mono- and bi-articular actuators simultaneously and increase stiffness at both hip and knee joints.

  11. Mechanical performance of artificial pneumatic muscles to power an ankle-foot orthosis.

    Science.gov (United States)

    Gordon, Keith E; Sawicki, Gregory S; Ferris, Daniel P

    2006-01-01

    We developed a powered ankle-foot orthosis that uses artificial pneumatic muscles to produce active plantar flexor torque. The purpose of this study was to quantify the mechanical performance of the orthosis during human walking. Three subjects walked at a range of speeds wearing ankle-foot orthoses with either one or two artificial muscles working in parallel. The orthosis produced similar total peak plantar flexor torque and network across speeds independent of the number of muscles used. The orthosis generated approximately 57% of the peak ankle plantar flexor torque during stance and performed approximately 70% of the positive plantar flexor work done during normal walking. Artificial muscle bandwidth and force-length properties were the two primary factors limiting torque production. The lack of peak force and work differences between single and double muscle conditions can be explained by force-length properties. Subjects altered their ankle kinematics between conditions resulting in changes in artificial muscle length. In the double muscle condition greater plantar flexion yielded shorter artificial muscles lengths and decreased muscle forces. This finding emphasizes the importance of human testing in the design and development of robotic exoskeleton devices for assisting human movement. The results of this study outline the mechanical performance limitations of an ankle-foot orthosis powered by artificial pneumatic muscles. This orthosis could be valuable for gait rehabilitation and for studies investigating neuromechanical control of human walking.

  12. Simulations and experimental evaluation of an active orthosis for interaction in virtual environments

    Directory of Open Access Journals (Sweden)

    Tsveov Mihail

    2018-01-01

    Full Text Available In this work, the development of a human arm active orthosis is presented. The orthosis is designed primarily for training and rehabilitation in virtual environments.The orthosis system is intended for embodiment in virtual reality where it is allowing human to perceive forces at different body parts or the weight of lifted objects. In the paper the choice of a mechanical structure is shown equivalent to the structure of the human arm. A mechanical model of the orthosis arm as haptic device is built, where kinematic and dynamic parameters are evaluated. Impedance control scheme is selected as the most suitable for force refection at the hand or arm. An open-loop impedance controller is presented in the paper. Computer experiments are carried out using the dimensions of a real arm orthosis. Computer experiments have been carried out to provide force reflection by VR, according to virtual scenario. The conducted simulations show the range of the forces on the operator hand, orthosis can provide. The results of additional measurements and experimental evaluations of physical quantities in the interaction in a virtual environment are revealed in the paper.

  13. Neuro-fuzzy controller for active ankle foot orthosis

    Directory of Open Access Journals (Sweden)

    Rishabh Kochhar

    2016-09-01

    Full Text Available The ankle foot orthosis (AFO is as an assistive device used in foot disability for gait improvement. The objective of this paper was to design a neuro fuzzy controller for an AFO. Adaptive neuro fuzzy inference system (ANFIS was selected after a detailed study of existing neuro-fuzzy architectures. Data of gait pattern was collected with the help of analog gyro sensors. This data was fed to the ANFIS and a fuzzy rule base was created to complete the neuro-fuzzy system which was used to control the gait pattern. Angular velocity and angle of feet served as inputs to the controller and the output was actuation. The results obtained showed sigmoidal membership functions for the various inputs and outputs due to their close resemblance with the normal human gait. Output of the ANFIS showcased the initial data which was fed to the system; the modified data; changed membership functions and error after training.

  14. Design of a portable hydraulic ankle-foot orthosis.

    Science.gov (United States)

    Neubauer, Brett C; Nath, Jonathan; Durfee, William K

    2014-01-01

    Small-scale hydraulics is ideal for powered human assistive devices including powered ankle foot orthoses because a large torque can be generated with an actuator that is small and light. A portable hydraulic ankle foot orthosis has been designed and is undergoing preliminary prototyping and engineering bench test evaluation. The device provides 90 Nm of ankle torque and has an operating pressure of 138 bar (2,000 psi). The battery-operated hydraulic power supply weighs about 3 kg and is worn at the waist. The ankle component weighs about 1.2 Kg and connects to the power supply with two hoses. Performance simulation and preliminary bench testing suggests that the device could be useful in certain rehabilitation applications.

  15. Manufacturing, testing, and numerical modeling a lower limb orthosis for a patient that has a partial foot amputation

    OpenAIRE

    Ayad Murad Takhakh, Hassanein Salih Hussain

    2017-01-01

    This study includes two main parts: The first part includes the process of manufacturing and testing partial foot orthosis for a patient suffering from partial foot amputation. The orthosis was manufactured from lamination Perlon-Carbon-Perlon(4-2-4) and then tested with Force plate and F-Socket. The patientwas tested in two cases: the first without wearing the orthosis and the second after wearing the orthosis. The results of gait cycle testshow that the gait cycle of the patient was improve...

  16. Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression

    Science.gov (United States)

    Herrnstadt, Gil; Menon, Carlo

    2016-01-01

    Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor

  17. Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression.

    Science.gov (United States)

    Herrnstadt, Gil; Menon, Carlo

    2016-01-01

    Robotic technology is gradually becoming commonplace in the medical sector and in the service of patients. Medical conditions that have benefited from significant technological development include stroke, for which rehabilitation with robotic devices is administered, and surgery assisted by robots. Robotic devices have also been proposed for assistance of movement disorders. Pathological tremor, among the most common movement disorders, is one such example. In practice, the dissemination and availability of tremor suppression robotic systems has been limited. Devices in the marketplace tend to either be non-ambulatory or to target specific functions, such as eating and drinking. We have developed a one degree-of-freedom (DOF) elbow orthosis that could be worn by an individual with tremor. A speed-controlled, voluntary-driven suppression approach is implemented with the orthosis. Typically tremor suppression methods estimate the tremor component of the signal and produce a canceling counterpart signal. The suggested approach instead estimates the voluntary component of the motion. A controller then actuates the orthosis based on the voluntary signal, while simultaneously rejecting the tremorous motion. In this work, we tested the suppressive orthosis using a one DOF robotic system that simulates the human arm. The suggested suppression approach does not require a model of the human arm. Moreover, the human input along with the orthosis forearm gravitational forces, of non-linear nature, are considered as part of the disturbance to the suppression system. Therefore, the suppression system can be modeled linearly. Nevertheless, the orthosis forearm gravitational forces can be compensated by the suppression system. The electromechanical design of the orthosis is presented, and data from an essential tremor patient is used as the human input. Velocity tracking results demonstrate an RMS error of 0.31 rad/s, and a power spectral density shows a reduction of the tremor

  18. Clinical application of the modified medially-mounted motor-driven hip gear joint for paraplegics.

    Science.gov (United States)

    Sonoda, S; Imahori, R; Saitoh, E; Tomita, Y; Domen, K; Chino, N

    2000-04-15

    This paper describes a motor-driven orthosis for paraplegics which has been developed. This orthosis is composed of a medially-mounted motor-driven hip joint and bilateral knee-ankle-foot orthosis. With the gear mechanism, the virtual axis of the hip joint of this orthosis is almost as high as the anatomical hip joint. A paraplegic patient with an injury level of T10/11 walked using bilateral lofstrand crutches and this new orthosis with or without the motor system. The motor is initiated by pushing a button attached at the edge of the grab of the crutches. Faster cadence and speed and smaller rotation angle of the trunk was obtained in motor walking compared with non-motor walking. The patient did not feel fearful of falling. The benefit of motor orthosis is that it can be used even in patients with lower motor lesions and that it provides stable regulation of hip flexion movement in spastic patients. In conclusion, this motor orthosis will enhance paraplegic walking.

  19. Scoliosis curve analysis with Milwaukee orthosis based on Open SIMM modeling

    Directory of Open Access Journals (Sweden)

    Mohammad Karimi

    2015-01-01

    Full Text Available Background: Scoliosis is a three-dimensional spinal deformity characterized by lateral curvature and rotational deformity of the spine. Various methods have been used to investigate the performance of the subjects during walking with an orthosis, but nobody study the biomechanics of orthotic use by understanding the length of the muscles and the force produced by them. Therefore, the aim of this research is to test the effect of the orthosis on the muscular force, tendon length during walking with and without orthosis. Materials and Methods: A 12-year-old scoliosis subject was recruited in this study. The forces produced by trunk musculature, joint reaction force, length of trunk musculature were some parameters selected in this study. Open SIMM and Visual 3D software were used to model the subject. Results: The results of this research showed that the length of erector spine muscles increased follow the use of orthosis. Moreover, the force produced by trunk muscles differed during walking with and without orthosis and also between right and left sides. Discussion: It seems that Open SIMM software can be used to predict the length of muscles, active-passive forces produced by muscles in scoliotic subjects. Therefore, it is recommended this research be done on more number of subjects.

  20. Scoliosis curve analysis with Milwaukee orthosis based on Open SIMM modeling.

    Science.gov (United States)

    Karimi, Mohammad; Kavyani, Mahsa

    2015-01-01

    Scoliosis is a three-dimensional spinal deformity characterized by lateral curvature and rotational deformity of the spine. Various methods have been used to investigate the performance of the subjects during walking with an orthosis, but nobody study the biomechanics of orthotic use by understanding the length of the muscles and the force produced by them. Therefore, the aim of this research is to test the effect of the orthosis on the muscular force, tendon length during walking with and without orthosis. A 12-year-old scoliosis subject was recruited in this study. The forces produced by trunk musculature, joint reaction force, length of trunk musculature were some parameters selected in this study. Open SIMM and Visual 3D software were used to model the subject. The results of this research showed that the length of erector spine muscles increased follow the use of orthosis. Moreover, the force produced by trunk muscles differed during walking with and without orthosis and also between right and left sides. It seems that Open SIMM software can be used to predict the length of muscles, active-passive forces produced by muscles in scoliotic subjects. Therefore, it is recommended this research be done on more number of subjects.

  1. Fully embedded myoelectric control for a wearable robotic hand orthosis.

    Science.gov (United States)

    Ryser, Franziska; Butzer, Tobias; Held, Jeremia P; Lambercy, Olivier; Gassert, Roger

    2017-07-01

    To prevent learned non-use of the affected hand in chronic stroke survivors, rehabilitative training should be continued after discharge from the hospital. Robotic hand orthoses are a promising approach for home rehabilitation. When combined with intuitive control based on electromyography, the therapy outcome can be improved. However, such systems often require extensive cabling, experience in electrode placement and connection to external computers. This paper presents the framework for a stand-alone, fully wearable and real-time myoelectric intention detection system based on the Myo armband. The hard and software for real-time gesture classification were developed and combined with a routine to train and customize the classifier, leading to a unique ease of use. The system including training of the classifier can be set up within less than one minute. Results demonstrated that: (1) the proposed algorithm can classify five gestures with an accuracy of 98%, (2) the final system can online classify three gestures with an accuracy of 94.3% and, in a preliminary test, (3) classify three gestures from data acquired from mildly to severely impaired stroke survivors with an accuracy of over 78.8%. These results highlight the potential of the presented system for electromyography-based intention detection for stroke survivors and, with the integration of the system into a robotic hand orthosis, the potential for a wearable platform for all day robot-assisted home rehabilitation.

  2. Design and evaluation of Mina: a robotic orthosis for paraplegics.

    Science.gov (United States)

    Neuhaus, Peter D; Noorden, Jerryll H; Craig, Travis J; Torres, Tecalote; Kirschbaum, Justin; Pratt, Jerry E

    2011-01-01

    Mobility options for persons suffering from paraplegia or paraparesis are limited to mainly wheeled devices. There are significant health, psychological, and social consequences related to being confined to a wheelchair. We present the Mina, a robotic orthosis for assisting mobility, which offers a legged mobility option for these persons. Mina is an overground robotic device that is worn on the back and around the legs to provide mobility assistance for people suffering from paraplegia or paraparesis. Mina uses compliant actuation to power the hip and knee joints. For paralyzed users, balance is provided with the assistance of forearm crutches. This paper presents the evaluation of Mina with two paraplegics (SCI ASIA-A). We confirmed that with a few hours of training and practice, Mina is currently able to provide paraplegics walking mobility at speeds of up to 0.20 m/s. We further confirmed that using Mina is not physically taxing and requires little cognitive effort, allowing the user to converse and maintain eye contact while walking. © 2011 IEEE

  3. A digital approach for design and fabrication by rapid prototyping of orthosis for developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Rodrigo Munhoz

    Full Text Available Abstract Introduction Immobilization in a hip spica cast is required in surgical and nonsurgical treatments for children aged three months to four years diagnosed with developmental dysplasia of the hip. Skin complications are associated with the use of the spica cast in 30% of the cases. This research explores the use of photogrammetry and rapid prototyping for the production of a lighter, shower friendly and hygienic hip orthosis that could replace the hip spica cast. Methods Digitalized data of a plastic dool was used for design and fabrication of a customised hip orthosis following four steps: 1 Digitalization of the external anatomical structure by photogrammetry using a smartphone and open source software; 2 Idealization and 3D modeling of the hip orthosis; 3 Rapid prototyping of a low cost orthosis in polymer polylact acid; 4 Evaluation tests. Results Photogrammetry provided a good 3D reconstruction of the dool's hip and legs. The manufacture method to produce the hip orthosis was accurate in fitting the hip orthosis to the contours of the doll. The orthosis could be easily placed on the doll ensuring mechanical strength to immobilize the region of the hip. Conclusion A new approach and the feasibility of both techniques for hip orthosis fabrication were described. It represents an exciting advance for the development of hip orthosis that could be used in orthopedics. To test the effectiveness of this orthosis for developmental dysplasia of the hip treatment in newborns, material and mechanical tests, design optimization and physical tests with patients should be carried.

  4. Gastrocnemius tendon strain in a dog treated with autologous mesenchymal stem cells and a custom orthosis.

    Science.gov (United States)

    Case, J Brad; Palmer, Ross; Valdes-Martinez, Alex; Egger, Erick L; Haussler, Kevin K

    2013-05-01

    To report clinical findings and outcome in a dog with gastrocnemius tendon strain treated with autologous mesenchymal stem cells and a custom orthosis. Clinical report. A 4-year-old spayed female Border Collie. Bone-marrow derived, autologous mesenchymal stem cells were transplanted into the tendon core lesion. A custom, progressive, dynamic orthosis was fit to the tarsus. Serial orthopedic examinations and ultrasonography as well as long-term force-plate gait analysis were utilized for follow up. Lameness subjectively resolved and peak vertical force increased from 43% to 92% of the contralateral pelvic limb. Serial ultrasonographic examinations revealed improved but incomplete restoration of normal linear fiber pattern of the gastrocnemius tendon. Findings suggest that autologous mesenchymal stem cell transplantation with custom, progressive, dynamic orthosis may be a viable, minimally invasive technique for treatment of calcaneal tendon injuries in dogs. © Copyright 2013 by The American College of Veterinary Surgeons.

  5. Effects of Minerva Orthosis on Larynx Height in Young, Healthy Volunteers

    Directory of Open Access Journals (Sweden)

    Pegah Saddat Hosseini

    2017-12-01

    Full Text Available Background: During speech, larynx is higher in the neck for high-pitched sounds and lower for low-pitched sounds. Patients with different problems in cervical and cervicothoracic spine use cervical orthosis to limit cervical motion. This study aimed to evaluate the effects of Minerva orthosis on larynx height in young, healthy volunteers. Subjects and methods: This study included 18 subjects. Acoustic measurement of frequency variability has been assessed in 3 brace conditions: (1 without brace, (2 with brace, and (3 30 minutes after wearing the brace. Results: Several statistically significant differences were found in the comparison between Minerva and 30 minutes after Minerva. Conclusion: When planning cervical orthosis treatment, it is important to consider the reduction in larynx height that may result from bracing for those who are already at risk of developing dysphagia and dysphonia.

  6. Wearing an active spinal orthosis improves back extensor strength in women with osteoporotic vertebral fractures

    DEFF Research Database (Denmark)

    Valentin, Gitte Hoff; Pedersen, Louise Nymann; Maribo, Thomas

    2014-01-01

    extensor strength can result in decreased kyphosis and thus a decreased risk of falls and fractures.Objectives:The aim was to examine the effects of an active spinal orthosis - Spinomed III - on back extensor strength, back pain and physical functioning in women with osteoporotic vertebral fractures.......Study design:Experimental follow-up.Methods:The women used the active spinal orthosis for 3 months. Outcomes were changes in isometric back extensor strength, changes in back pain and changes in physical functioning.Results:A total of 13 women were included in the trial. Wearing the orthosis during a 3-month...... period was associated with an increase in back extensor strength of 50% (p = 0.01). The study demonstrated a 33% reduction in back pain and a 6.5-point improvement in physical functioning. The differences in pain and physical functioning were borderline significant.Conclusion:The women demonstrated...

  7. Weight transfer analysis in adults with hemiplegia using ankle foot orthosis.

    Science.gov (United States)

    Nolan, Karen J; Yarossi, Mathew

    2011-03-01

    Identifying and understanding the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia. The purpose of this investigation was to use a novel analysis technique to objectively measure weight transfer during double support (DS) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis. Prospective, Repeated measures, case-controlled trial. Participants included 25 adults with stroke-related hemiplegia >6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls. Main outcome measures included the weight transfer point timing (WTP, %DS), maximum total force timing (MTF, %DS), timing difference between WTP and MTF (MTF-WTP, %DS) and the linearity of loading (LOL, R(2)) during the DS phase of the gait cycle. The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals, p ≤ 0.01. The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group, p ≤ 0.0001 and p = 0.03, respectively. MTF, MTF-WTP and LOL were significantly different between individuals with stroke (during affected limb loading) and healthy controls (during right limb loading). This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait. This novel method can be used to elucidate biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation. This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic

  8. Three dimensional design, simulation and optimization of a novel, universal diabetic foot offloading orthosis

    Science.gov (United States)

    Sukumar, Chand; Ramachandran, K. I.

    2016-09-01

    Leg amputation is a major consequence of aggregated foot ulceration in diabetic patients. A common sense based treatment approach for diabetic foot ulceration is foot offloading where the patient is required to wear a foot offloading orthosis during the entire treatment course. Removable walker is an excellent foot offloading modality compared to the golden standard solution - total contact cast and felt padding. Commercially available foot offloaders are generally customized with huge cost and less patient compliance. This work suggests an optimized 3D model of a new type light weight removable foot offloading orthosis for diabetic patients. The device has simple adjustable features which make this suitable for wide range of patients with weight of 35 to 74 kg and height of 137 to 180 cm. Foot plate of this orthosis is unisexual, with a size adjustability of (US size) 6 to 10. Materials like Aluminum alloy 6061-T6, Acrylonitrile Butadiene Styrene (ABS) and Polyurethane acted as the key player in reducing weight of the device to 0.804 kg. Static analysis of this device indicated that maximum stress developed in this device under a load of 1000 N is only 37.8 MPa, with a small deflection of 0.150 cm and factor of safety of 3.28, keeping the safety limits, whereas dynamic analysis results assures the load bearing capacity of this device. Thus, the proposed device can be safely used as an orthosis for offloading diabetic ulcerated foot.

  9. Role of three side support ankle–foot orthosis in improving the ...

    African Journals Online (AJOL)

    Cerebral palsy (CP) is a heterogeneous group of permanent, non-progressive motor disorders of movement and posture. Ankle–foot orthoses (AFOs) are frequently prescribed to correct skeletal misalignments in spastic CP. The present study aims to evaluate the effect of the three side support ankle–foot orthosis on ...

  10. Parametric design of pressure-relieving foot orthosis using statistics-based finite element method.

    Science.gov (United States)

    Cheung, Jason Tak-Man; Zhang, Ming

    2008-04-01

    Custom-molded foot orthoses are frequently prescribed in routine clinical practice to prevent or treat plantar ulcers in diabetes by reducing the peak plantar pressure. However, the design and fabrication of foot orthosis vary among clinical practitioners and manufacturers. Moreover, little information about the parametric effect of different combinations of design factors is available. As an alternative to the experimental approach, therefore, computational models of the foot and footwear can provide efficient evaluations of different combinations of structural and material design factors on plantar pressure distribution. In this study, a combined finite element and Taguchi method was used to identify the sensitivity of five design factors (arch type, insole and midsole thickness, insole and midsole stiffness) of foot orthosis on peak plantar pressure relief. From the FE predictions, the custom-molded shape was found to be the most important design factor in reducing peak plantar pressure. Besides the use of an arch-conforming foot orthosis, the insole stiffness was found to be the second most important factor for peak pressure reduction. Other design factors, such as insole thickness, midsole stiffness and midsole thickness, contributed to less important roles in peak pressure reduction in the given order. The statistics-based FE method was found to be an effective approach in evaluating and optimizing the design of foot orthosis.

  11. Evaluation of performance and personal satisfaction of the patient with spastic hand after using a volar dorsal orthosis.

    Science.gov (United States)

    Garros, Danielle dos Santos Cutrim; Gagliardi, Rubens José; Guzzo, Regina Aparecida Rossetto

    2010-06-01

    The performance and the satisfaction of the patient were quantitatively compared with the use of the volar dorsal orthosis in order to position the spastic hand. Thirty patients wearing the orthosis for eight hours daily were evaluated by the Canadian Occupational Performance Measure and the box and blocks test, for a three-month period. Five activities were selected (among daily life activities, productive activities, and leisure activities) by the patients, which were impaired by spasticity. There was an improvement related to performance after use of orthosis, with an average of 1.4 + or - 0.5 to 6.3 + or - 0.8 (pPatient satisfaction average after wearing the orthosis was of 1.7 + or - 0.4 to 6.3 + or - 0.6 (ppatient satisfaction.

  12. Gait characteristics of post-poliomyelitis patients: standardization of quantitative data reporting.

    Science.gov (United States)

    Portnoy, S; Schwartz, I

    2013-10-01

    To evaluate the differences in gait characteristics and gait symmetry of post-polio syndrome (PPS) patients ambulating with or without shoes and between subgroups walking with different walking aids and orthoses, study the correlation of these data with personal data, illness condition, physical health, frequency of using aids and orthotics and frequency of falls, and derive recommendations for standardization of reporting these data. Twenty-six PPS subjects ambulated with their own walking devices. We calculated spatio-temporal parameters and symmetry indices (SI) of gait using a data acquired by a motion capture system. We compared inter-subject differences in gait pattern for PPS groups that differed by questionnaire-obtained data of demographics, physical activity, polio history, falls and walking aids. Additional inter-subject comparisons were performed between normal subjects (n=16), PPS patients walking with shoes with/without an ankle-foot-orthosis (n=11), PPS patients walking with knee-ankle-foot-orthosis (n=5), and PPS patients walking with a walker/crutches (n=10). We also compared intra-subject variability in PPS subjects who were able to repeat the trials barefoot. Our main results show that subjects who reported participating in physical activity twice a week or more had significantly better step time and double support symmetry. Subjects who use walking aids on a daily basis had significantly higher gait cadence and shorter stride time. Also, subjects that do not require knee-ankle-foot orthoses and/or walking aids walked with a smaller base width and better symmetry in stance and swing durations than PPS subjects who require these aids. The gait pattern of PPS patients is related to numerous intrinsic and extrinsic factors. Standardization of the reporting protocol of gait-related data of PPS patients is crucial for patient evaluation and treatment design. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  13. A Novel Approach For Ankle Foot Orthosis Developed By Three Dimensional Technologies

    Science.gov (United States)

    Belokar, R. M.; Banga, H. K.; Kumar, R.

    2017-12-01

    This study presents a novel approach for testing mechanical properties of medical orthosis developed by three dimensional (3D) technologies. A hand-held type 3D laser scanner is used for generating 3D mesh geometry directly from patient’s limb. Subsequently 3D printable orthotic design is produced from crude input model by means of Computer Aided Design (CAD) software. Fused Deposition Modelling (FDM) method in Additive Manufacturing (AM) technologies is used to fabricate the 3D printable Ankle Foot Orthosis (AFO) prototype in order to test the mechanical properties on printout. According to test results, printed Acrylonitrile Butadiene Styrene (ABS) AFO prototype has sufficient elasticity modulus and durability for patient-specific medical device manufactured by the 3D technologies.

  14. Development of Ankle Foot Orthosis (AFO) Using Pneumatic Artificial Muscle for Disabled Children

    OpenAIRE

    Ishak N.Z.; Mohamaddan S.; Kamaruddin A.M.N.A; Khamis H.; Yamamoto S.; Dawal S.Z.M.

    2017-01-01

    Ankle foot orthosis (AFO) are commonly used to correct the instabilities and joint weakness of lower limb. In this research, AFO was developed by using pneumatic artificial muscle (PAM) to prevent plantarflexion to occur and also to correct the foot from the inversion syndrome. The research started with designing the AFO by using SolidWorks software based on anthropometry measurement data (n=5, age=12 years old). The mechanical simulation was conducted by using Autodesk Inventor software to o...

  15. A Critical Analysis of a Hand Orthosis Reverse Engineering and 3D Printing Process

    Directory of Open Access Journals (Sweden)

    Gabriele Baronio

    2016-01-01

    Full Text Available The possibility to realize highly customized orthoses is receiving boost thanks to the widespread diffusion of low-cost 3D printing technologies. However, rapid prototyping (RP with 3D printers is only the final stage of patient personalized orthotics processes. A reverse engineering (RE process is in fact essential before RP, to digitize the 3D anatomy of interest and to process the obtained surface with suitable modeling software, in order to produce the virtual solid model of the orthosis to be printed. In this paper, we focus on the specific and demanding case of the customized production of hand orthosis. We design and test the essential steps of the entire production process with particular emphasis on the accurate acquisition of the forearm geometry and on the subsequent production of a printable model of the orthosis. The choice of the various hardware and software tools (3D scanner, modeling software, and FDM printer is aimed at the mitigation of the design and production costs while guaranteeing suitable levels of data accuracy, process efficiency, and design versatility. Eventually, the proposed method is critically analyzed so that the residual issues and critical aspects are highlighted in order to discuss possible alternative approaches and to derive insightful observations that could guide future research activities.

  16. Exoskeleton Technology in Rehabilitation: Towards an EMG-Based Orthosis System for Upper Limb Neuromotor Rehabilitation

    Directory of Open Access Journals (Sweden)

    Luis Manuel Vaca Benitez

    2013-01-01

    Full Text Available The rehabilitation of patients should not only be limited to the first phases during intense hospital care but also support and therapy should be guaranteed in later stages, especially during daily life activities if the patient’s state requires this. However, aid should only be given to the patient if needed and as much as it is required. To allow this, automatic self-initiated movement support and patient-cooperative control strategies have to be developed and integrated into assistive systems. In this work, we first give an overview of different kinds of neuromuscular diseases, review different forms of therapy, and explain possible fields of rehabilitation and benefits of robotic aided rehabilitation. Next, the mechanical design and control scheme of an upper limb orthosis for rehabilitation are presented. Two control models for the orthosis are explained which compute the triggering function and the level of assistance provided by the device. As input to the model fused sensor data from the orthosis and physiology data in terms of electromyography (EMG signals are used.

  17. Single DoF Hand Orthosis for Rehabilitation of Stroke and SCI Patients

    Science.gov (United States)

    Kannan Megalingam, Rajesh; Apuroop, K. G. S.; Boddupalli, Sricharan

    2017-08-01

    Many stroke and spinal cord injury patients suffer from paralysis which range from severe to nominal. Some of them, after therapy, could regain most of the motor control, particularly in hands if the severity level is not so high. In this paper we propose a hand orthosis for such patients whose stroke and spinal cord injury severity is nominal and the motor control in hands can be regained by therapy as part of their rehabilitation process. The patients can wear this orthosis and the therapy can be done with simple Human Computer Interface. The physicians, the physiotherapists and the patients themselves can carry out the therapy with the help of this device. The tests conducted in the lab and the results obtained are very promising that this can be an effective mechanism for stroke and spinal cord injury patients in their rehabilitation process. The hand orthosis is designed and fabricated locally so that it can be made available to such patients at an affordable cost.

  18. iGrab: hand orthosis powered by twisted and coiled polymer muscles

    Science.gov (United States)

    Saharan, Lokesh; de Andrade, Monica Jung; Saleem, Wahaj; Baughman, Ray H.; Tadesse, Yonas

    2017-10-01

    Several works have been reported in powered hand orthosis in the last ten years for assistive or rehabilitative purposes. However, most of these approaches uses conventional actuators such as servo motors to power orthosis. In this work, we demonstrate the recently reported twisted and coiled polymeric (TCP) muscles to drive a compact, light, inexpensive and wearable upper extremity device, iGrab. A 3D printed orthotic hand module was designed, developed and tested for the performance. The device has six 2-ply muscles of diameter 1.35 mm with a length of 380 mm. We used a single 2-ply muscle for each finger and two 2-ply muscles for the thumb. Pulsed actuation of the muscles at 1.8 A current for 25 s with 7% duty cycle under natural cooling showed full flexion of the fingers within 2 s. Modeling and simulation were performed on the device using standard Euler-Lagrangian equations. Our artificial muscles powered hand orthosis demonstrated the capability of pinching and picking objects of different shapes, weights, and sizes.

  19. Comparison of three ankle-foot orthosis configurations for children with spastic hemiplegia.

    Science.gov (United States)

    Buckon, C E; Thomas, S S; Jakobson-Huston, S; Sussman, M; Aiona, M

    2001-06-01

    The purpose of this study was to examine the effectiveness of the hinged ankle-foot orthosis (HAFO), posterior leaf spring (PLS), and solid ankle-foot orthosis (SAFO), in preventing contracture, improving efficiency of gait, and enhancing performance of functional motor skills in 30 children (21 male, 9 female; mean age 9 years 4 months; age range 4 to 18 years,) with spastic hemiplegia. Following a 3-month baseline period of no ankle-foot orthosis (AFO) use, each AFO was worn for 3 months after which ankle range of motion, gait analysis, energy consumption, and functional motor skills were assessed. The HAFO and PLS increased passive ankle dorsiflexion and normalization of ankle rocker function during gait. Normalization of knee motion in stance was dependent upon the knee abnormality present and AFO configuration. The HAFO was the most effective in controlling knee hyperextension in stance, while PLS was the most effective in promoting knee extension in children with >10 degree knee flexion in stance. Energy efficiency was improved in 21 of the children, with 13 of these children demonstrating the greatest improvement in HAFO and PLS. Improvements in functional mobility were greatest in the HAFO and PLS.

  20. Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke.

    Science.gov (United States)

    Peters, Heather T; Page, Stephen J; Persch, Andrew

    2017-09-01

    To determine the immediate effect of a portable, myoelectric elbow-wrist-hand orthosis on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors. Observational cohort study. Outpatient rehabilitation clinic. Participants exhibiting chronic, moderate, stable, poststroke, UE hemiparesis (N=18). Subjects were administered a battery of measures testing UE impairment and function. They then donned a fabricated myoelectric elbow-wrist-hand orthosis and were again tested on the same battery of measures while wearing the device. The primary outcome measure was the UE Section of the Fugl-Meyer Scale. Subjects were also administered a battery of functional tasks and the Box and Block (BB) test. Subjects exhibited significantly reduced UE impairment while wearing the myoelectric elbow-wrist-hand orthosis (FM: t 17 =8.56, Phand orthosis, with 3 subtasks showing significant increases (feeding [grasp]: z=2.251, P=.024; feeding [elbow]: z=2.966, P=.003; drinking [grasp]: z=3.187, P=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (z=1.286, P=.016) and increased gross manual dexterity while wearing a myoelectric elbow-wrist-hand orthosis (BB test: z=3.42, Phand orthosis, and these changes exceeded the Fugl-Meyer Scale's clinically important difference threshold. Further, utilization of a myoelectric elbow-wrist-hand orthosis significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects' ability to perform multijoint functional movements and attain consistent functional changes. Copyright © 2017. Published by Elsevier Inc.

  1. Short-term effects and long-term use of a hybrid orthosis for neuromuscular electrical stimulation of the upper extremity in patients after chronic stroke.

    NARCIS (Netherlands)

    Meijer, J.W.; Voerman, G.E.; Santegoets, K.M.; Geurts, A.C.H.

    2009-01-01

    OBJECTIVE: To associate the short-term effects of the Handmaster orthosis on disabling symptoms of the affected upper extremity with long-term Handmaster orthosis use after stroke. DESIGN: Historic cohort study. PATIENTS: Patients with chronic stroke. METHODS: The Modified Ashworth Scale (0-5) for

  2. One- or Two-Legged Standing: What Is the More Suitable Protocol to Assess the Postural Effects of the Rigid Ankle Orthosis?

    Science.gov (United States)

    Rougier, Patrice; Genthon, Nicolas; Gallois-Montbrun, Thibault; Brugiere, Steve; Bouvat, Eric

    2009-01-01

    To highlight the capacity of one- and two-legged standing protocols when assessing postural behavior induced by a rigid ankle orthosis, 14 healthy individuals stood upright barefoot and wore either an elastic stocking on the preferred leg or a rigid orthosis with or without additional taping in one- or two-legged (TL) conditions. Traditional…

  3. The evaluation of modified foot orthosis on muscle activity and kinetic in a subject with flexible flat foot : single case study.

    Science.gov (United States)

    Saeedi, Hassan; Mousavi, Mohammad E; Majddoleslam, Basir; Rahgozar, Mehdi; Aminian, Gholamreza; Tabatabai Ghomshe, Farhad; Movahedi Yeganeh, Mohsen

    2014-04-01

    Due to blocking of pronation/dorsiflexion in flexible flat foot and restriction of these movements in using the University of California Berkeley Laboratory orthosis, provided pressures in sole by the orthosis were increased. Therefore, this article describes the evaluation of modified foot orthosis with flexible structure in the management of individuals with flexible flat foot. CASE DESCRIPTION AND METHOD: The patient was a 21-year-old male who had symptomatic flat foot. The modified foot orthosis included movable surface and the outside structure. The modified foot orthosis was evaluated by standing foot X-ray, comfort rate, electromyography of leg muscle and vertical ground reaction force during walking. The modified foot orthosis improved the foot alignment and decreased the symptoms of flat foot with more comfort. Subtalar position by sub-maximum supination had higher position than neutral in sagittal plane. It may increase the muscle activity of peroneus longus by 7% compared to barefoot, and there was a decrease of 11% ground reaction force in mid stance. The result of this single case evaluation only proposed the feasibility of this modified insole as the orthotic treatment in flexible flat foot. Clinical relevance The modified foot orthosis, which is mobile in the midfoot, is an orthosis for walking and standing in subjects with flexible flat foot.

  4. Use of a temporary supramalleolar orthosis to manage foot pain in a patient with rheumatoid arthritis: A case report.

    Science.gov (United States)

    Weber, Nicholas J; McPoil, Thomas G

    2016-06-01

    Rheumatoid arthritis is a chronic inflammatory condition characterized by joint pain, stiffness, and functional disability. Approximately 90% of patients will report symptoms in the foot or ankle during the course of their disease. A case of a 40-year-old woman with a 12-year history of rheumatoid arthritis referred to outpatient physical therapy with a chief complaint of pain in the lateral rearfoot and forefoot is presented. At the time of the initial examination, the patient reported persistent pain ranging from 3 to 9/10, aggravated when standing and walking during activities of daily living. Treatment consisted of the fabrication of a supramalleolar orthosis that incorporated an in-shoe foot orthosis to address functional limitations and abnormal foot and ankle posture. A home exercise program was prescribed to address potential balance deficits and strength loss following the application of the orthosis. Clinically significant improvements were seen in pain, gait speed, and on the Foot Function Index following the implementation of the orthotic device. The patient returned to standing and walking with minimal symptom limitations. This case report highlights the short-term clinical outcomes when using a supramalleolar orthosis in conjunction with an in-shoe foot orthosis to manage lateral rearfoot and forefoot pain in a patient with rheumatoid arthritis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Randomized Controlled Trial Comparing Orthosis Augmented by Either Stretching or Stretching and Strengthening for Stage II Tibialis Posterior Tendon Dysfunction.

    Science.gov (United States)

    Houck, Jeff; Neville, Christopher; Tome, Josh; Flemister, Adolph

    2015-09-01

    The value of strengthening and stretching exercises combined with orthosis treatment in a home-based program has not been evaluated. The purpose of this study was to compare the effects of augmenting orthosis treatment with either stretching or a combination of stretching and strengthening in participants with stage II tibialis posterior tendon dysfunction (TPTD). Participants included 39 patients with stage II TPTD who were recruited from a medical center and then randomly assigned to a strengthening or stretching treatment group. Excluding 3 dropouts, there were 19 participants in the strengthening group and 17 in the stretching group. The stretching treatment consisted of a prefabricated orthosis used in conjunction with stretching exercises. The strengthening treatment consisted of a prefabricated orthosis used in conjunction with the stretching and strengthening exercises. The main outcome measures were self-report (ie, Foot Function Index and Short Musculoskeletal Function Assessment) and isometric deep posterior compartment strength. Two-way analysis of variance was used to test for differences between groups at 6 and 12 weeks after starting the exercise programs. Both groups significantly improved in pain and function over the 12-week trial period. The self-report measures showed minimal differences between the treatment groups. There were no differences in isometric deep posterior compartment strength. A moderate-intensity, home-based exercise program was minimally effective in augmenting orthosis wear alone in participants with stage II TPTD. Level I, prospective randomized study. © The Author(s) 2015.

  6. The effects of foot orthosis on the gait ability of college students in their 20s with flat feet.

    Science.gov (United States)

    Seo, Kyo Chul; Park, Kwang Yong

    2014-10-01

    [Purpose] This study examined the effects of foot orthosis on the gait ability of college students in their 20s with flat feet. [Subjects and Methods] The subjects were 20 college students who had been diagnosed with flat feet. The subjects' step time, step length, stride time, stride length, and gait velocity were measured using the VICON Motion System (Vicon, Oxford, UK) prior to and while wearing foot orthoses. The resulting data were analyzed using SPSS v. 12.0. [Results] The subject's step time and stride time significantly decreased for both feet after they began using foot orthosis, and stride length and gait velocity significantly increased in both feet orthosis; however, step length did not significantly increase on either side. [Conclusions] College students with flat feet saw an improvement in elements of their gait while using the foot orthosis. The results of this study verified that students with flat feet might walk more efficiently if they received active gait training via long-term use of foot orthosis.

  7. Assist-as-Needed Control of a Robotic Orthosis Actuated by Pneumatic Artificial Muscle for Gait Rehabilitation

    Directory of Open Access Journals (Sweden)

    Quy-Thinh Dao

    2018-03-01

    Full Text Available Rehabilitation robots are designed to help patients improve their recovery from injury by supporting them to perform repetitive and systematic training sessions. These robots are not only able to guide the subjects’ lower-limb to a designate trajectory, but also estimate their disability and adapt the compliance accordingly. In this research, a new control strategy for a high compliant lower-limb rehabilitation orthosis system named AIRGAIT is developed. The AIRGAIT orthosis is powered by pneumatic artificial muscle actuators. The trajectory tracking controller based on a modified computed torque control which employs a fractional derivative is proposed for the tracking purpose. In addition, a new method is proposed for compliance control of the robotic orthosis which results in the successful implementation of the assist-as-needed training strategy. Finally, various subject-based experiments are carried out to verify the effectiveness of the developed control system.

  8. Immediate effect of a functional wrist orthosis for children with cerebral palsy or brain injury: A randomized controlled trial.

    Science.gov (United States)

    Jackman, Michelle; Novak, Iona; Lannin, Natasha; Galea, Claire

    2017-10-28

    Two-group randomized controlled trial. Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence. The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury. A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group. After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], -0.954; P = .348; and 95% confidence interval, -12.380 to 4.513). In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a 'typical' position, may not lead to an immediate improvement in hand function. Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term. Copyright © 2017 Hanley & Belfus. All rights reserved.

  9. [Influence of spinal orthosis on gait and physical functioning in women with postmenopausal osteoporosis].

    Science.gov (United States)

    Schmidt, K; Hübscher, M; Vogt, L; Klinkmüller, U; Hildebrandt, H D; Fink, M; Banzer, W

    2012-03-01

    Osteoporosis is a widespread chronic bone disease leading to an increased risk of bone fractures. The most common clinical consequences are back pain, hyperkyphosis, limitations of physical functioning and activities of daily living as well as reduced quality of life. Furthermore, osteoporosis is associated with decreased strength and deficits of gait and balance, all together resulting in an increased risk of falls and a subsequent aggravation of fracture risk. Besides pharmaceutical and exercise therapy, back orthoses are increasingly being used in the therapy of osteoporosis and rehabilitation after vertebral fractures. Previous studies have shown that wearing a spinal orthosis results in a reduction of pain as well as improvements of posture and back extensor strength. To date there is no study that has evaluated the effects of a spinal orthosis on gait stability and physical functioning in patients with osteoporosis. Therefore the purpose of the present study was to assess the effects of a spinal orthosis on gait and pain-induced limitations of activities of daily living (ADL) in women with osteoporosis. A total of 69 postmenopausal osteoporotic women with and without vertebral fractures were randomly assigned to receive either a spinal orthosis (Thämert Osteo-med intervention group n=35; average age 74 ± 8.3 years, height 158.3 ± 6.3 cm, weight 62.8 ± 9.6 kg, t-score -2.6  ± 1.0, number of vertebral fractures 1.4 ± 2.0) or to a waiting list control group (n= 34, age 74.1 ± 7.7 years, height 159.6 ± 5.9 cm, weight 65.4 ± 11.3 kg, t-score -2.9± 0.8, number of vertebral fractures: 0.9 ± 1.2). The following outcome measures were collected at baseline and at 3 and 6 months follow-up: gait parameters including gait analysis: velocity, stride length and width, double support time (% of gait cycle) and perceived limitations in activities of daily living (numeric rating scale 1-10; 1=best, 10= worst situation). The ANCOVA indicated a

  10. Literature Review of the Effect of Ankle-Foot Orthosis on Gait Parameters After Stroke

    Directory of Open Access Journals (Sweden)

    Elnaz Esfandiari

    2017-07-01

    Conclusion This study showed that the AFOs based on the models (static or dynamic had a paradoxical effect on balance, kinetic and kinematic parameters of gait in the stroke patients. AFOs had a significant improvement in balance, kinetic and kinematic parameters of gait compared to those without orthosis situation in the stroke patients. According to the result of this study, depending on the patient's needs and situation, the best and the most suitable ankle foot orthoses should be designed and custom molded for them.

  11. Powered orthosis and attachable power-assist device with Hydraulic Bilateral Servo System.

    Science.gov (United States)

    Ohnishi, Kengo; Saito, Yukio; Oshima, Toru; Higashihara, Takanori

    2013-01-01

    This paper discusses the developments and control strategies of exoskeleton-type robot systems for the application of an upper limb powered orthosis and an attachable power-assist device for care-givers. Hydraulic Bilateral Servo System, which consist of a computer controlled motor, parallel connected hydraulic actuators, position sensors, and pressure sensors, are installed in the system to derive the joint motion of the exoskeleton arm. The types of hydraulic component structure and the control strategy are discussed in relation to the design philosophy and target joints motions.

  12. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis.

    Science.gov (United States)

    O'Connor, Joanne; McCaughan, Dorothy; McDaid, Catriona; Booth, Alison; Fayter, Debra; Rodriguez-Lopez, Roccio; Bowers, Roy; Dyson, Lisa; Iglesias, Cynthia P; Lalor, Simon; O'Connor, Rory J; Phillips, Margaret; Ramdharry, Gita

    2016-07-01

    Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs. Qualitative study of views of orthoses users - a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review - 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis - a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis. Qualitative study - a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients' prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness

  13. The smart Peano fluidic muscle: a low profile flexible orthosis actuator that feels pain

    Science.gov (United States)

    Veale, Allan J.; Anderson, Iain A.; Xie, Shane Q.

    2015-03-01

    Robotic orthoses have the potential to provide effective rehabilitation while overcoming the availability and cost constraints of therapists. These orthoses must be characterized by the naturally safe, reliable, and controlled motion of a human therapist's muscles. Such characteristics are only possible in the natural kingdom through the pain sensing realized by the interaction of an intelligent nervous system and muscles' embedded sensing organs. McKibben fluidic muscles or pneumatic muscle actuators (PMAs) are a popular orthosis actuator because of their inherent compliance, high force, and muscle-like load-displacement characteristics. However, the circular cross-section of PMA increases their profile. PMA are also notoriously unreliable and difficult to control, lacking the intelligent pain sensing systems of their biological muscle counterparts. Here the Peano fluidic muscle, a new low profile yet high-force soft actuator is introduced. This muscle is smart, featuring bioinspired embedded pressure and soft capacitive strain sensors. Given this pressure and strain feedback, experimental validation shows that a lumped parameter model based on the muscle geometry and material parameters can be used to predict its force for quasistatic motion with an average error of 10 - 15N. Combining this with a force threshold pain sensing algorithm sets a precedent for flexible orthosis actuation that uses embedded sensors to prevent damage to the actuator and its environment.

  14. Underactuated Potential Energy Shaping with Contact Constraints: Application to a Powered Knee-Ankle Orthosis.

    Science.gov (United States)

    Lv, Ge; Gregg, Robert D

    2018-01-01

    Body-weight support (i.e., gravity compensation) is an effective clinical tool for gait rehabilitation after neurological impairment. Body-weight supported training systems have been developed to help patients regain mobility and confidence during walking, but conventional systems constrain the patient's treatment in clinical environments. We propose that this challenge could be addressed by virtually providing patients with bodyweight support through the actuators of a powered orthosis (or exoskeleton) utilizing potential energy shaping control. However, the changing contact conditions and degrees of underactuation encountered during human walking present significant challenges to consistently matching a desired potential energy for the human in closed loop. We therefore derive a generalized matching condition for shaping Lagrangian systems with holonomic contact constraints. By satisfying this matching condition for four phases of gait, we derive passivity-based control laws to achieve virtual body-weight support through a powered knee-ankle orthosis. We demonstrate beneficial effects of virtual body-weight support in simulations of a human-like biped model, indicating the potential clinical value of this proposed control approach.

  15. The Effect of Using Anti spastic Orthosis on the Reduction of Spasticity in Diplegic Spastic Children

    Directory of Open Access Journals (Sweden)

    Ashkan Irani

    2012-10-01

    Full Text Available Background and aim: Cerebral palsy is a non progressive brain disorder and, cerebral plasy is the most common type of spastic paralysis which can be the cause of motor and postural deficits during child development. The purpose of this study was to investigate the effect of using Anti spastic Orthosis on the Reduction of Spasticity and in diplegic spastic children between 2 – 5 years in Tehran.Materials & Methods: 20 diplegic spastic children between 2- 5 years were selected randomly and divided into two groups. The first lower limb spasticity was assessed by a neurologist, and then by an experienced occupational therapist whitout being aware of research process before the intervention, The experimental group went under treatment using positioning therapeutic intervention and neurodevelopmental treatment, while the control group was treated and only with NDT. The research Instrument used was the Modified Ashworth scale (MAS and the H-Reflex and, H/M ratio in the lower limb spasticity was assessed, Utilizing Experimental pretest - post test with control group design. The data of this study was analyzed using t Test k square test and the findings showed meaningful differences between the two groups.Result: The findings of this study reveraled meaningful differences between the two groups, scores of mean spasticity in interference group was significantly less than control group (p=0/003 Conclusion: Application of Anti spastic Orthosis before rehabilitation exercises is recommended for diplegic spastic children.

  16. Influence of orthosis on the foot progression angle in children with spastic cerebral palsy.

    Science.gov (United States)

    Danino, Barry; Erel, Snir; Kfir, Meital; Khamis, Sam; Batt, Reuven; Hemo, Yoram; Wientroub, Shlomo; Hayek, Shlomo

    2015-10-01

    We retrospectively assessed the effect of ankle-foot orthosis (AFO) on the foot progression angle (FPA) of 97 children with spastic cerebral palsy (CP) who had undergone comprehensive computer-based gait analysis both barefoot and with their orthosis, during the same session. The physical examination results and the gait study temporal and kinematic parameters comprise the study data. We focused on the peak FPA reached during stance and swing phases and at mid-stance and mid-swing, and also measured the transverse rotations of the pelvis, the femur and the tibia. AFOs improved gait, as reflected by improved temporal parameters, but they also increased internal rotation of the feet in diplegic CP children by 4.29 degrees for mid-stance, and by 3.72 degrees for mid-swing. The correlation between components of the rotational profile and FPA was significant for the diplegic group. AFOs did not produce any noteworthy differences between walking barefoot and walking with the brace in the hemiplegic group in what concerns FPA. Children with diplegic CP who use AFOs walk with increased internal FPAs in their orthoses. These findings might be explained by anatomical attributes as well as dynamic features during gait. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. The Effect of Ankle-Foot Orthosis on Walking Ability in Chronic Stroke Patients: A randomised controlled trial.

    NARCIS (Netherlands)

    de Wit, D.C.M.; Buurke, Jaap; Nijlant, J.M.M.; IJzerman, Maarten Joost; Hermens, Hermanus J.

    2004-01-01

    Objective: Regaining walking ability is a major goal during the rehabilitation of stroke patients. To support this process an ankle-foot orthosis (AFO) is often prescribed. The aim of this study is to investigate the effect of an AFO on walking ability in chronic stroke patients. Design: Cross-over

  18. The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion.

    Science.gov (United States)

    Almonroeder, Thomas G; Benson, Lauren C; O'Connor, Kristian M

    2016-09-01

    Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253.

  19. Effectiveness of modified ankle foot orthosis of low-temperature thermoplastics in idiopathic congenital talipes equino varus.

    Science.gov (United States)

    Solanki, Punita Vasant; Sheth, Binoti Arun; Poduval, Murali; Sams, Stephen Brian Austin

    2010-07-01

    The aim of this study was to study the effectiveness of modified ankle foot orthosis fabricated from low-temperature thermoplastics, as an alternative orthosis for the maintenance of correction in idiopathic congenital talipes equino varus (CTEV) deformity. The study was conducted in infants after the completion of the Ponseti serial manipulation and cast treatment, with or without, percutaneous Achilles tenotomy. Both male and female infants with unilateral or bilateral CTEV deformity were included in our study. A custom-made modified ankle foot orthosis was fabricated on the day of the removal of the last plaster of Paris cast. Initial clinical assessment, including medical history, Pirani score, modified Dimeglio score, clinical method of evaluating tibial torsion, ankle and foot range of motion were carried out on the day of the fabrication of the orthosis. Follow-up assessments were carried out at regular intervals for a duration of 6 months. All infants were provided with a set of exercises in the outpatient department three to five times per week, and other sessions were carried out by the caregivers in the form of home exercise programmes, daily every 2 h. In our study, we had 40 infants. Of these, 12 were lost to follow-up. The remaining 28 infants (22 males and six females) were included in the study. Of the 28 infants, six were left sided, seven were right sided and 15 were bilateral cases. The age at which cast treatment was initiated ranged from 1 week to 8 months, and the age at which modified ankle foot orthosis was given ranged from 1 month 1 week to 15 months. The average number of plaster of Paris casts given was six. Sixteen infants required tenotomy. We found that there was a significant reduction in the Pirani and modified Dimeglio scores from baseline to the third and to the sixth months, that is, improvement and/or maintenance of the baseline scores of Pirani and modified Dimeglio was observed (P0.05). The difference was independent of the

  20. Pneumatic Muscles Actuated Lower-Limb Orthosis Model Verification with Actual Human Muscle Activation Patterns

    Directory of Open Access Journals (Sweden)

    Dzahir M.A.M

    2017-01-01

    Full Text Available A review study was conducted on existing lower-limb orthosis systems for rehabilitation which implemented pneumatic muscle type of actuators with the aim to clarify the current and on-going research in this field. The implementation of pneumatic artificial muscle will play an important role for the development of the advanced robotic system. In this research a derivation model for the antagonistic mono- and bi-articular muscles using pneumatic artificial muscles of a lower limb orthosis will be verified with actual human’s muscle activities models. A healthy and young male 29 years old subject with height 174cm and weight 68kg was used as a test subject. Two mono-articular muscles Vastus Medialis (VM and Vastus Lateralis (VL were selected to verify the mono-articular muscle models and muscle synergy between anterior muscles. Two biarticular muscles Rectus Femoris (RF and Bicep Femoris (BF were selected to verify the bi-articular muscle models and muscle co-contraction between anterior-posterior muscles. The test was carried out on a treadmill with a speed of 4.0 km/h, which approximately around 1.25 m/s for completing one cycle of walking motion. The data was collected for about one minute on a treadmill and 20 complete cycles of walking motion were successfully recorded. For the evaluations, the mathematical model obtained from the derivation and the actual human muscle activation patterns obtained using the surface electromyography (sEMG system were compared and analysed. The results shown that, high correlation values ranging from 0.83 up to 0.93 were obtained in between the derivation model and the actual human muscle’s model for both mono- and biarticular muscles. As a conclusion, based on the verification with the sEMG muscle activities data and its correlation values, the proposed derivation models of the antagonistic mono- and bi-articular muscles were suitable to simulate and controls the pneumatic muscles actuated lower limb

  1. The effect of different shoes on functional mobility and energy expenditure in post-stroke hemiplegic patients using ankle-foot orthosis.

    Science.gov (United States)

    Farmani, Farzad; Mohseni Bandpei, Mohammad Ali; Bahramizadeh, Mahmood; Aminian, Gholamreza; Nikoo, Mohammad Reza; Sadeghi-Goghari, Mohammad

    2016-10-01

    Ankle-foot orthoses could be utilized both with and without shoes. While several studies have shown that ankle-foot orthoses improve gait abilities in hemiplegic patients, it remains unclear whether they should be used with shoes or without. The study purpose was to compare the effect of standard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle-foot orthosis. Randomized clinical study. Thirty post-stroke hemiplegic patients participated in this study randomly assigned to two groups. Group I received standard shoes + ankle-foot orthosis and group II were provided with rocker shoes + ankle-foot orthosis. Their functional mobility and energy expenditure parameters including timed up and go, timed up stairs, timed down stairs, preferred walking speed, and oxygen (O2) cost (mL/kg/m) were measured. In group I, no significant changes were seen in outcome measures after wearing standard shoes. While in group II, O2 cost and timed up and go time significantly decreased, and preferred walking speed increased when patients wore rocker shoes. Also, there was a significant difference between rocker shoes and standard shoes in improvement of timed up and go, preferred walking speed, and O2 cost. When patients using ankle-foot orthosis wore rocker shoes, their functional mobility improved and oxygen cost diminished. Also, rocker shoes was significantly more effective than standard shoes in improving functional mobility parameters. This study suggests that in post-stroke hemiplegic patients using ankle-foot orthosis, wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle-foot orthosis only. Thus, in stroke patients, the combination of ankle-foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle-foot orthosis efficacy investigations. © The International Society for Prosthetics and Orthotics 2015.

  2. Carbon Modular Orthosis (Ca.M.O.): An innovative hybrid modular ankle-foot orthosis to tune the variable rehabilitation needs in hemiplegic cerebral palsy.

    Science.gov (United States)

    Tavernese, E; Petrarca, M; Rosellini, G; Di Stanislao, E; Pisano, A; Di Rosa, G; Castelli, E

    2017-01-01

    Hemiplegic Celebral Palsy (CP) children commonly use AFO orthoses as walking aids. It is known that AFOs may have a detrimental effect on gait. To enhance mechanical properties of AFOs we developed an innovative, custom-made, carbon, ankle-foot orthosis (Ca.M.O) which offers the opportunity to tune its response to the patient's gait characteristics and/or functional maturity. To assess the efficacy of Ca.M.O. in improving gait in a group of hemiplegic CP children and to compare its performances with those of commonly prescribed AFO. A clinical and instrumental gait analysis was performed on a group of 15 spastic hemiplegic children (WINTERS-GAGE type I-II) walking barefoot, with commonly prescribed AFOs and with Ca.M.O.Temporal, kinematic and kinetic data were collected with an 8 cameras optoelectronic system and 2 force plates. Studied variables were comparable walking with Ca.M.O. and with the commonly prescribed AFO and are significantly different (p < 0.01) with respect to barefoot condition. Both types of orthoses normalize the kinematics of the first and second ankle rocker. The main advantage of Ca.M.O. is its modularity that allows to tune its effect on gait in relationship with the progress or involution of the child's functional development.

  3. Effect of medial arch support foot orthosis on plantar pressure distribution in females with mild-to-moderate hallux valgus after one month of follow-up.

    Science.gov (United States)

    Farzadi, Maede; Safaeepour, Zahra; Mousavi, Mohammad E; Saeedi, Hassan

    2015-04-01

    Higher plantar pressures at the medial forefoot are reported in hallux valgus. Foot orthoses with medial arch support are considered as an intervention in this pathology. However, little is known about the effect of foot orthoses on plantar pressure distribution in hallux valgus. To investigate the effect of a foot orthosis with medial arch support on pressure distribution in females with mild-to-moderate hallux valgus. Quasi-experimental. Sixteen female volunteers with mild-to-moderate hallux valgus participated in this study and used a medial arch support foot orthosis for 4 weeks. Plantar pressure for each participant was assessed using the Pedar-X(®) in-shoe system in four conditions including shoe-only and foot orthosis before and after the intervention. The use of the foot orthosis for 1 month led to a decrease in peak pressure and maximum force under the hallux, first metatarsal, and metatarsals 3-5 (p hallux and the first metatarsal head by transferring the load to the other regions. It would appear that this type of foot orthosis can be an effective method of intervention in this pathology. Findings of this study will improve the clinical knowledge about the effect of the medial arch support foot orthosis used on plantar pressure distribution in hallux valgus pathology. © The International Society for Prosthetics and Orthotics 2014.

  4. Development and simulation of a passive upper extremity orthosis for amyoplasia

    DEFF Research Database (Denmark)

    Jensen, Erik Føge; Raunsbæk, Joakim; Lund, Jan Nørgaard

    2018-01-01

    Introduction People who are born with arthrogryposis multiplex congenita are typically not able to perform activities of daily living (ADL) due to decreased muscle mass, joint contractures and unnatural upper extremity positioning. They are, therefore, potential users of an assistive device capable....... Results For a given configuration using a mono- and a bi-articular spring, the simulations showed that spring stiffnesses of 400?Nm?1 and of 1029?Nm?1, respectively, were able to lower the maximal muscle activity estimated by the musculoskeletal model to a level in which the 10 postures can be realized....... Conclusion By augmenting residual muscle strength with a partially gravity-balanced passive orthosis, ADLs may be achievable for people with arthrogryposis multiplex congenita....

  5. Effect of a rigid ankle-foot orthosis on hamstring length in children with hemiplegia.

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    Thompson, N S; Taylor, T C; McCarthy, K R; Cosgrove, A P; Baker, R J

    2002-01-01

    Eighteen children with hemiplegia, mean age 8 years 5 months, underwent gait analysis and musculoskeletal modelling using specially designed software. The maximum lengths of the hamstrings were determined for each child walking in and out of an ankle-foot orthosis (AFO). The muscles were deemed to be short if shorter than the normal average -1SD. In bare feet 8 participants had short medial hamstrings with a higher proportion of these in the less involved individuals. All participants showed an increase in maximum hamstring length when wearing an AFO. In all but one child this was sufficient to restore hamstring length to within normal limits. These finding suggest that hamstring pathology in hemiplegic gait is usually secondary to more distal lower limb pathology.

  6. Arm Orthosis/Prosthesis Movement Control Based on Surface EMG Signal Extraction.

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    Suberbiola, Aaron; Zulueta, Ekaitz; Lopez-Guede, Jose Manuel; Etxeberria-Agiriano, Ismael; Graña, Manuel

    2015-05-01

    This paper shows experimental results on electromyography (EMG)-based system control applied to motorized orthoses. Biceps and triceps EMG signals are captured through two biometrical sensors, which are then filtered and processed by an acquisition system. Finally an output/control signal is produced and sent to the actuators, which will then perform the actual movement, using algorithms based on autoregressive (AR) models and neural networks, among others. The research goal is to predict the desired movement of the lower arm through the analysis of EMG signals, so that the movement can be reproduced by an arm orthosis, powered by two linear actuators. In this experiment, best accuracy has achieved values up to 91%, using a fourth-order AR-model and 100ms block length.

  7. Development of Ankle Foot Orthosis (AFO Using Pneumatic Artificial Muscle for Disabled Children

    Directory of Open Access Journals (Sweden)

    Ishak N.Z.

    2017-01-01

    Full Text Available Ankle foot orthosis (AFO are commonly used to correct the instabilities and joint weakness of lower limb. In this research, AFO was developed by using pneumatic artificial muscle (PAM to prevent plantarflexion to occur and also to correct the foot from the inversion syndrome. The research started with designing the AFO by using SolidWorks software based on anthropometry measurement data (n=5, age=12 years old. The mechanical simulation was conducted by using Autodesk Inventor software to obtain a safety factor before the fabrication process was conducted. The AFO was fabricated using 3D printer and the thermoplastic elastomer (TPE rubber was selected as the material. PAM was tested by using test bed machine to generate the force and contraction by muscle. The result shows that the PAM was suitable for low speed as the displacement was greater. The AFO could be valuable for the gait rehabilitation.

  8. Fuzzy-logic-based hybrid locomotion mode classification for an active pelvis orthosis: Preliminary results.

    Science.gov (United States)

    Yuan, Kebin; Parri, Andrea; Yan, Tingfang; Wang, Long; Munih, Marko; Vitiello, Nicola; Wang, Qining

    2015-01-01

    In this paper, we present a fuzzy-logic-based hybrid locomotion mode classification method for an active pelvis orthosis. Locomotion information measured by the onboard hip joint angle sensors and the pressure insoles is used to classify five locomotion modes, including two static modes (sitting, standing still), and three dynamic modes (level-ground walking, ascending stairs, and descending stairs). The proposed method classifies these two kinds of modes first by monitoring the variation of the relative hip joint angle between the two legs within a specific period. Static states are then classified by the time-based absolute hip joint angle. As for dynamic modes, a fuzzy-logic based method is proposed for the classification. Preliminary experimental results with three able-bodied subjects achieve an off-line classification accuracy higher than 99.49%.

  9. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study

    OpenAIRE

    Sankaranarayan, H.; Gupta, Anupam; Khanna, Meeka; Taly, Arun B.; Thennarasu, K.

    2016-01-01

    Objective: To study role of ankle foot orthosis (AFO) in improving locomotion and functional recovery after stroke. Setting: Neurological Rehabilitation Department of a university research tertiary hospital. Patients and Methods: AFO and activity based rehabilitation. Main Outcome Measures: Distance (meters) covered during the 6-minute walk test (6MWT) and speed (meter/second) during the 10-meter walk test. Functional abilities assessed using Functional Independence Measure (FIM®). Results: ...

  10. Gait training after stroke: a pilot study combining a gravity-balanced orthosis, functional electrical stimulation, and visual feedback.

    Science.gov (United States)

    Krishnamoorthy, Vijaya; Hsu, Wei-Li; Kesar, Trisha M; Benoit, Daniel L; Banala, Sai K; Perumal, Ramu; Sangwan, Vivek; Binder-Macleod, Stuart A; Agrawal, Sunil K; Scholz, John P

    2008-12-01

    This case report describes the application of a novel gait retraining approach to an individual with poststroke hemiparesis. The rehabilitation protocol combined a specially designed leg orthosis (the gravity-balanced orthosis), treadmill walking, and functional electrical stimulation to the ankle muscles with the application of motor learning principles. The participant was a 58-year-old man who had a stroke more than three years before the intervention. He underwent gait retraining over a period of five weeks for a total of 15 sessions during which the gravity compensation provided by the gravity-balanced orthosis and visual feedback about walking performance was gradually reduced. At the end of five weeks, he decreased the time required to complete the Timed Up and Go test; his gait speed increased during overground walking; gait was more symmetrical; stride length, hip and knee joint excursions on the affected side increased. Except for gait symmetry, all other improvements were maintained one month post-intervention. This case report describes possible advantages of judiciously combining different treatment techniques in improving the gait of chronic stroke survivors. Further studies are planned to evaluate the effectiveness of different components of this training in both the subacute and chronic stages of stroke recovery.

  11. Development of an orthosis for walking assistance using pneumatic artificial muscle: a quantitative assessment of the effect of assistance.

    Science.gov (United States)

    Kawamura, T; Takanaka, K; Nakamura, T; Osumi, H

    2013-06-01

    In recent years, there is an increase in the number of people that require support during walking as a result of a decrease in the leg muscle strength accompanying aging. An important index for evaluating walking ability is step length. A key cause for a decrease in step length is the loss of muscle strength in the legs. Many researchers have designed and developed orthoses for walking assistance. In this study, we advanced the design of an orthosis for walking assistance that assists the forward swing of the leg to increase step length. We employed a pneumatic artificial muscle as the actuator so that flexible assistance with low rigidity can be achieved. To evaluate the performance of the system, we measured the effect of assistance quantitatively. In this study, we constructed a prototype of the orthosis and measure EMG and step length on fitting it to a healthy subject so as to determine the effect of assistance, noting the increase in the obtained step length. Although there was an increase in EMG stemming from the need to maintain body balance during the stance phase, we observed that the EMG of the sartorius muscle, which helps swing the leg forward, decreased, and the strength of the semitendinosus muscle, which restrains the leg against over-assistance, did not increase but decreased. Our experiments showed that the assistance force provided by the developed orthosis is not adequate for the intended task, and the development of a mechanism that provides appropriate assistance is required in the future.

  12. Characteristics of the muscle activities of the elderly for various pressures in the pneumatic actuator of lower limb orthosis

    Science.gov (United States)

    Kim, Kyong; Yu, Chang-Ho; Kwon, Tae-Kyu; Hong, Chul-Un; Kim, Nam-Gyun

    2005-12-01

    There developed a lower limb orthosis with a pneumatic rubber actuator, which can assist and improve the muscular activities in the lower limb of the elderly. For this purpose, the characteristics of the lower limbs muscle activities for various pressures in the pneumatic actuator for the lower limb orthosis was investigated. To find out the characteristics of the muscle activities for various pneumatic pressures, it analyzed the flexing and extending movement of the knees, and measured the lower limbs muscular power. The subjects wearing the lower limbs orthosis were instructed to perform flexing and extending movement of the knees. The variation in the air pressure of the pneumatic actuator was varies from one kgf/cm2 to four kgf/cm2. The muscular power was measured by monitoring electromyogram using MP100 (BIOPAC Systems, Inc.) and detailed three-dimensional motions of the lower limbs were collected by APAS 3D Motion Analysis system. Through this study, it expected to find the most suitable air pressure for the improvement of the muscular power of the aged.

  13. Efficacy of a trunk orthosis with joints providing resistive force on low-back load in elderly persons during static standing.

    Science.gov (United States)

    Katsuhira, Junji; Matsudaira, Ko; Yasui, Tadashi; Iijima, Shinno; Ito, Akihiro

    2015-01-01

    Postural alignment of elderly people becomes poor due to aging, possibly leading to low-back pain and spinal deformity. Although there are several interventions for treating these conditions, no previous study has reported the effectiveness of a spinal orthosis or lumbosacral orthosis (LSO) in healthy elderly people without specific spinal deformity. We therefore developed a trunk orthosis to decrease low-back muscle activity while training good postural alignment through resistive force provided by joints with springs (here, called the ORF, which stands for orthosis with joints providing resistive force) as a preventive method against abnormal posture and low-back pain in healthy elderly persons. Fifteen community-dwelling elderly men participated in this study. Participants stood freely for 10 seconds in a laboratory setting under three conditions: without an orthosis, with the ORF, and with an LSO. The Damen corset LSO was selected as it is frequently prescribed for patients with low-back pain. Postural alignment during static standing was recorded using a three-dimensional motion capture system employing infrared cameras. Two force plates were used to record center of pressure. Electromyograms were obtained for bilateral erector spinae (ES), left internal abdominal oblique, and right gluteus medius muscles. Pelvis forward tilt angle tended to increase while wearing the ORF and decrease while wearing the LSO, but these results were not significant compared to no orthosis. Thorax extension angle and thorax angle on pelvis coordinate system significantly increased while wearing the ORF compared to the other two conditions. ES activity significantly decreased while wearing the ORF compared to the other two conditions. Internal oblique activity was significantly smaller while wearing the LSO than with no orthosis. Center of pressure did not significantly differ among the conditions. The ORF significantly improved trunk alignment and decreased ES activity in healthy

  14. Efficacy of a trunk orthosis with joints providing resistive force on low-back load in elderly persons during static standing

    Science.gov (United States)

    Katsuhira, Junji; Matsudaira, Ko; Yasui, Tadashi; Iijima, Shinno; Ito, Akihiro

    2015-01-01

    Purpose Postural alignment of elderly people becomes poor due to aging, possibly leading to low-back pain and spinal deformity. Although there are several interventions for treating these conditions, no previous study has reported the effectiveness of a spinal orthosis or lumbosacral orthosis (LSO) in healthy elderly people without specific spinal deformity. We therefore developed a trunk orthosis to decrease low-back muscle activity while training good postural alignment through resistive force provided by joints with springs (here, called the ORF, which stands for orthosis with joints providing resistive force) as a preventive method against abnormal posture and low-back pain in healthy elderly persons. Patients and methods Fifteen community-dwelling elderly men participated in this study. Participants stood freely for 10 seconds in a laboratory setting under three conditions: without an orthosis, with the ORF, and with an LSO. The Damen corset LSO was selected as it is frequently prescribed for patients with low-back pain. Postural alignment during static standing was recorded using a three-dimensional motion capture system employing infrared cameras. Two force plates were used to record center of pressure. Electromyograms were obtained for bilateral erector spinae (ES), left internal abdominal oblique, and right gluteus medius muscles. Results Pelvis forward tilt angle tended to increase while wearing the ORF and decrease while wearing the LSO, but these results were not significant compared to no orthosis. Thorax extension angle and thorax angle on pelvis coordinate system significantly increased while wearing the ORF compared to the other two conditions. ES activity significantly decreased while wearing the ORF compared to the other two conditions. Internal oblique activity was significantly smaller while wearing the LSO than with no orthosis. Center of pressure did not significantly differ among the conditions. Conclusion The ORF significantly improved trunk

  15. COMPARISON BETWEEN PHYSIOLOGICAL COST INDEX IN HEALTHY NORMAL CHILDREN AS AGAINST AMBULATORY SPASTIC DIPLEGIC CEREBRAL PALSY (WITH AND WITHOUT ORTHOSIS IN THE AGE GROUP 6 TO 18 YEARS

    Directory of Open Access Journals (Sweden)

    Swatia Bhise

    2016-08-01

    Full Text Available Background: Efficacy of rehabilitation program for subjects with orthosis with objective measurement. The study aiming to objectively compare the PCI and walking speed of normal children with ambulatory spastic diaplegic. Also we aimed to analyze whether BMIhad impact on energy cost. Methods: 41 normal children and 41 community walking spastic diaplegic aged between 6 to 18 yrs. were assessed to compare the PCI. Speed of walking and heart rate were checked constantlyboth barefoot and in shoes in normal children and with and without conventional AFO in children with spastic diaplegic at their chosen velocities over four consecutive lengths of a 12.5m walkway i.e. total 50m.,Pre and Post readings are taken. Heart rate is affected by speed; PCI with speed of walking and heart rate was calculated for each child. Results: The mean PCI in shoes and barefoot was same in normal children i.e. 0.05 ±0.039beats/meter. The PCI for children with pathological gait i.e. spastic diaplegic without orthosis and with orthosis is 0.199 ±0.176 and 0.104± 0.093beats/meter appreciably greater than that for normal children(p less than 0.05. Conclusion: This study showed that walking with orthosis in spastic diplegic CP children showed higher costs of energy and slower walking speed compared normal children with age matched. The PCI of walking, with orthosis in children with spastic Diplegic cerebral palsy is less as compared to without orthosis i.e. gait is more energy efficient with orthosis. BMI doesn’t show any correlation with PCI further study may require.

  16. Immediate effect of orthopedic shoe and functional foot orthosis on center of pressure displacement and gait parameters in juvenile flexible flat foot.

    Science.gov (United States)

    Aboutorabi, Atefeh; Saeedi, Hassan; Kamali, Mohammad; Farahmand, Behshid; Eshraghi, Arezoo; Dolagh, Roghaye S

    2014-06-01

    Flat foot in children is a common deformity in which the medial longitudinal arch is reduced or eliminated. The objective of this article was to compare flat foot and healthy children on the displacement of the center of pressure and walking parameters in children with two common orthoses (functional foot orthosis and medical shoe). Comparative study. This study included 30 children with flat foot and 20 healthy children as a control group. The step length and width, walking velocity, symmetry, and center of pressure (CoP) displacements were recorded and compared for three conditions: functional foot orthosis and regular shoe, a medical shoe and barefoot. The results from the CoP displacements showed that the regular shoe with functional foot orthosis caused a significant decrease in the level of displacement of the CoP in flat foot children. The findings indicated a significant improvement in symmetry of steps and walking speed with the functional foot orthosis in comparison to the medical shoe in flat foot children. The CoP displacement was decreased and the percentage of gait symmetry and walking speed were increased by the use of regular shoes with a functional foot orthosis in comparison to the medical shoes. An orthopaedic shoe can be expensive, and in particular heavy with most children reluctant to wear it. This study focussed on the CoP displacement and selected gait parameters with an orthopaedic shoe and functional foot orthosis, and showed that a combined prescription of a functional foot orthosis and with regular shoes may be a useful alternative for children with moderate flat foot. © The International Society for Prosthetics and Orthotics 2013.

  17. Single leg stance control in individuals with symptomatic gluteal tendinopathy.

    Science.gov (United States)

    Allison, Kim; Bennell, Kim L; Grimaldi, Alison; Vicenzino, Bill; Wrigley, Tim V; Hodges, Paul W

    2016-09-01

    Lateral hip pain during single leg loading, and hip abductor muscle weakness, are associated with gluteal tendinopathy, but it has not been shown how or whether kinematics in single leg stance differ in those with gluteal tendinopathy. To compare kinematics in preparation for, and during, single leg stance between individuals with and without gluteal tendinopathy, and the effect of hip abductor muscle strength on kinematics. Twenty individuals with gluteal tendinopathy and 20 age-matched pain-free controls underwent three-dimensional kinematic analysis of single leg stance and maximum isometric hip abductor strength testing. Maximum values of hip adduction, pelvic obliquity (contralateral pelvis rise/drop), lateral pelvic translation (ipsilateral/contralateral shift) and ipsilateral trunk lean during preparation for leg lift and average values in steady single leg stance, were compared between groups using an analysis of covariance, with and without anthropometric characteristics and strength as covariates. Individuals with gluteal tendinopathy demonstrated greater hip adduction (standardized mean difference (SMD)=0.70, P=0.04) and ipsilateral pelvic shift (SMD=1.1, P=0.002) in preparation for leg lift, and greater hip adduction (SMD=1.2, P=0.002) and less contralateral pelvic rise (SMD=0.86, P=0.02) in steady single leg stance than controls. When including strength as a covariate, only between-group differences in lateral pelvic shift persisted (SMD=1.7, P=0.01). Individuals with gluteal tendinopathy use different frontal plane kinematics of the hip and pelvis during single leg stance than pain-free controls. This finding is not influenced by pelvic dimension or the potentially modifiable factor of body mass index, but is by hip abductor muscle weakness. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Effects of a functional foot orthosis on the knee angle in the sagittal plane of college students in their 20s with flatfoot.

    Science.gov (United States)

    Park, KwangYong; Seo, KyoChul

    2015-04-01

    [Purpose] The purpose of this study was to examine the effects of a functional foot orthosis on the knee angle in the sagittal plane of college students in their 20s who had flatfoot. [Subjects and Methods] The subjects of this study were 20 college students diagnosed as having flatfoot. The variations of their knee angle (Q-angle) in the sagittal plane during the stance phase were measured using the VICON Motion System (Vicon, Hansung, Korea) before and while wearing a foot orthosis. The experimental data were analyzed using SPSS 12.0 for Windows. [Results] The Q-angle in the test group during the stance phase showed statistically significant declines on the right and left sides while wearing the foot orthosis during the gait-phases of loading response and midstance. During initial contact, terminal stance, and preswing, the Q-angle also decreased on the right and left sides after wearing the foot orthosis, but the changes were not statistically significant. [Conclusion] The college students with flatfoot exhibited declines in the Q-angle in the sagittal plane while wearing a foot orthosis. In this regard, the application of active gait training using orthotic shoes for long hours is likely to help individuals with flatfoot to achieve normal gait.

  19. Effect of ankle-foot orthosis on postural control after stroke: a systematic review.

    Science.gov (United States)

    Guerra Padilla, M; Molina Rueda, F; Alguacil Diego, I M

    2014-09-01

    Stroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke. The review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance. Because of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, 0these results should be considered with caution. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  20. Modeling and simulation of paraplegic ambulation in a reciprocating gait orthosis.

    Science.gov (United States)

    Tashman, S; Zajac, F E; Perkash, I

    1995-08-01

    We developed a three dimensional, four segment, eight-degree-of-freedom model for the analysis of paraplegic ambulation in a reciprocating gait orthosis (RGO). Model development was guided by experimental analysis of a spinal cord injured individual walking in an RGO with the additional assistance of arm crutches. Body forces and torques required to produce a dynamic simulation of the RGO gait swing phase were found by solving an optimal control problem to track the recorded kinematics and ground reaction forces. We found that high upper body forces are required, not only during swing but probably also during double support to compensate for the deceleration of the body during swing, which is due to the pelvic thrust necessary to swing the leg forward. Other stimulations showed that upper body forces and body deceleration during swing can be reduced substantially by producing a ballistic swing. Functional neuromuscular stimulation of the hip musculature during double support would then be required, however, to establish the initial conditions needed in a ballistic swing.

  1. Ankle-Foot Orthosis Made by 3D Printing Technique and Automated Design Software

    Directory of Open Access Journals (Sweden)

    Yong Ho Cha

    2017-01-01

    Full Text Available We described 3D printing technique and automated design software and clinical results after the application of this AFO to a patient with a foot drop. After acquiring a 3D modelling file of a patient’s lower leg with peroneal neuropathy by a 3D scanner, we loaded this file on the automated orthosis software and created the “STL” file. The designed AFO was printed using a fused filament fabrication type 3D printer, and a mechanical stress test was performed. The patient alternated between the 3D-printed and conventional AFOs for 2 months. There was no crack or damage, and the shape and stiffness of the AFO did not change after the durability test. The gait speed increased after wearing the conventional AFO (56.5 cm/sec and 3D-printed AFO (56.5 cm/sec compared to that without an AFO (42.2 cm/sec. The patient was more satisfied with the 3D-printed AFO than the conventional AFO in terms of the weight and ease of use. The 3D-printed AFO exhibited similar functionality as the conventional AFO and considerably satisfied the patient in terms of the weight and ease of use. We suggest the possibility of the individualized AFO with 3D printing techniques and automated design software.

  2. Effects of joint alignment and type on mechanical properties of thermoplastic articulated ankle-foot orthosis.

    Science.gov (United States)

    Gao, Fan; Carlton, William; Kapp, Susan

    2011-06-01

    Articulated or hinged ankle-foot orthosis (AFO) allow more range of motion. However, quantitative investigation on articulated AFO is still sparse. The objective of the study was to quantitatively investigate effects of alignment and joint types on mechanical properties of the thermoplastic articulated AFO. Tamarack dorsiflexion assist flexure joints with three durometers (75, 85 and 95) and free motion joint were tested. The AFO joint was aligned with the center of the motor shaft (surrogate ankle joint), 10 mm superior, inferior, anterior and posterior with respect to the motor shaft center. The AFO was passively moved from 20° plantar flexion to 15° dorsiflexion at a speed of 10°/s using a motorized device. Mechanical properties including index of hysteresis, passive resistance torque and quasi-static stiffness (at neutral, 5°, 10° and 15° in plantar flexion) were quantified. Significant effects of joint types and joint alignment on the mechanical properties of an articulated thermoplastic AFO were revealed. Specifically, center alignment showed minimum resistance and stiffness while anterior and posterior alignment showed significantly higher resistance and stiffness. The dorsiflexion assist torques at neutral position ranged from 0.69 ± 0.09 to 1.88 ± 0.10 Nm. Anterior and posterior alignment should be avoided as much as possible. The current study suggested that anterior and posterior alignment be avoided as much as possible in clinical practice due to potential skin irritation and increase in stress around the ankle joint.

  3. Use of a bivalved polypropylene orthosis in the postoperative management of idiopathic scoliosis.

    Science.gov (United States)

    Roberts, R S; Price, C T; Riddick, M F

    1984-05-01

    Forty-four consecutive patients with idiopathic scoliosis treated by posterior spinal fusion and Harrington rod instrumentation were immobilized after surgery with bivalved polypropylene orthoses. Immediate ambulation was allowed, and the patients wore the orthoses for a mean of 5.9 months. Brace removal was permitted with the patient recumbent for sponge bathing. These patients were followed up for a mean of 2.1 years (range, 1.0-4.3 years). The average final correction for all curves was 45%. The average loss of correction was 2.4 degrees (5.3%). Combined distraction and compression instrumentation was found to improve final correction in all curves by 3 degrees (6.2%) as compared with distraction instrumentation alone. There were no pseudarthroses and no rod breakage. Patients enjoyed the benefits of improved personal hygiene, pleasing cosmetic appearance, and increased life-style flexibility, especially swimming, which was not possible with the conventional Risser plaster cast. Use of the polypropylene orthosis offers significant advantages as compared with previous methods of postoperative management: it not only provides consistently good results but is enthusiastically accepted by patients as well.

  4. The effects of an ankle foot orthosis on cerebral palsy gait: A multiple regression analysis.

    Science.gov (United States)

    Wahid, Ferdous; Begg, Rezaul; Sangeux, Morgan; Halgamuge, Saman; Ackland, David C

    2015-08-01

    The aim of this study was twofold. Firstly, to develop a multiple regression normalization (MR) strategy to decorrelate physical properties and walking speed from spatiotemporal gait data in healthy children; and secondly, to use this MR approach to identify the effect of a solid ankle foot orthosis (AFO) on gait in children with cerebral palsy (CP). Spatiotemporal gait data during self-selected walking were obtained from 51 children with diplegic CP and 34 aged-matched healthy controls. Data were normalized using standard dimensionless equations (DS) and a MR approach. Stride length, stance time, swing time, and double support time were significantly different between children with CP and healthy controls using DS (pchildren with CP walked with and without an AFO. Normalizing gait data using DS demonstrated significant differences in cadence and step time in children with CP when wearing an AFO compared to the controls (pchildren with CP with and without an AFO, except double support time. After MR normalization, spatiotemporal parameters in children wearing an AFO became closer to those of the controls, except for double support time. The MR approach presented will assist in evaluating the effectiveness of conservative interventions such as AFOs in children with CP, as well as in surgery, and may be useful in gait classification using machine learning.

  5. Experimental Implementation of Underactuated Potential Energy Shaping on a Powered Ankle-Foot Orthosis.

    Science.gov (United States)

    Lv, Ge; Zhu, Hanqi; Elery, Toby; Li, Luwei; Gregg, Robert D

    2016-05-01

    Traditional control methodologies of rehabilitation orthoses/exoskeletons aim at replicating normal kinematics and thus fall into the category of kinematic control . This control paradigm depends on pre-defined reference trajectories, which can be difficult to adjust between different locomotor tasks and human subjects. An alternative control category, kinetic control , enforces kinetic goals (e.g., torques or energy) instead of kinematic trajectories, which could provide a flexible learning environment for the user while freeing up therapists to make corrections. We propose that the theory of underactuated potential energy shaping, which falls into the category of kinetic control, could be used to generate virtual body-weight support for stroke gait rehabilitation. After deriving the nonlinear control law and simulating it on a human-like biped model, we implemented this controller on a powered ankle-foot orthosis that was designed specifically for testing torque control strategies. Experimental results with an able-bodied human subject demonstrate the feasibility of the control approach for both positive and negative virtual body-weight augmentation.

  6. Mobility training using a bionic knee orthosis in patients in a post-stroke chronic state: a case series.

    Science.gov (United States)

    Byl, Nancy N

    2012-07-23

    An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. Three individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks) with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago.Immediately after training, all participants demonstrated improved gait speed (10 meter walk), stride length and walking endurance (6 minute walk) compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm. Lower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight-supported treadmill training program. The wearable, mobile assistive robotic device

  7. Comparison of three ankle-foot orthosis configurations for children with spastic diplegia.

    Science.gov (United States)

    Buckon, Cathleen E; Thomas, Susan Sienko; Jakobson-Huston, Sabrina; Moor, Michael; Sussman, Michael; Aiona, Michael

    2004-09-01

    This study compared the functional efficacy of three commonly prescribed ankle-foot orthosis (AFO) configurations (solid [SAFO], hinged [HAFO], and posterior leaf spring [PLS]). Sixteen independently ambulatory children (10 males, six females; mean age 8 years 4 months, SD 2 years 4 months; range 4 years 4 months to 11 years 6 months) with spastic diplegia participated in this study. Four children were classified at level I of the Gross Motor Function Classification System (GMFCS; Palisano et al. 1997); the remaining 12 were at level II. Children were assessed barefoot (BF) at baseline (baseline assessment of energy consumption was performed with shoes on, no AFO) and in each orthotic configuration after three months of use, using gait analysis, oxygen consumption, and functional outcome measures. AFO use did not markedly alter joint kinematics or kinetics at the pelvis, hip, or knee. All AFO configurations normalized ankle kinematics in stance, increased step/stride length, decreased cadence, and decreased energy cost of walking. Functionally, all AFO configurations improved the execution of walking/running/jumping skills, upper extremity coordination, and fine motor speed/dexterity. However, the quality of gross motor skill performance and independence in mobility were unchanged. These results suggest that most children with spastic diplegia benefit functionally from AFO use. However, some children at GMFCS level II demonstrated a subtle but detrimental effect on function with HAFO use, shown by an increase in peak knee extensor moment in early stance, excessive ankle dorsiflexion, decreased walking velocity, and greater energy cost. Therefore, constraining ankle motion by using a PLS or SAFO should be considered for most, but not all, children with spastic diplegia.

  8. Development of body weight support gait training system using pneumatic Mckibben actuators -control of lower extremity orthosis.

    Science.gov (United States)

    Mat Dzahir, M A; Nobutomo, T; Yamamoto, S I

    2013-01-01

    Recently, robot assisted therapy devices are increasingly used for spinal cord injury (SCI) rehabilitation in assisting handicapped patients to regain their impaired movements. Assistive robotic systems may not be able to cure or fully compensate impairments, but it should be able to assist certain impaired functions and ease movements. In this study, the control system of lower extremity orthosis for the body weight support gait training system which implements pneumatic artificial muscle (PAM) is proposed. The hip and knee joint angles of the gait orthosis system are controlled based on the PAM coordinates information from the simulation. This information provides the contraction data for the mono- and bi-articular PAMs that are arranged as posterior and anterior actuators to simulate the human walking motion. The proposed control system estimates the actuators' contraction as a function of hip and knee joint angles. Based on the contraction model obtained, input pressures for each actuators are measured. The control system are performed at different gait cycles and two PMA settings for the mono- and bi-articular actuators are evaluated in this research. The results showed that the system was able to achieve the maximum muscle moment at the joints, and able to perform the heel contact movement. This explained that the antagonistic mono- and bi-articular actuators worked effectively.

  9. Effectiveness of an innovative hip energy storage walking orthosis for improving paraplegic walking: A pilot randomized controlled study.

    Science.gov (United States)

    Yang, Mingliang; Li, Jianjun; Guan, Xinyu; Gao, Lianjun; Gao, Feng; Du, Liangjie; Zhao, Hongmei; Yang, Degang; Yu, Yan; Wang, Qimin; Wang, Rencheng; Ji, Linhong

    2017-09-01

    The high energy cost of paraplegic walking using a reciprocating gait orthosis (RGO) is attributed to limited hip motion and excessive upper limb loading for support. To address the limitation, we designed the hip energy storage walking orthosis (HESWO) which uses a spring assembly on the pelvic shell to store energy from the movements of the healthy upper limbs and flexion-extension of the lumbar spine and hip and returns this energy to lift the pelvis and lower limb to assist with the swing and stance components of a stride. Our aim was to evaluate gait and energy cost indices for the HESWO compared to the RGO in patients with paraplegia. The cross-over design was used in the pilot study. Twelve patients with a complete T4-L5 chronic spinal cord injury underwent gait training using the HESWO and RGO. Gait performance (continuous walking distance, as well as the maximum and comfortable walking speeds) and energy expenditure (at a walking speed of 3.3m/min on a treadmill) were measured at the end of the 4-week training session. Compared to the RGO, the HESWO increased continuous walking distance by 24.7% (Penergy expenditure by 13.9% (Puse of the HESWO as an alternative support for paraplegic walking. Copyright © 2017. Published by Elsevier B.V.

  10. Recent Trends in Lower-Limb Robotic Rehabilitation Orthosis: Control Scheme and Strategy for Pneumatic Muscle Actuated Gait Trainers

    Directory of Open Access Journals (Sweden)

    Mohd Azuwan Mat Dzahir

    2014-04-01

    Full Text Available It is a general assumption that pneumatic muscle-type actuators will play an important role in the development of an assistive rehabilitation robotics system. In the last decade, the development of a pneumatic muscle actuated lower-limb leg orthosis has been rather slow compared to other types of actuated leg orthoses that use AC motors, DC motors, pneumatic cylinders, linear actuators, series elastic actuators (SEA and brushless servomotors. However, recent years have shown that the interest in this field has grown exponentially, mainly due to the demand for a more compliant and interactive human-robotics system. This paper presents a survey of existing lower-limb leg orthoses for rehabilitation, which implement pneumatic muscle-type actuators, such as McKibben artificial muscles, rubbertuators, air muscles, pneumatic artificial muscles (PAM or pneumatic muscle actuators (PMA. It reviews all the currently existing lower-limb rehabilitation orthosis systems in terms of comparison and evaluation of the design, as well as the control scheme and strategy, with the aim of clarifying the current and on-going research in the lower-limb robotic rehabilitation field.

  11. Polymer optical fiber strain gauge for human-robot interaction forces assessment on an active knee orthosis

    Science.gov (United States)

    Leal-Junior, Arnaldo G.; Frizera, Anselmo; Marques, Carlos; Sánchez, Manuel R. A.; Botelho, Thomaz R.; Segatto, Marcelo V.; Pontes, Maria José

    2018-03-01

    This paper presents the development of a polymer optical fiber (POF) strain gauge based on the light coupling principle, which the power attenuation is created by the misalignment between two POFs. The misalignment, in this case, is proportional to the strain on the structure that the fibers are attached. This principle has the advantages of low cost, ease of implementation, temperature insensitiveness, electromagnetic fields immunity and simplicity on the sensor interrogation and signal processing. Such advantages make the proposed solution an interesting alternative to the electronic strain gauges. For this reason, an analytical model for the POF strain gauge is proposed and validated. Furthermore, the proposed POF sensor is applied on an active orthosis for knee rehabilitation exercises through flexion/extension cycles. The controller of the orthosis provides 10 different levels of robotic assistance on the flexion/extension movement. The POF strain gauge is tested at each one of these levels. Results show good correlation between the optical and electronic strain gauges with root mean squared deviation (RMSD) of 1.87 Nm when all cycles are analyzed, which represents a deviation of less than 8%. For the application, the proposed sensor presented higher stability than the electronic one, which can provide advantages on the rehabilitation exercises and on the inner controller of the device.

  12. Comparison of custom-moulded ankle orthosis with hinged joints and off-the-shelf ankle braces in preventing ankle sprain in lateral cutting movements.

    Science.gov (United States)

    Lee, Winson C C; Kobayashi, Toshiki; Choy, Barton T S; Leung, Aaron K L

    2012-06-01

    A custom moulded ankle orthosis with hinged joints potentially offers a better control over the subtalar joint and the ankle joint during lateral cutting movements, due to total contact design and increase in material strength. To test the above hypothesis by comparing it to three other available orthoses. Repeated measures. Eight subjects with a history of ankle sprains (Grade 2), and 11 subjects without such history performed lateral cutting movements in four test conditions: 1) non-orthotic, 2) custom-moulded ankle orthosis with hinges, 3) Sport-Stirrup, and 4) elastic ankle sleeve with plastic support. A VICON motion analysis system was used to study the motions at the ankle and subtalar joints. The custom-moulded ankle orthosis significantly lowered the inversion angle at initial contact (p = 0.006) and the peak inversion angle (p = 0.000) during lateral cutting movements in comparison to non-orthotic condition, while the other two orthoses did not. The three orthoses did not affect the plantarflexion motions, which had been suggested by previous studies to be important in shock wave attenuation. The custom-moulded ankle orthosis with hinges could better control inversion and thus expected to better prevent ankle sprain in lateral cutting movements. Custom-moulded ankle orthoses are not commonly used in preventing ankle sprains. This study raises the awareness of the use of custom-moulded ankle orthoses which are expected to better prevent ankle sprains.

  13. The capacity to restore steady gait after a step modification is reduced in people with poststroke foot drop using an ankle-foot orthosis

    NARCIS (Netherlands)

    Swigchem, R. van; Roerdink, M.; Weerdesteyn, V.G.M.; Geurts, A.C.H.; Daffertshofer, A.

    2014-01-01

    BACKGROUND: A reduced capacity to modify gait to the environment may contribute to the risk of falls in people with poststroke foot drop using an ankle-foot orthosis. OBJECTIVE: This study aimed to quantify their capacity to restore steady gait after a step modification. DESIGN: This was a

  14. The Capacity to Restore Steady Gait After a Step Modification Is Reduced in People With Poststroke Foot Drop Using an Ankle-Foot Orthosis

    NARCIS (Netherlands)

    van Swigchem, R.; Roerdink, M.; Weerdesteyn, V.; Geurts, A.C.; Daffertshofer, A.

    2014-01-01

    Background. A reduced capacity to modify gait to the environment may contribute to the risk of falls in people with poststroke foot drop using an ankle-foot orthosis. Objective. This study aimed to quantify their capacity to restore steady gait after a step modification. Design. This was a

  15. Guillain-Barre Syndrome – rehabilitation outcome, residual deficits and requirement of lower limb orthosis for locomotion at 1 year follow-up.

    Science.gov (United States)

    Gupta, Anupam; Taly, Arun B; Srivastava, Abhishek; Murali, Thyloth

    2010-01-01

    To analyse long-term functional recovery, deficits and requirement of lower limb orthosis (LLO) for locomotion in patients with Guillain-Barre Syndrome (GBS). Prospective longitudinal follow-up study. Neurological Rehabilitation unit of university hospital. Sixty-nine patients of GBS admitted for inpatient rehabilitation. Thirty-five patients (M:F, 19:16) reporting after 1 year follow-up (50.72%) were included in study (between September 2005 and July 2009). Their residual deficits and requirement of LLO were recorded and analysed. Age ranged from 4 to 65 year (29.74 ± 15.75). Twenty-seven patients had typical GBS and eight patients had acute motor axonal neuropathy variant. Twenty-eight patients (80%) had neuropathic pain needing medication with 11 required more than one drug. Twenty-one patients (60%) had foot drop and advised ankle-foot orthosis-AFO (20 bilateral AFO). Thirty patients (85.71%) needed assistive devices also for locomotion at discharge. After 1 year, foot drop was still present in 12 patients (34.28%) using orthosis. Modified Barthel Index scores, Modified Rankin Scale and Hughes Disability Scale were used to assess functional disabilities. Significant recovery was observed at the time of discharge and after 1 year (p < 0.001 each). Patients with GBS continue to show significant functional recovery for long period. They have residual deficits even after 1 year with requirement of orthosis in large number of patients.

  16. Defining the Mechanical Properties of a Spring-Hinged Ankle Foot Orthosis to Assess its Potential Use in Children With Spastic Cerebral Palsy

    NARCIS (Netherlands)

    Kerkum, Y.L.; Brehm, M.A.; Buizer, A.I.; van den Noort, J.C.; Becher, J.G.; Harlaar, J.

    2014-01-01

    A rigid ventral shelf ankle foot orthosis (AFO) may improve gait in children with spastic cerebral palsy (SCP) whose gait is characterized by excessive knee flexion in stance. However, these AFOs can also impede ankle range of motion (ROM) and thereby inhibit push-off power. A more spring-like AFO

  17. Defining the mechanical properties of a spring-hinged ankle foot orthosis to assess its potential use in children with spastic cerebral palsy

    NARCIS (Netherlands)

    Kerkum, Yvette L.; Brehm, Merel-Anne; Buizer, Annemieke I.; van den Noort, Josien C.; Becher, Jules G.; Harlaar, Jaap

    2014-01-01

    A rigid ventral shelf ankle foot orthosis (AFO) may improve gait in children with spastic cerebral palsy (SCP) whose gait is characterized by excessive knee flexion in stance. However, these AFOs can also impede ankle range of motion (ROM) and thereby inhibit push-off power. A more spring-like AFO

  18. Design and Evaluation of a New Type of Knee Orthosis to Align the Mediolateral Angle of the Knee Joint with Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Amir Esrafilian

    2012-01-01

    Full Text Available Background. Osteoarthritis (OA is a disease which influences the performance of the knee joint. Moreover, the force and moments applied on the joint increase in contrast to normal subjects. Various types of knee orthoses have been designed to solve the mentioned problems. However, there are other problems in terms of distal migration during walking and the alignment of the orthosis which cannot be changed following the use of brace. Therefore, the main aim of the research was to design an orthosis to solve the aforementioned problems. Method. A new type of knee orthosis was designed with a modular structure. Two patients with knee OA participated in this research project. The force applied on the foot, moment transmitted through the knee joint, and spatiotemporal gait parameters were measured by use of a motion analysis system. Results. The results of the research showed that the adduction moment applied on the knee joint decreased while subjects walked with the new knee orthosis (P-value < 0.05. Conclusion. The new design of the knee brace can be used as an effective treatment to decrease the loads applied on the knee joint and to improve the alignment whilst walking.

  19. A COMPARATIVE STUDY TO FIND OUT IMMEDIATE EFFECTIVENESS OF MOVEMENT WITH MOBILIZATION VERSUS ELBOW ORTHOSIS ON PAIN AND GRIP STRENGTH IN LATERAL EPICONDYLITIS IN HOUSEWIVES

    Directory of Open Access Journals (Sweden)

    Trishna Kakati

    2015-12-01

    Full Text Available Background: There are various studies using Mulligan’s MWM with or without combining with electrotherapy modalities and proved the efficacy of the technique in immediately decreasing pain and improving grip strength in patients with lateral epicondylitis. Orthotic as a treatment is also proved to be beneficial in decreasing pain and improving grip strength. There is evidence that housewives are prone to develop lateral epicondylitis due to their routine household work. But there is lack of evidence which compare initial effects of MWM and orthosis in housewives bringing up better outcome measures. The purpose of this study is to compare the initial effectiveness of Mulligan’s MWM and elbow orthosis on pain and grip strength in housewives with lateral epicondylitis. The aim of the study is to evaluate the effectiveness of Mulligan’s MWM technique versus counterforce elbow orthosis in immediately reducing pain and improving grip strength in lateral epicondylitis in housewives. Methodos: All subjects underwent a pre-treatment examination to assess pain and pain free hand grip strength with the help of outcome measures. Subjects were randomly assigned into two groups, A and B respectively; having 25 subjects in each group. Group A was treated with one session of Mulligan’s MWM technique. Group B was treated with Counterforce elbow strap orthosis. Data was assessed pre-treatment and immediately after treatment. Visual Analogue Scale (VAS and hand grip on Hand Grip Dynamometer (HGD were used as outcome measures. Results: Independent t-test was performed to see the effectiveness between Mulligan’s MWM and elbow orthosis. For VAS, t = - 2.243 which is significant at 5% level of significance. It has been inferred that VAS decreases more when Mulligan’s MWM was applied. For HGD, t = 0.878 which is not significant implying that increase in HGD do not differ remarkably for the two treatments. Conclusion: It has been recorded from the study that

  20. Efficacy of a trunk orthosis with joints providing resistive force on low-back load in elderly persons during static standing

    Directory of Open Access Journals (Sweden)

    Katsuhira J

    2015-09-01

    Full Text Available Junji Katsuhira,1 Ko Matsudaira,2 Tadashi Yasui,3 Shinno Iijima,4 Akihiro Ito4 1Department of Nursing and Rehabilitation Science at Odawara, International University of Health and Welfare, Odawara, Kanagawa, 2Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, 3Kawamura-Gishi Company, Ltd., Daito-shi, Osaka, 4Graduate School of International University of Health and Welfare, Otawara, Tochigi, Japan Purpose: Postural alignment of elderly people becomes poor due to aging, possibly leading to low-back pain and spinal deformity. Although there are several interventions for treating these conditions, no previous study has reported the effectiveness of a spinal orthosis or lumbosacral orthosis (LSO in healthy elderly people without specific spinal deformity. We therefore developed a trunk orthosis to decrease low-back muscle activity while training good postural alignment through resistive force provided by joints with springs (here, called the ORF, which stands for orthosis with joints providing resistive force as a preventive method against abnormal posture and low-back pain in healthy elderly persons. Patients and methods: Fifteen community-dwelling elderly men participated in this study. Participants stood freely for 10 seconds in a laboratory setting under three conditions: without an orthosis, with the ORF, and with an LSO. The Damen corset LSO was selected as it is frequently prescribed for patients with low-back pain. Postural alignment during static standing was recorded using a three-dimensional motion capture system employing infrared cameras. Two force plates were used to record center of pressure. Electromyograms were obtained for bilateral erector spinae (ES, left internal abdominal oblique, and right gluteus medius muscles. Results: Pelvis forward tilt angle tended to increase while wearing the ORF and decrease while wearing the LSO, but these

  1. Physical human-robot interaction of an active pelvis orthosis: toward ergonomic assessment of wearable robots.

    Science.gov (United States)

    d'Elia, Nicolò; Vanetti, Federica; Cempini, Marco; Pasquini, Guido; Parri, Andrea; Rabuffetti, Marco; Ferrarin, Maurizio; Molino Lova, Raffaele; Vitiello, Nicola

    2017-04-14

    In human-centered robotics, exoskeletons are becoming relevant for addressing needs in the healthcare and industrial domains. Owing to their close interaction with the user, the safety and ergonomics of these systems are critical design features that require systematic evaluation methodologies. Proper transfer of mechanical power requires optimal tuning of the kinematic coupling between the robotic and anatomical joint rotation axes. We present the methods and results of an experimental evaluation of the physical interaction with an active pelvis orthosis (APO). This device was designed to effectively assist in hip flexion-extension during locomotion with a minimum impact on the physiological human kinematics, owing to a set of passive degrees of freedom for self-alignment of the human and robotic hip flexion-extension axes. Five healthy volunteers walked on a treadmill at different speeds without and with the APO under different levels of assistance. The user-APO physical interaction was evaluated in terms of: (i) the deviation of human lower-limb joint kinematics when wearing the APO with respect to the physiological behavior (i.e., without the APO); (ii) relative displacements between the APO orthotic shells and the corresponding body segments; and (iii) the discrepancy between the kinematics of the APO and the wearer's hip joints. The results show: (i) negligible interference of the APO in human kinematics under all the experimented conditions; (ii) small (i.e., body segments (called stability); and (iii) significant increment in the human-robot kinematics discrepancy at the hip flexion-extension joint associated with speed and assistance level increase. APO mechanics and actuation have negligible interference in human locomotion. Human kinematics was not affected by the APO under all tested conditions. In addition, under all tested conditions, there was no relevant relative displacement between the orthotic cuffs and the corresponding anatomical segments

  2. Mobility training using a bionic knee orthosis in patients in a post-stroke chronic state: a case series

    Directory of Open Access Journals (Sweden)

    Byl Nancy N

    2012-07-01

    Full Text Available Abstract Introduction An emerging area of neurorehabilitation is the use of robotic devices to enhance the efficiency and effectiveness of lower extremity physical therapy post-stroke. Many of the robotic devices currently available rely on computer-driven locomotive algorithms combined with partial bodyweight-supported treadmill training that drive reflex stepping with minimal patient intention during therapy. In this case series, we examined the effect of task-oriented mobility training in patients in a post-stroke chronic state using a novel, wearable, mobile, intention-based robotic leg orthosis. Case presentation Three individuals, all of whom had reached a plateau with conventional bodyweight-supported treadmill training, participated in task-oriented mobility therapy (1.5 hours, two to four times per week for four weeks with a robotic leg orthosis under supervision by a physical therapist. Participant 1 was a 59-year-old Caucasian man, who had an ischemic left stroke six years previously with resultant right hemiparesis. Participant 2 was a 42-year-old Caucasian woman with left hemiparesis after a right stroke 15 months previously. Participant 3 was a 62-year-old Caucasian woman with a history of a right middle cerebral artery aneurysm with third degree sub-arachnoid hemorrhage 10 years ago. Immediately after training, all participants demonstrated improved gait speed (10 meter walk, stride length and walking endurance (6 minute walk compared with baseline measurements. Improvements were maintained one month after training. Timed up and go and five times sit-to-stand were maintained for all three participants, with only one individual remaining outside the safety performance norm. Conclusions Lower extremity training integrating an intention-based robotic leg orthosis may improve gait speed, endurance and community levels of participation in select patients in a post-stroke chronic state after plateauing within a bodyweight

  3. Effect of ankle-foot orthosis on weight bearing of chronic stroke patients performing various functional standing tasks.

    Science.gov (United States)

    Don Kim, Kyoung; Lee, Hyun Jin; Lee, Myoung Hyo; Hwangbo, Gak

    2015-04-01

    [Purpose] This study examined how an ankle-foot orthosis (AFO) influences the weight-bearing of chronic stroke patients during the performance of five functional standing tasks. [Subjects and Methods] Sixteen patients with stroke participated in this experiment. The subjects performed functional standing tasks with or without the AFO and weight bearing was measured during the tasks. [Results] Patients showed increased weight-bearing ability on the affected side during wearing the AFO in all tasks, and there were significant differences among Tasks 1, 2, and 3. Patients showed a small amount of increased weight bearing on the unaffected side while wearing the AFO in all tasks except for Task 2. [Conclusion] ADL-related functional standing tasks with AFO increased the weight bearing.

  4. Effect of an Ankle Foot Orthosis Intervention for Children With Non-Central Nervous System Cancers: A Pilot Study.

    Science.gov (United States)

    Tanner, Lynn R; Hooke, Mary C; Hinshon, Scott; Hansen, Cheryl R

    2015-01-01

    Children with cancer are at risk for physical performance limitations. In this pilot study we investigated the feasibility and initial efficacy of an ankle foot orthosis (AFO) in children with non-central nervous system cancer with peripheral weakness. Participants included children aged 5 to 11 years diagnosed with cancer. Children wore AFOs for 1 cycle of chemotherapy. Pre- and postintervention adverse events, adherence, gait, strength, range of motion, activity, and fatigue were measured. Six of 7 children completed the study; none of the 7 reported adverse events. Positive trends were observed in step length (46.23-49.25 cm), dorsiflexion strength (19.25-24.50 lb), ankle dorsiflexion range of motion (0.5-8°), and activity (7850-9857 epochs). Negative trends observed included cadence and fatigue ratings. No change was observed in the 6-minute walk or parent-reported fatigue. An AFO intervention is feasible in children with cancer. Initial efficacy results warrant further study.

  5. A comparison study on the efficacy of SpinoMed® and soft lumbar orthosis for osteoporotic vertebral fracture.

    Science.gov (United States)

    Li, Meng; Law, Sheung-wai; Cheng, Jack; Kee, Ho-man; Wong, Man Sang

    2015-08-01

    Osteoporosis is one of the major health problems in aging population and may lead to osteoporotic vertebral fracture that causes severe back pain and reduced functional independency. To compare the efficacy of SpinoMed® and soft lumbar orthosis at the subacute stage (the second and third weeks of disease onset) of the patients with osteoporotic vertebral fracture. Prospective randomized trial, pilot trial. A total of 51 female subjects aged 55 years or above with osteoporotic vertebral fracture were randomly distributed to the soft lumbar orthosis (control group, n = 24) and SpinoMed® (test group, n = 27) groups after the acute stage (the first week of disease onset). The pain level was assessed by obtaining verbally feedback in 10-point scale scoring, while functional mobility level was estimated with Functional Independence Measure-motor Scores, Elderly Mobility Scale, and Modified Functional Ambulation Category. The thoracic kyphosis angle was measured from standing X-ray on 10 out of 51 subjects. Both groups showed significant reduction in the patients' pain level and limitations of daily life (p 0.05) at the subacute stage. In this study, SpinoMed® could not provide additional treatment benefits to patients with osteoporotic vertebral fracture regarding pain relief and functional independence improvement at the subacute stage. The effects of SpinoMed® in muscle-strengthening and thoracic kyphotic angle reduction for patients with osteoporotic vertebral fracture need to be further verified in a more intensive and longer-term training program. © The International Society for Prosthetics and Orthotics 2014.

  6. Ankle-Foot Orthosis in Duchenne Muscular Dystrophy: A 4 year Experience in a Multidisciplinary Neuromuscular Disorders Clinic.

    Science.gov (United States)

    Gupta, Anupam; Nalini, Atchayaram; Arya, Shanti Prakash; Vengalil, Seena; Khanna, Meeka; Krishnan, Rashmi; Taly, Arun B

    2017-03-01

    To assess Ankle-Foot-Orthosis (AFO) requirement and ambulation in Duchenne Muscular Dystrophy (DMD) patients seen over a period of 4 y at a multi-disciplinary Neuromuscular disorders clinic (NMD). A study was conducted in university quaternary research hospital with DMD patients confirmed by MLPA (multiplex ligation - dependent probe amplification) method and were evaluated between January 2012 and December 2015. Their ambulatory status, detailed neurological and functional status were recorded. Requirement of AFOs was determined and provided. In total 126 DMD children reported to the NMD clinic. Mean age at presentation was 7.6 y (range 2 to12 y, SD 2.1). Mean duration of illness at first evaluation was 3.4 y (range 0.5 to 10 y, SD 2.0). AFO's were advised at a mean age of 8.5 y (range 7 to 12 y, SD 1.8). Fifty-nine patients were advised AFO as resting or walking splint. At last follow-up 113 patients were still ambulatory whereas 13 had become wheel chair bound. Out of 59 patients, 48 were still wearing AFOs and the remaining discontinued AFOs for various reasons. Children with DMD require wearing of AFOs as resting or walking splint, mostly in first or early second decade of life. As there is some gap between onset of clinical signs and requirement of orthosis, follow-up preferably at a multidisciplinary clinic at regular intervals is desirable for timely intervention in the form of AFOs or other splints to prolong ambulatory status in these patients.

  7. Effect of mobility devices on orientation sensors that contain magnetometers.

    Science.gov (United States)

    Kendell, Cynthia; Lemaire, Edward D

    2009-01-01

    Orientation sensors containing magnetometers use the earth's magnetic field as a reference. Ferromagnetic objects may distort this magnetic field, leading to inaccurate orientation output. We explored the viability of these orientation sensors for motion analysis in an assistive mobility device rehabilitative setting. We attached two MTx orientation sensors (XSens; Enschade, the Netherlands), connected to the XBus Master data collection unit (XSens), to a plastic frame such that the relative angle between sensors was constant. We then moved a series of mobility devices in proximity to the plastic frame: two knee-ankle-foot orthoses (aluminum, stainless steel), one ankle-foot orthosis, two transtibial prostheses (exoskeletal, endoskeletal), two walkers (standard, Challenger Low Wide [Evolution Technologies; Port Coquitlam, Canada]), and two wheelchairs (Tango [OrthoFab; Quebec City, Canada], GTi [Quickie; Phoenix, Arizona]). For each mobility device, we calculated the average difference in relative angle between the baseline and peak angles for each of five trials. Errors ranged from less than 0.10 to 35.29 degrees, depending on the mobility device and frame positioning near the device. This demonstrated the large errors that can occur when magnetometer-based orientation sensors with mobility devices are used. While strategic orientation sensor placement on some mobility devices can minimize these errors to an acceptable level, testing protocols should be implemented to verify orientation sensor accuracy for these applications.

  8. Early functional postoperative therapy of distal radius fracture with a dynamic orthosis: results of a prospective randomized cross-over comparative study.

    Directory of Open Access Journals (Sweden)

    Fabian M Stuby

    Full Text Available This study was conducted according to GCP criteria as a prospective randomized cross-over study. The primary goal of the study was to determine clinical findings and patient satisfaction with postoperative treatment. 29 patients with a distal radius fracture that was surgically stabilized from volar and who met the inclusion criteria were enrolled over a 12-month period. Each patient randomly received either a dorsal plaster splint or a vacuum-fit flexible but blocked orthosis applied postoperatively in the operating theatre to achieve postoperative immobilization. After one week all patients were crossed over to the complementary device maintaining the immobilization until end of week 2. After week 2 both groups were allowed to exercise wrist mobility with a physiotherapist, in the orthosis group the device was deblocked, thus allowing limited wrist mobility. After week 4 the devices were removed in both groups. Follow-up exams were performed after postoperative weeks 1, 2, 4 and 12.Results were determined after week 1 and 2 using SF 36 and a personally compiled questionnaire; after weeks 4 and 12 with a clinical check-up, calculation of ROM and the DASH Score. Comparison of the two groups showed a significant difference in ROM for volar flexion after 4 weeks, but no significant differences in DASH Score, duration of disability or x-ray findings. With regard to satisfaction with comfort and hygiene, patients were significantly more satisfied with the dynamic orthosis, and 23 of the 29 patients would prefer the flexible vacuum orthosis in future.German Clinical Trials Register (DRKS DRKS00006097.

  9. Effect of semi-rigid lumbosacral orthosis use on oxygen consumption during repetitive stoop and squat lifting.

    Science.gov (United States)

    Duplessis, D H; Greenway, E H; Keene, K L; Lee, I E; Clayton, R L; Metzler, T; Underwood, F B

    1998-06-01

    The use of back belts in industry has increased despite the lack of scientific evidence supporting their efficacy. The purpose of this study was to investigate the effect of a semi-rigid lumbosacral orthosis (SRLSO) on oxygen consumption during 6-min submaximal repetitive lifting bouts of 10 kg at a lifting frequency of 20 repetitions min-1. Fifteen healthy subjects (13 men, two women) participated in this study. Each subject performed squat and stoop lifting with and without an SRLSO for a total of four lifting bouts. Lifting bouts were performed in random order. Oxygen consumption during the final minute of each lifting bout was used for analysis. A two-way analysis of variance with repeated measures was used to analyse the effects of lift and belt conditions. The stoop and squat methods were significantly different, with the squat lift requiring 23% more oxygen on average than the stoop lift for equal bouts of work. No significant difference was found between the belt and no belt condition within the same lifting technique and no interaction was present. These data suggest that an SRLSO does not passively assist the paravertebral muscles (PVM) in stabilizing the spine during submaximal lifting bouts.

  10. Design of an automated device to measure sagittal plane stiffness of an articulated ankle-foot orthosis.

    Science.gov (United States)

    Kobayashi, Toshiki; Leung, Aaron K L; Akazawa, Yasushi; Naito, Hisashi; Tanaka, Masao; Hutchins, Stephen W

    2010-12-01

    The purpose of this study was to design a new automated stiffness measurement device which could perform a simultaneous measurement of both dorsi- and plantarflexion angles and the corresponding resistive torque around the rotational centre of an articulated ankle-foot orthosis (AAFO). This was achieved by controlling angular velocities and range of motion in the sagittal plane. The device consisted of a hydraulic servo fatigue testing machine, a torque meter, a potentiometer, a rotary plate and an upright supporter to enable an AAFO to be attached to the device via a surrogate shank. The accuracy of the device in reproducing the range of motion and angular velocity was within 4% and 1% respectively in the range of motion of 30° (15° plantarflexion to 15° dorsiflexion) at the angular velocity of 10°/s, while that in the measurement of AAFO torque was within 8% at the 0° position. The device should prove useful to assist an orthotist or a manufacturer to quantify the stiffness of an AAFO and inform its clinical use.

  11. A comparative study between total contact cast and pressure-relieving ankle foot orthosis in diabetic neuropathic foot ulcers.

    Science.gov (United States)

    Chakraborty, Partha Pratim; Ray, Sayantan; Biswas, Dibakar; Baidya, Arjun; Bhattacharjee, Rana; Mukhopadhyay, Pradip; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar

    2015-03-01

    Off-loading of the ulcer area is extremely important for the healing of plantar ulcers. Off-loading with total contact cast (TCC) may be superior to other off-loading strategies studied so far, but practical limitations can dissuade clinicians from using this modality. This study was conducted to evaluate the efficacy of TCC compared with that of a pressure-relieving ankle foot orthosis (PRAFO) in healing of diabetic neuropathic foot ulcers and their effect on gait parameters. Thirty adult diabetic patients attending the foot clinic with neuropathic plantar ulcers irrespective of sex, age, duration and type of diabetes were randomly assigned to 1 of 2 off-loading modalities (TCC and PRAFO). Main outcome measures were ulcer healing after 4 weeks of randomization and effect of each of the modalities on various gait parameters. The percentage reduction of the ulcer surface area at 4 weeks from baseline was 75.75 ± 9.25 with TCC and 34.72 ± 13.07 with PRAFO, which was significantly different (P diabetic neuropathic foot ulcer. Further studies are needed involving larger subjects and using 3D gait analysis to collect more accurate data on gait parameters and wound healing with different off-loading devices. © 2014 Diabetes Technology Society.

  12. Effects on foot external rotation of the modified ankle-foot orthosis on post-stroke hemiparetic gait.

    Science.gov (United States)

    Kim, Ha Jeong; Chun, Min Ho; Kim, Hong Min; Kim, Bo Ryun

    2013-08-01

    To evaluate the effects of heel-opened ankle foot orthosis (HOAFO) on hemiparetic gait after stroke, especially on external foot rotation, and to compare the effects of HOAFO with conventional plastic-AFO (pAFO) and barefoot during gait. This cross-over observational study involved 15 hemiparetic patients with external rotation of the affected foot. All subjects were able to walk independently, regardless of their usual use of a single cane, and had a less than fair-grade in ankle dorsiflexion power. Each patient was asked to walk in three conditions with randomized sequences: 1) barefoot, 2) with a pAFO, and 3) with an HOAFO. Their gait patterns were analyzed using a motion analysis system. Fifteen patients consisted of nine males and six females. On gait analysis, hip and foot external rotation were significantly greater in pAFO (-3.35° and -23.68°) than in barefoot and HOAFO conditions (pexternal rotation compared with pAFO; although there was no significant difference between HOAFO and barefoot walking. Walking speed and percentage of single limb support were significantly greater for HOAFO than in barefoot walking. HOAFO was superior to pAFO in reducing hip and foot external rotation during the stance phase in patients with post-stroke hemiparesis. HOAFO may, therefore, be useful in patients with excessive external rotation of the foot during conventional pAFO.

  13. The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy.

    Science.gov (United States)

    Balaban, Birol; Yasar, Evren; Dal, Ugur; Yazicioglu, Kamil; Mohur, Haydar; Kalyon, Tunc Alp

    2007-01-30

    To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines. Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0 degrees with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period. AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking. The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.

  14. Dual-strap augmentation of a halo orthosis in the treatment of atlantooccipital dislocation in infants and young children. Technical note.

    Science.gov (United States)

    Steinmetz, Michael P; Verrees, Meg; Anderson, James S; Lechner, Roseanna M

    2002-04-01

    Two children who were 13 months and 3 years old and who had suffered traumatic atlantooccipital dislocation were each treated by being placed in a halo orthosis for 10 weeks. Because of a continued loss of reduction due to the poor fit of the halo vest, a dual-strap augmentation was developed. This strap augmentation allowed consistent reduction to be maintained. Both children were therefore successfully treated nonsurgically with a halo vest. One child remained neurologically intact and the other had improvement in motor strength. There were no complications from the use of strap augmentation for halo vest fixation.

  15. Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO to Create Normal Ankle Joint Behavior

    Directory of Open Access Journals (Sweden)

    Amirhesam Amerinatanzi

    2017-12-01

    Full Text Available Hinge-based Ankle Foot Orthosis (HAFO is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II: (i subjects with bare foot; (ii subjects wearing a conventional HAFO with no spring; (iii subjects wearing a conventional Stainless Steel-based HAFO; and (iv subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree and an increased level of moment (0.55 versus 0.36 N·m/kg. Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects.

  16. Application of the Superelastic NiTi Spring in Ankle Foot Orthosis (AFO) to Create Normal Ankle Joint Behavior.

    Science.gov (United States)

    Amerinatanzi, Amirhesam; Zamanian, Hashem; Shayesteh Moghaddam, Narges; Jahadakbar, Ahmadreza; Elahinia, Mohammad

    2017-12-07

    Hinge-based Ankle Foot Orthosis (HAFO) is one of the most common non-surgical solutions for the foot drop. In conventional HAFOs, the ankle joint is almost locked, and plantar flexion is restricted due to the high stiffness of the hinge mechanism. This often leads to a rigid walking gate cycle, poor muscle activity, and muscle atrophy. Since the ankle torque-angle loop has a non-linear profile, the use of a superelastic NiTi spring within the hinge, due to its nonlinear behavior, could recreate a close-to-normal stiffness of the normal ankle joint, which, in turn, could create a more natural walk. The focus of this study is to evaluate the performance of a superelastic NiTi spring versus a conventional Stainless Steel spring in a hinge mechanism of a custom-fit HAFO. To this aim, a custom-fit HAFO was fabricated via the fast casting technique. Then, motion analysis was performed for two healthy subjects (Case I and Case II): (i) subjects with bare foot; (ii) subjects wearing a conventional HAFO with no spring; (iii) subjects wearing a conventional Stainless Steel-based HAFO; and (iv) subjects wearing a NiTi spring-based HAFO. The data related to the ankle angle and the amount of moment applied to the ankle during walking were recorded using Cortex software and used for the evaluations. Finally, Finite Element Analysis (FEA) was performed to evaluate the safety of the designed HAFO. The NiTi spring offers a higher range of motion (7.9 versus 4.14 degree) and an increased level of moment (0.55 versus 0.36 N·m/kg). Furthermore, a NiTi spring offers an ankle torque-angle loop closer to that of the healthy subjects.

  17. The influence of seat adjustment and a thoraco-lumbar-sacral orthosis on the distribution of body-seat pressure in children with scoliosis and pelvic obliquity.

    Science.gov (United States)

    Shoham, Yehudit; Meyer, Shirley; Katz-Leurer, Michal; Tamar Weiss, Patrice L

    2004-01-07

    To determine the effect of a thoraco-lumbar-sacral orthosis (TLSO) on the distribution of body-seat interface pressure in children with concomitant scoliosis and pelvic obliquity and to determine the effects of two methods commonly used in customized seating--elevation (push up) of the lower side of the pelvis or a wedge insertion beneath the raised pelvis--on the distribution of body-seat interface pressure. The study population comprised 15 children with an underlying neuromuscular disorder. All had scoliosis and pelvic obliquity when seated, and used a TLSO during sitting. Body-seat interface pressure was measured using the QA Pad. Maximum pressure, mean pressure and contact area were recorded at baseline and at 10 degrees 'push up' and 10 degrees wedge insertion, with and without the TLSO. X-rays were performed with and without the orthosis at baseline position. The TLSO reduced the scoliosis deformity by a mean of 5.3 degrees and significantly (p pelvic obliquity was contralateral to the side of the curve. Seat adjustment did not have any significant effect on pressure readings. Application of a TLSO in a child with scoliosis and contralateral pelvic obliquity significantly reduced the spinal curvature and interface sitting pressure. Manipulation of sitting by use of wedges under the pelvis had no significant effect on pressure distribution.

  18. Design of a 3D printed lightweight orthotic device based on twisted and coiled polymer muscle: iGrab hand orthosis

    Science.gov (United States)

    Saharan, Lokesh; Sharma, Ashvath; Jung de Andrade, Monica; Baughman, Ray H.; Tadesse, Yonas

    2017-04-01

    Partial or total upper extremity impairment affects the quality of life of a vast number of people due to stroke, neuromuscular disease, or trauma. Many researchers have presented hand orthosis to address the needs of rehabilitation or assistance on upper extremity function. Most of the devices available commercially and in literature are powered by conventional actuators such as DC motors, servomotors or pneumatic actuators. Some prototypes are developed based on shape memory alloy (SMA) and dielectric elastomers (DE). This study presents a customizable, 3D printed, a lightweight exoskeleton (iGrab) based on recently reported Twisted and Coiled Polymer (TCP) muscles, which are lightweight, provide high power to weight ratio and large stroke. We used silver coated nylon 6, 6 threads to make the TCP muscles, which can be easily actuated electrothermally. We reviewed briefly hand orthosis created with various actuation technologies and present our design of tendon-driven exoskeleton with the muscles confined in the forearm area. A single muscle is used to facilitate the motion of all three joints namely DIP (Distal interphalangeal), PIP (Proximal Interphalangeal) and MCP (Metacarpophalangeal) using passive tendons though circular rings. The grasping capabilities, along with TCP muscle properties utilized in the design such as life cycle, actuation under load and power inputs are discussed.

  19. Effects of implantable peroneal nerve stimulation on gait quality, energy expenditure, participation and user satisfaction in patients with post-stroke drop foot using an ankle-foot orthosis

    NARCIS (Netherlands)

    Schiemanck, Sven; Berenpas, Frank; van Swigchem, Roos; van den Munckhof, Pepijn; de Vries, Joost; Beelen, Anita; Nollet, Frans; Geurts, Alexander C.

    2015-01-01

    To investigate whether an implantable functional electrical stimulation (FES) system of the common peroneal nerve (ActiGait®) improves relevant aspects of gait in chronic stroke patients with a drop foot typically using an ankle-foot orthosis (AFO). Ten community-dwelling patients participated, of

  20. Is transcutaneous peroneal stimulation beneficial to patients with chronic stroke using an ankle-foot orthosis? A within-subjects study of patients' satisfaction, walking speed and physical activity level.

    NARCIS (Netherlands)

    Swigchem, R. van; Vloothuis, J.; Boer, J. de; Weerdesteijn, V.G.M.; Geurts, A.C.H.

    2010-01-01

    OBJECTIVE: The aim of this study was to evaluate whether community-dwelling chronic stroke patients wearing an ankle-foot orthosis would benefit from changing to functional electrical stimulation of the peroneal nerve. METHODS: In 26 community-dwelling chronic (> 6 months post-onset) patients after

  1. An anterior ankle-foot orthosis improves walking economy in Charcot-Marie-Tooth type 1A patients.

    Science.gov (United States)

    Menotti, Federica; Laudani, Luca; Damiani, Antonello; Mignogna, Teresa; Macaluso, Andrea

    2014-10-01

    Ankle-foot orthoses are commonly prescribed in Charcot-Marie-Tooth type 1A disease to improve quality of walking and reduce the risk of falling due to the foot drop. This study aimed at assessing the effect of an anterior ankle-foot orthosis on walking economy in a group of Charcot-Marie-Tooth type 1A patients. Within-group comparisons. 7 Charcot-Marie-Tooth type 1A patients (four women and three men; 37 ± 11 years; age range = 22-53 years) were asked to walk on a circuit at their self-selected speeds ('slow', 'comfortable' and 'fast') in two walking conditions: (1) with shoes only and (2) with Taloelast(®) anterior elastic ankle-foot orthoses. Speed of walking and metabolic cost of walking energy cost per unit of distance were assessed at the three self-selected speeds of walking for both walking conditions. Speed of walking at the three self-selected speeds did not differ between shoes only and anterior elastic ankle-foot orthoses, whereas walking energy cost per unit of distance at comfortable speed was lower in patients using anterior elastic ankle-foot orthoses with respect to shoes only (2.39 ± 0.22 vs 2.70 ± 0.19 J kg(-1) m(-1); P Charcot-Marie-Tooth type 1A patients, the use of anterior elastic ankle-foot orthoses improved walking economy by reducing the energy cost of walking per unit of distance, thus reflecting a lower level of metabolic effort and improved mechanical efficiency in comparison with shoes only. From a practical perspective, Charcot-Marie-Tooth type 1A patients with anterior elastic ankle-foot orthoses can walk for a longer duration with a lower level of physical effort. Improvements in walking economy due to ankle-foot orthoses are likely a consequence of the reduction in steppage gait. © The International Society for Prosthetics and Orthotics 2013.

  2. A series of case studies on the effect of a midfoot control ankle foot orthosis in the prevention of unresolved pressure areas in children with cerebral palsy.

    Science.gov (United States)

    Bill, M; McIntosh, R; Myers, P

    2001-12-01

    This paper reports on a series of case studies where improvements were sought in muscle tone and gait in children with cerebral palsy. A Midfoot Control Ankle Foot Orthosis (AFO) was developed to control foot position in a cohort of patients with cerebral palsy (CP). The concept of controlling midfoot and hindfoot with an encapsulated internal Supra-Malleolar AFO that fitted into an external AFO was shown to be effective in ambulant children with CP. Some initial problems of compliance were noted and postulated to be due to difficulties associated with previous orthotic devices. Evidence from the case studies suggest that the developed Supra-Malleolar AFO orthoses enables children with CP to maintain mobility without skin tissue damage, delays the need for surgery and at the same time maintains the length of the Triceps Surae (Gastrocnemius and Soleus) complex. Plans for further research are discussed which will contribute to the evidence base for this particular orthotic device.

  3. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study.

    Science.gov (United States)

    Desloovere, Kaat; Molenaers, Guy; Van Gestel, Leen; Huenaerts, Catherine; Van Campenhout, Anja; Callewaert, Barbara; Van de Walle, Patricia; Seyler, J

    2006-10-01

    Several studies indicated that walking with an ankle foot orthosis (AFO) impaired third rocker. The purpose of this study was to evaluate the effects of two types of orthoses, with similar goal settings, on gait, in a homogeneous group of children, using both barefoot and shoe walking as control conditions. Fifteen children with hemiplegia, aged between 4 and 10 years, received two types of individually tuned AFOs: common posterior leaf-spring (PLS) and Dual Carbon Fiber Spring AFO (CFO) (with carbon fibre at the dorsal part of the orthosis). Both orthoses were expected to prevent plantar flexion, thus improving first rocker, allowing dorsiflexion to improve second rocker, absorbing energy during second rocker, and returning it during the third rocker. The effect of the AFOs was studied using objective gait analysis, including 3D kinematics, and kinetics in four conditions: barefoot, shoes without AFO, and PLS and CFO combined with shoes. Several gait parameters significantly changed in shoe walking compared to barefoot walking (cadence, ankle ROM and velocity, knee shock absorption, and knee angle in swing). The CFO produced a significantly larger ankle ROM and ankle velocity during push-off, and an increased plantar flexion moment and power generation at pre-swing compared to the PLS (<0.01). The results of this study further support the findings of previous studies indicating that orthoses improve specific gait parameters compared to barefoot walking (velocity, step length, first and second ankle rocker, sagittal knee and hip ROM). However, compared to shoes, not all improvements were statistically significant.

  4. AN ANALYSIS OF THE MANUFACTURING POSSIBILITY OF SPECIAL ANKLE FOOT ORTHOSIS COMPONENTS BY OMPARISON BETWEEN THE REQUIRED PRECISION AND THE VAILABLE PRECISION ON A VERTICAL MACHINING CENTER PROGRAMED WITH TOPSOLID

    Directory of Open Access Journals (Sweden)

    Alexandru STANIMIR

    2010-06-01

    Full Text Available Validation of different solutions adopted to achieve new ankle foot orthosis involves among others their prototyping. In these paper we developed a representative part for two axis machining that requires the use of the main features of TopSolid Cad and Cam modules, and that assumes the use of the main manufacturing processes that usually may be met on a vertical machining center. Also, in order to determine the dimensional and geometrical deviations of the part this was done on the YMC 1050 machining center. After comparing the measured deviations with the requirements of various components of orthesis, we concluded that the available precision meets the requirements and that the machining center with TopSolid software that we have will enable us to realize special ankle foot orthosis of quality, for experimental research .

  5. A Robotic Exoskeleton for Treatment of Crouch Gait in Children With Cerebral Palsy: Design and Initial Application.

    Science.gov (United States)

    Lerner, Zachary F; Damiano, Diane L; Park, Hyung-Soon; Gravunder, Andrew J; Bulea, Thomas C

    2017-06-01

    Crouch gait, a pathological pattern of walking characterized by excessive knee flexion, is one of the most common gait disorders observed in children with cerebral palsy (CP). Effective treatment of crouch during childhood is critical to maintain mobility into adulthood, yet current interventions do not adequately alleviate crouch in most individuals. Powered exoskeletons provide an untapped opportunity for intervention. The multiple contributors to crouch, including spasticity, contracture, muscle weakness, and poor motor control make design and control of such devices challenging in this population. To our knowledge, no evidence exists regarding the feasibility or efficacy of utilizing motorized assistance to alleviate knee flexion in crouch gait. Here, we present the design of and first results from a powered exoskeleton for extension assistance as a treatment for crouch gait in children with CP. Our exoskeleton, based on the architecture of a knee-ankle-foot orthosis, is lightweight (3.2 kg) and modular. On board sensors enable knee extension assistance to be provided during distinct phases of the gait cycle. We tested our device on one six-year-old male participant with spastic diplegia from CP. Our results show that the powered exoskeleton improved knee extension during stance by 18.1° while total knee range of motion improved 21.0°. Importantly, we observed no significant decrease in knee extensor muscle activity, indicating the user did not rely solely on the exoskeleton to extend the limb. These results establish the initial feasibility of robotic exoskeletons for treatment of crouch and provide impetus for continued investigation of these devices with the aim of deployment for long term gait training in this population.

  6. The effects of gait training using powered lower limb exoskeleton robot on individuals with complete spinal cord injury.

    Science.gov (United States)

    Wu, Cheng-Hua; Mao, Hui-Fen; Hu, Jwu-Sheng; Wang, Ting-Yun; Tsai, Yi-Jeng; Hsu, Wei-Li

    2018-03-05

    Powered exoskeleton can improve the mobility for people with movement deficits by providing mechanical support and facilitate the gait training. This pilot study evaluated the effect of gait training using a newly developed powered lower limb exoskeleton robot for individuals with complete spinal cord injury (SCI). Two participants with a complete SCI were recruited for this clinical study. The powered exoskeleton gait training was 8 weeks, 1 h per session, and 2 sessions per week. The evaluation was performed before and after the training for (1) the time taken by the user to don and doff the powered exoskeleton independently, (2) the level of exertion perceived by participants while using the powered exoskeleton, and (3) the mobility performance included the timed up-and-go test, 10-m walk test, and 6-min walk test with the powered exoskeleton. The safety of the powered exoskeleton was evaluated on the basis of injury reports and the incidence of falls or imbalance while using the device. The results indicated that the participants were donning and doffing the powered lower limb exoskeleton robot independently with a lower level of exertion and walked faster and farther without any injury or fall incidence when using the powered exoskeleton than when using a knee-ankle-foot orthosis. Bone mineral densities was also increased after the gait training. No adverse effects, such as skin abrasions, or discomfort were reported while using the powered exoskeleton. The findings demonstrated that individuals with complete SCI used the powered lower limb exoskeleton robot independently without any assistance after 8 weeks of powered exoskeleton gait training. Trial registration: National Taiwan University Hospital. 201210051RIB . Name of registry: Hui-Fen Mao. URL of registry: Not available. Date of registration: December 12th, 2012. Date of enrolment of the first participant to the trial: January 3rd, 2013.

  7. A pelvic implant orthosis in rodents, for spinal cord injury rehabilitation, and for brain machine interface research: construction, surgical implantation and validation.

    Science.gov (United States)

    Udoekwere, Ubong Ime; Oza, Chintan S; Giszter, Simon F

    2014-01-30

    Rodents are important model systems used to explore spinal cord injury (SCI) and rehabilitation, and brain machine interfaces (BMI). We present a new method to provide mechanical interaction for BMI and rehabilitation in rat models of SCI. We present the design and implantation procedures for a pelvic orthosis that allows direct force application to the skeleton in brain machine interface and robot rehabilitation applications in rodents. We detail the materials, construction, machining, surgery and validation of the device. We describe the statistical validation of the implant procedures by comparing stepping parameters of 8 rats prior to and after implantation and surgical recovery. An ANOVA showed no effects of the implantation on stepping. Paired tests in the individual rats also showed no effect in 7/8 rats and minor effects in the last rat, within the group's variance. Our method allows interaction with rats at the pelvis without any perturbation of normal stepping in the intact rat. The method bypasses slings, and cuffs, avoiding cuff or slings squeezing the abdomen, or other altered sensory feedback. Our implant osseointegrates, and thus allows an efficient high bandwidth mechanical coupling to a robot. The implants support quadrupedal training and are readily integrated into either treadmill or overground contexts. Our novel device and procedures support a range of novel experimental designs and motor tests for rehabilitative and augmentation devices in intact and SCI model rats, with the advantage of allowing direct force application at the pelvic bones. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. Variations of ankle-foot orthosis-constrained movements increase ankle range of movement while maintaining power output of recumbent cycling.

    Science.gov (United States)

    Hamdan, Puteri N F; Hamzaid, Nur Azah; Usman, Juliana; Islam, Md Anamul; Kean, Victor S P; Wahab, Ahmad K Abdul; Hasnan, Nazirah; Davis, Glen M

    2017-09-15

    Previous research investigated recumbent cycle power output (PO) from the perspective of knee and hip joint biomechanics. However, ankle-foot biomechanics and, in particular, the effect of ankle-foot orthosis (AFO)-constrained movements on cycle PO has not been widely explored. Therefore, the purpose of this study was to determine whether AFOs of a fixed position (FP) and in dorsi-plantarflexion (DPF)-, dorsiflexion (DF)- and plantarflexion (PF)-constrained movements might influence PO during voluntary recumbent cycling exercises. Twenty-five healthy individuals participated in this study. All underwent 1-min cycling at a fixed cadence for each of the AFOs. The peak and average PO of each condition were analyzed. The peak and average PO were 27.2±12.0 W (range 6-60) and 17.2±9.0 W (range 2-36), respectively, during voluntary cycling. There were no significant differences in the peak PO generated by the AFOs (p=0.083). There were also no significant differences in the average PO generated using different AFOs (p=0.063). There were no significant differences in the changes of the hip and knee joint angles with different AFOs (p=0.974 and p=1.00, respectively). However, there was a significant difference in the changes of the ankle joint angle (pcycling in healthy individuals. This finding might serve as a reference for future rehabilitative cycling protocols.

  9. Defining the mechanical properties of a spring-hinged ankle foot orthosis to assess its potential use in children with spastic cerebral palsy.

    Science.gov (United States)

    Kerkum, Yvette L; Brehm, Merel-Anne; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap

    2014-12-01

    A rigid ventral shelf ankle foot orthosis (AFO) may improve gait in children with spastic cerebral palsy (SCP) whose gait is characterized by excessive knee flexion in stance. However, these AFOs can also impede ankle range of motion (ROM) and thereby inhibit push-off power. A more spring-like AFO can enhance push-off and may potentially reduce walking energy cost. The recent development of an adjustable spring-hinged AFO now allows adjustment of AFO stiffness, enabling tuning toward optimal gait performance. This study aims to quantify the mechanical properties of this spring-hinged AFO for each of its springs and settings. Using an AFO stiffness tester, two AFO hinges and their accompanying springs were measured. The springs showed a stiffness range of 0.01-1.82 N · m · deg(-1). The moment-threshold increased with increasing stiffness (1.13-12.1 N · m), while ROM decreased (4.91-16.5°). Energy was returned by all springs (11.5-116.3 J). These results suggest that the two stiffest available springs should improve joint kinematics and enhance push-off in children with SCP walking with excessive knee flexion.

  10. Are Gait Indices Sensitive Enough to Reflect the Effect of Ankle Foot Orthosis on Gait Impairment in Cerebral Palsy Diplegic Patients?

    Science.gov (United States)

    Danino, Barry; Erel, Snir; Kfir, Meital; Khamis, Sam; Batt, Reuven; Hemo, Yoram; Wientroub, Shlomo; Hayek, Shlomo

    2016-01-01

    Neuromuscular impairments may compromise gait function in patients with cerebral palsy (CP). As such, ambulatory children with CP often use ankle foot orthosis (AFO) to facilitate and optimize their ability to walk.The aim of this study was to evaluate whether the different gait indices, the Gillette Gait Index (GGI), the Gait Deviation Index (GDI), and the Gait Profile Score (GPS), reflect the improved gait that was previously shown using AFO. A retrospective analysis of 53 studies on children with spastic diplegic CP. All had undergone a comprehensive gait study and were analyzed while walking, both barefoot and with their braces, in the same session.Kinematic and temporal spatial data were determined and summarized by 3 methods: GPS, GDI, and GGI. Significant differences were found between the barefoot condition and the AFO conditions for temporal and kinematic parameters: changes in GGI, GDI, and GPS were not statistically significant, with an improvement of 9.33% in GGI (P=0.448) and no change in GDI and GPS. The use of AFO in diplegic CP children caused a statistically significant improvement in temporal and kinematic parameters. Interestingly, it was found that this improvement was not reflected by GGI, GDI, or GPS.These findings might suggest that gait indices, as outcome measures, may sometimes not reflect all the effects of specific interventions. Level III-retrospective study.

  11. The influence of orthotic gait training with an isocentric reciprocating gait orthosis on the walking ability of paraplegic patients: a pilot study.

    Science.gov (United States)

    Samadian, M; Arazpour, M; Ahmadi Bani, M; Pouyan, A; Bahramizadeh, M; Hutchins, S W

    2015-10-01

    The aim of this study was to evaluate the influence of walking with an isocentric reciprocating gait orthosis (IRGO) by spinal cord injury (SCI) patients on walking speed, distance walked and energy consumption whilst participating in a 12-week gait re-training program. Six people with motor complete SCI (mean age 29 years, weight 63 kg and height 160 cm with injury levels ranging from T8 to T12) participated in this study. Gait evaluation was performed at baseline and after 4, 8 and 12 weeks. Walking speed and heart rate were measured to calculate the resulting physiological cost index (PCI). Reductions in energy consumption were observed after 4, 8 and 12 weeks compared with baseline but were not significant. However, walking distance increased significantly (P=0.010, P=0.003 and P=0.005, respectively) and also did so during the 8-12-week period (P=0.013). Walking speed also improved, but not significantly. Intensive gait training with the IRGO improved walking speed and the distance walked by paraplegics, as well as reducing the PCI of walking, as compared with baseline during the whole 12-week period. This indicates that further improvements in these parameters may be expected when utilizing gait training longer than 8 weeks.

  12. EFFECT OF KINESIO TAPING AND SOFT ORTHOSIS APPLICATION ON THE PAIN AND FUNCTIONAL DISABILITY IN LUMBAR REGION PATHOLOGIES WITHOUT NEUROLOGICAL DEFICITS: A RANDOMIZED CONTROLLED EXPERIMENTAL STUDY

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    Burcu TALU

    2016-12-01

    Full Text Available Background: Back pain caused by lumbar region pathologies is a condition that leads to loss of productivity and physical disability, with high costs of diagnosis and treatment. This study was planned to investigate the effect of taping and soft orthosis application on the pain and functional disability in the pathology of lumbar region without neurological deficit. Methods: This study is randomized controlled trial. Sixty-three volunteer patients were randomly divided into three groups of 21 people. Group I, soft orthotics and stabilization exercise program; Group II, Kinesio taping and stabilization exercise program; Group III, stabilization exercise program was applied. After obtaining demographic data of the participants; patients were evaluated in terms of range of motion and muscle strength. We used visual analog scale for pain level assessment, sit and reach test for flexibility assessment, timed up and go test (TUG for functional ambulation and balance, modified Schober test for lumbar spine flexibility, Oswestry Disability Index in the assessment of functional disability. They were assessed at the pretreatment, third (post treatment and six week (home programs and follow-up. Results: The results showed that significant differences (p<0.05 occurred over time in the study parameters such as functional ambulation, flexibility, lumbar flexibility, functional disability, pain, strength, range of motion in all groups. In comparisons between groups, there was a difference mainly in favor of Group II (p<0.05. Conclusions: We have concluded that in lumbar region pathologies without neurological deficits, stabilization exercises combined with orthotics and Kinesio taping applications reduces pain and functional disability.

  13. Development and reliability of a measure evaluating dynamic proprioception during walking with a robotized ankle-foot orthosis, and its relation to dynamic postural control.

    Science.gov (United States)

    Fournier Belley, Amélie; Bouffard, Jason; Brochu, Karine; Mercier, Catherine; Roy, Jean-Sébastien; Bouyer, Laurent

    2016-09-01

    Proprioception is important for proper motor control. As the central nervous system modulates how sensory information is processed during movement (sensory gating), proprioceptive tests performed at rest do not correlate well with performance during dynamic tasks such as walking. Proprioception therefore needs to be assessed during movement execution. 1) To develop a test evaluating the ability to detect movement errors during walking, and its test-retest reliability; 2) to quantify the relationship between proprioceptive threshold (obtained with this new test) and performance in a standardized dynamic balance task. Thirty healthy subjects walked on a treadmill while wearing a robotized ankle-foot orthosis (rAFO) for 2 bouts of 6min on 2 evaluation sessions (test-retest reliability). Force perturbations resisting ankle dorsiflexion during swing were applied to the ankle via the rAFO (150ms duration, variable amplitude). Participants pushed a button when they detected the perturbations. The Star Excursion Balance Test (SEBT) was used to evaluate dynamic balance. Angular differences between perturbed and non-perturbed gait cycles were used to quantify movement error. Detection threshold was defined as the minimal movement error at which 50% of the perturbations were perceived. Intraclass correlation coefficients (ICCs) estimated test-retest reliability, and Pearson coefficients were used to determine the correlation between detection threshold and SEBT. Detection threshold was 5.31±2.12°. Good reliability (ICC=0.70) and a moderate to strong correlation to SEBT (r=-0.57 to -0.76) were found. Force perturbations produced by the robotized AFO provides a reliable way of evaluating proprioception during walking. Copyright © 2016 Elsevier B.V. All rights reserved.

  14. An Ankle-Foot Orthosis With a Lateral Extension Reduces Forefoot Abduction in Subjects With Stage II Posterior Tibial Tendon Dysfunction

    Science.gov (United States)

    NEVILLE, CHRISTOPHER; BUCKLIN, MARY; ORDWAY, NATHANIEL; LEMLEY, FREDERICK

    2018-01-01

    STUDY DESIGN Controlled laboratory, repeated measures. BACKGROUND Posterior tibial tendon dysfunction is a common musculoskeletal problem that includes tendon degeneration and collapse of the medial arch of the foot (flatfoot deformity). Ankle-foot orthoses (AFOs) typically are used to correct flatfoot deformity. Correction of flatfoot deformity involves increasing forefoot adduction, forefoot plantar flexion, and hindfoot inversion. OBJECTIVES To test whether a foot orthosis with a lateral extension reduces forefoot abduction in patients with stage II posterior tibial tendon dysfunction while walking. METHODS The gait of 15 participants with stage II posterior tibial tendon dysfunction was evaluated under 3 conditions: a standard AFO, an AFO with a lateral extension, and a shoe-only control condition. Kinematic variables of interest were evaluated at designated time points in the gait cycle and included hindfoot inversion/eversion, forefoot plantar flexion/dorsiflexion, and forefoot abduction/adduction. A 3-by-4, repeated-measures analysis of variance (brace condition by gait phase) was used to compare variables across conditions. RESULTS The AFO with a lateral extension resulted in a significantly greater change in forefoot adduction compared to the standard AFO (2.6°, P = .02) and shoe-only conditions (4.1°, P<.01) across all phases of stance. Forefoot plantar flexion was significantly increased when comparing the standard AFO and AFO with a lateral extension to the shoe-only condition. The AFO with the lateral extension also demonstrated significantly increased hindfoot inversion during the loading response and terminal stance phases. CONCLUSION Off-the-shelf and standard AFOs have been shown to improve forefoot plantar flexion and hindfoot eversion, but not forefoot adduction. A lateral extension added to a standard AFO along the forefoot significantly improved forefoot adduction in participants with posterior tibial tendon dysfunction while walking. PMID

  15. Orthosis-Shaped Sandals Are as Efficacious as In-Shoe Orthoses and Better than Flat Sandals for Plantar Heel Pain: A Randomized Control Trial.

    Directory of Open Access Journals (Sweden)

    Bill Vicenzino

    Full Text Available To investigate efficacy of a contoured sandal being marketed for plantar heel pain with comparison to a flat flip-flop and contoured in-shoe insert/orthosis.150 volunteers aged 50 (SD: 12 years with plantar heel pain (>4 weeks were enrolled after responding to advertisements and eligibility determined by telephone and at first visit. Participants were randomly allocated to receive commercially available contoured sandals (n = 49, flat flip-flops (n = 50 or over the counter, pre-fabricated full-length foot orthotics (n = 51. Primary outcomes were a 15-point Global Rating of Change scale (GROC: 1 = a very great deal worse, 15 = a very great deal better, 13 to 15 representing an improvement and the 20-item Lower Extremity Function Scale (LEFS on which participants rate 20 common weight bearing activities and activities of daily living on a 5-point scale (0 = extreme difficulty, 4 = no difficulty. Secondary outcomes were worst level of heel pain in the preceding week, and the foot and ankle ability measure. Outcomes were collected blind to allocation. Analyses were done on an intention to treat basis with 12 weeks being the primary outcome time of interest.The contoured sandal was 68% more likely to report improvement in terms of GROC compared to flat flip-flop. On the LEFS the contoured sandal was 61% more likely than flat flip-flop to report improvement. The secondary outcomes in the main reflected the primary outcomes, and there were no differences between contoured sandal and shoe insert.Physicians can have confidence in supporting a patient's decision to wear contoured sandals or in-shoe orthoses as one of the first and simple strategies to manage their heel pain.The Australian New Zealand Clinical Trials Registry ACTRN12612000463875.

  16. Comparison of functional electrical stimulation to long leg braces for upright mobility for children with complete thoracic level spinal injuries.

    Science.gov (United States)

    Bonaroti, D; Akers, J M; Smith, B T; Mulcahey, M J; Betz, R R

    1999-09-01

    To prospectively compare functional electrical stimulation (FES) to long leg braces (LLB) as a means of upright mobility for children with motor-complete thoracic level spinal cord injuries (SCIs). Intrasubject group comparison of two interventions. Nonprofit pediatric orthopedic rehabilitation facility specializing in SCI. Convenience sample of five children between 9 and 18 years old with motor-complete thoracic level SCI. The hip and knee extensors were excitable by electrical stimulation. The FES system consisted of percutaneous intramuscular electrodes implanted to the hip and knee extensors and a push-button activated stimulator worn about the waist. Standing was accomplished by simultaneous stimulation of all implanted muscles. For foot and ankle stability, either ankle-foot orthoses (AFO) or supramalleolar orthoses were used. The LLB system consisted of a custom knee-ankle foot orthosis (KAFO) for four subjects and a custom reciprocating gait orthosis (RGO) for one subject who required bracing at the hip. For both interventions, either a front-wheeled walker or Lofstrand crutches were used as assistive devices. Each subject was trained in the use of both FES and LLB in seven standardized upright mobility activities: stand and reach, high transfer, toilet transfer, floor to stand, 6-meter walk, stair ascent, and stair descent. For each mobility activity, five repeated measures of level of independence, using the 7-point Functional Independence Measure (FIM) scale, and time to completion were recorded for each intervention. Subjects were also asked which intervention they preferred. For 94% of comparisons, subjects required equal (70%) or less (24%) assistance using FES as compared with LLB. Six of the seven mobility activities required less time to complete using FES, two activities at significant levels. The FES system was preferred in 62% of the cases, LLB were desired 27% of the time, and there was no preference in 11% of the cases. The FES system

  17. Development of multisensory reweighting is impaired for quiet stance control in children with developmental coordination disorder (DCD.

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    Woei-Nan Bair

    Full Text Available Developmental Coordination Disorder (DCD is a leading movement disorder in children that commonly involves poor postural control. Multisensory integration deficit, especially the inability to adaptively reweight to changing sensory conditions, has been proposed as a possible mechanism but with insufficient characterization. Empirical quantification of reweighting significantly advances our understanding of its developmental onset and improves the characterization of its difference in children with DCD compared to their typically developing (TD peers.Twenty children with DCD (6.6 to 11.8 years were tested with a protocol in which visual scene and touch bar simultaneously oscillateded medio-laterally at different frequencies and various amplitudes. Their data were compared to data on TD children (4.2 to 10.8 years from a previous study. Gains and phases were calculated for medio-lateral responses of the head and center of mass to both sensory stimuli. Gains and phases were simultaneously fitted by linear functions of age for each amplitude condition, segment, modality and group. Fitted gains and phases at two comparison ages (6.6 and 10.8 years were tested for reweighting within each group and for group differences. Children with DCD reweight touch and vision at a later age (10.8 years than their TD peers (4.2 years. Children with DCD demonstrate a weak visual reweighting, no advanced multisensory fusion and phase lags larger than those of TD children in response to both touch and vision.Two developmental perspectives, postural body scheme and dorsal stream development, are provided to explain the weak vision reweighting. The lack of multisensory fusion supports the notion that optimal multisensory integration is a slow developmental process and is vulnerable in children with DCD.

  18. Efeito do uso de órtese de punho na ativação da musculatura flexora e extensora do punho Effect of the use of wrist orthosis on forearm muscle activation

    Directory of Open Access Journals (Sweden)

    Adriana Maria Valladão Novais Van Petten

    2010-01-01

    (James® dynamometer under three conditions: free hand, wearing a composite orthosis, and wearing a thermoplastic orthosis. The tests were carried out using the dominant hand only. During the tests, surface electrodes were placed on the flexor and extensor muscles of the forearm to record the electrical muscle activity. The results obtained in the three conditions were compared, and the results analyzed using the statistical Wilcoxon Test. RESULTS: Significant differences were found in muscle activation when comparing the free hand with the use of any of the orthoses. In the comparison of data for the two different orthoses, no significant differences were found. A decrease in activity of the extensor muscles of the forearm was observed during all the tasks, as well as an increase in activation of the flexor muscles with the use of the orthoses. CONCLUSION: These results are important for the prescription of an orthosis during the rehabilitation process of a wide range of pathologies, such as tendinitis of the flexors and extensors of the first and fingers, as well as for forecasting the time of use of these devices.

  19. Evaluation of performance and personal satisfaction of the patient with spastic hand after using a volar dorsal orthosis Avaliação do desempenho e da satisfação pessoal do paciente com mão espástica após o uso da órtese dorsal volar

    Directory of Open Access Journals (Sweden)

    Danielle dos Santos Cutrim Garros

    2010-06-01

    Full Text Available The performance and the satisfaction of the patient were quantitatively compared with the use of the volar dorsal orthosis in order to position the spastic hand. Thirty patients wearing the orthosis for eight hours daily were evaluated by the Canadian Occupational Performance Measure and the box and blocks test, for a three-month period. Five activities were selected (among daily life activities, productive activities, and leisure activities by the patients, which were impaired by spasticity. There was an improvement related to performance after use of orthosis, with an average of 1.4±0.5 to 6.3±0.8 (pComparou-se quantitativamente o desempenho e a satisfação do paciente com o uso da órtese dorsal volar para posicionamento da mão espástica. Foram analisados 30 pacientes que fizeram uso da órtese por 8 horas diárias, avaliados por meio da Medida Canadense de Desempenho Ocupacional e teste caixa e blocos, no intervalo de 3 meses. Foram selecionadas 5 atividades (entre as atividades de vida diária, produtivas e de lazer pelos pacientes que estavam comprometidas pela espasticidade. Obteve-se melhora em relação ao desempenho após o uso da órtese, com média de 1,4±0,5 para 6,3±0,8 (p<0,01. Quanto à média da satisfação foi de 1,7±0,4 para 6,3±0,6 (p<0,01 com o uso da órtese. Nesta casuística, o uso da órtese de punho e dedos para espasticidade apresentou melhora no desempenho funcional e satisfação do paciente.

  20. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis.

    OpenAIRE

    O'Connor, Joanne; McCaughan, Dorothy; McDaid, Catriona; Booth, Alison; Fayter, Debra; Rodriguez-Lopez, Roccio; Bowers, Roy; Dyson, Lisa; Iglesias, Cynthia P; Lalor, Simon; O'Connor, Rory J; Phillips, Margaret; Ramdharry, Gita

    2016-01-01

    BACKGROUND: \\ud \\ud Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs).\\ud \\ud OBJECTIVES: \\ud \\ud To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs.\\ud \\ud METHODS: \\ud \\ud Qualitative study of views of orthoses users - a qualitative in-...

  1. Undisturbed stance control in healthy adults is achieved differently along anteroposterior and mediolateral axes: evidence from visual feedback of various signals from center of pressure trajectories.

    Science.gov (United States)

    Rougier, Patrice R

    2009-05-01

    Provided through the screen of a monitor, the participant's resultant center of pressure (CPRes) movements from a force platform device, modified the postural performance of a healthy individual. However, these effects could largely vary with the axis that researchers consider (mediolateral [ML] or anteroposterior [AP]), because they know these controls are involved in 2 distinct ankle and hip mechanisms. To demonstrate this organization, the author tested a group of healthy adults in several conditions that gave the whole or some part of the information in the CPRes displacements. Compared with the CPRes feedback, left and right plantar CP or body weight distribution feedback deteriorated the control of the vertically projected center of gravity (CGv) along the ML and AP axes, whose amplitudes increased, respectively. These data highlight the primary role of loading or unloading and pressure variations in the achievement of postural control along each ML or AP axis, respectively. It is interesting that merging these 2 pieces of information (CPRes displacements) helped participants optimize their postural performance.

  2. Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis Mudanças na cinemática articular em crianças com paralisia cerebral durante o andar com e sem órteses de reação ao solo

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Garcia Lucareli

    2007-02-01

    Full Text Available INTRODUCTION: The floor reaction ankle-foot orthosis is commonly prescribed in the attempt to decrease knee flexion during the stance phase in the cerebral palsy (CP gait. Reported information about this type of orthosis is insufficient. PURPOSE: The purpose of this study was to determine the effect of clinically prescribed floor reaction ankle-foot orthosis on kinematic parameters of the hip, knee and ankle in the stance phase of the gait cycle, compared to barefoot walking on children with cerebral palsy. METHODS: A retrospective chart review of 2200 patients revealed that 71 patients (142 limbs had a diagnosis of diplegia, with no contractures in hip, knee or ankle flexion. Their average age was 12.2 ± 3.9. All of them were wearing clinically prescribed hinged floor reaction ankle-foot orthosis undergoing a three dimensional gait analysis. We divided the patients in three groups: Group I, with limited extension (maximum knee extension less than 15º; Group II, with moderate limited extension (maximum knee extension between 15º and 30º and Group III Crouch (maximum knee extension in stance more than 30º. RESULTS: Results indicate the parameters maximum knee extension and ankle dorsiflexion were significant in Group II e III; no change was observed in Group I. The maximum hip extension was not significant in all three groups. Conclusion: when indicated to improve the extension of the knees and ankle in the stance of the CP patients floor reaction ankle-foot orthosis was effective.INTRODUÇÃO: A órtese de reação ao solo é freqüentemente prescrita com o objetivo de reduzir a flexão do joelho durante a fase de apoio na marcha de pacientes com paralisia cerebral. Não há informações suficientes relatadas na literature sobre este tipo de órteses. OBJETIVOS: O objetivo deste estudo foi determinar o efeito que a órtese de reação ao solo tem na cinamática angular das articulações do quadril, joelho e tornozelo durante a fase de

  3. Uso de órtese para abdução do polegar no desempenho funcional de criança portadora de paralisia cerebral: estudo de caso único Use of abduction thumb orthosis in functional performance of a child with cerebral palsy: a single-subject study

    Directory of Open Access Journals (Sweden)

    Adriana M. Valladão N. Rodrigues

    2007-12-01

    Full Text Available OBJETIVOS: documentar o impacto do uso da órtese de abdução do polegar no desempenho funcional de uma criança hemiparética com leve espasticidade. MÉTODOS: foi utilizado um desenho experimental de caso-único do tipo AB. A fase A consistiu na coleta de dados durante um período sem intervenção (condição controle. A fase B incluiu o uso de órtese de abdução do polegar como procedimento terapêutico associado ao atendimento de terapia ocupacional tradicional. A fase A teve a duração de seis semanas e a fase subseqüente de oito semanas. A criança foi avaliada semanalmente quanto à amplitude ativa de movimento de extensão e flexão de punho, abdução e oponência do polegar e quanto à função manual. A análise dos dados foi realizada através dos métodos estatísticos Celeration Line e Banda de Dois Desvios-Padrão, assim como da Análise Visual. RESULTADOS: a criança apresentou melhora significativa na amplitude de movimento do punho e polegar (ADM ativa. Com relação à função manual observou-se redução do tempo para realização das tarefas, porém não significativa, exceto para a tarefa de empilhar blocos. CONCLUSÕES: os resultados sugerem que o uso da órtese de abdução do polegar pode ser útil no tratamento de crianças com paralisia cerebral espástica para a melhoria da ADM ativa da mão, podendo ser utilizada como adjuvante a outras terapêuticas.OBJECTIVE: to investigate the impact of a thumb abduction orthosis on functional skills of a child with hemiparetic cerebral palsy and mild spasticity. METHODS: an AB single-subject design was used in this study. Baseline A consisted of data collected during a period without intervention (control conditions. The intervention phase B included the use of a thumb abduction orthosis in association with traditional occupational therapy. The baseline lasted six weeks and the intervention period eight weeks. Assessments were performed once a week throughout the study and

  4. Avaliação das propriedades mecânicas de atadura gessada de três diferentes fabricantes, utilizada para confecção de órteses Evaluation of the mechanical properties of plaster bandages used for orthosis manufacture, marketed by three different manufacturers

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    Gustavo Cardoso Vieira

    2006-01-01

    Full Text Available Foram realizados testes mecânicos com atadura gessada de três diferentes fabricantes, utilizada para confecção de órteses. Para isso, foram confeccionados corpos de provas (CDPs na forma de placas e de cilindros. Os CDPs foram submetidos a dois tipos de ensaios mecânicos: para o grupo das placas foi realizado ensaio de flexão em três pontos e para o grupo dos cilindros, ensaio de compressão. Os ensaios mecânicos foram realizados na Máquina Universal de Ensaios EMIC®. Três propriedades mecânicas foram avaliadas após os ensaios: carga no limite máximo, carga no limite de proporcionalidade e rigidez. Os resultados mostraram que um fabricante foi superior aos demais para as propriedades avaliadas.Mechanical tests have been performed in plaster bandages used in orthosis supplied by three different manufacturers. For this, bodies of evidence (BOEs were made with plates and cylinders shapes. BOEs were submitted to two kinds of mechanical assays: for the plate group, a flexion assay was performed at three points, and, for the cylinder group, a compression assay was performed. Mechanical assays were performed on the Universal Assay Machine EMIC®. Three mechanical properties were assessed after assays: maximum limit load, proportional limit load and stiffness. Results show that a manufacturer was superior over the others for the properties assessed.

  5. How to improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids--canes and an orthosis TheraTogs--on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomised control trial

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    Maguire Clare

    2012-03-01

    Full Text Available Abstract Background Annually, some 9000 people in Switzerland suffer a first time stroke. Of these 60% are left with moderate to severe walking disability. Evidence shows that rehabilitation techniques which emphasise activity of the hemiplegic side increase ipsilesional cortical plasticity and improve functional outcomes. Canes are commonly used in gait rehabilitation although they significantly reduce hemiplegic muscle activity. We have shown that an orthosis "TheraTogs" (a corset with elasticated strapping significantly increases hemiplegic muscle activity during gait. The aim of the present study is to investigate the long term effects on the recovery of gait, balance and social participation of gait rehabilitation with TheraTogs compared to gait rehabilitation with a cane following first time acute stroke. Methods/Design Multi-centre, single blind, randomised trial with 120 patients after first stroke. When subjects have reached Functional Ambulation Category 3 they will be randomly allocated into TheraTogs or cane group. TheraTogs will be applied to support hip extensor and abductor musculature according to a standardised procedure. Cane walking held at the level of the radial styloid of the sound wrist. Subjects will walk throughout the day with only the assigned walking aid. Standard therapy treatments and usual care will remain unchanged and documented. The intervention will continue for five weeks or until patients have reached Functional Ambulation category 5. Outcome measures will be assessed the day before begin of intervention, the day after completion, 3 months, 6 months and 2 years. Primary outcome: Timed "up and go" test, secondary outcomes: peak surface EMG of gluteus maximus and gluteus medius, activation patterns of hemiplegic leg musculature, temporo-spatial gait parameters, hemiplegic hip kinematics in the frontal and sagittal planes, dynamic balance, daily activity measured by accelerometry, Stroke Impact Scale

  6. 21 CFR 888.3060 - Spinal intervertebral body fixation orthosis.

    Science.gov (United States)

    2010-04-01

    ... the plates. A braided cable is threaded through each eye-type screw. The cable is tightened with a tension device and it is fastened or crimped at each eye-type screw. The device is used to apply force to...

  7. foot orthosis in improving the balance in children with spastic

    African Journals Online (AJOL)

    Khaled A. Olama

    2012-11-02

    Nov 2, 2012 ... exercise program is highly useful in rehabilitation of spastic diplegic cerebral palsy children as they enabled them ... Rehabilitation of the patient with cerebral ..... Stepping before standing: hip muscle function in stepping and standing balance after stroke. J Neurol Neurosurg Psychiatry 2000;68(4):458–64.

  8. 21 CFR 888.3050 - Spinal interlaminal fixation orthosis.

    Science.gov (United States)

    2010-04-01

    ... made of an alloy, such as stainless steel, that consists of various hooks and a posteriorly placed... (a dislocation of the spinal column), and lower back syndrome. (b) Classification. Class II. ...

  9. Comparative Effect of Orthosis Design on Functional Performance

    Science.gov (United States)

    2012-03-21

    stride length, ankle power, and range of motion in small series of patients27-30. These studies have addressed children with cerebral palsy ...unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT UU 18. NUMBER OF PAGES...Motor-vehicle collision 4 Fall from height 2 Iatrogenic 1 Sports injury 1 Injury characteristics Peroneal nerve palsy 5 Tibial fracture (closed) 4 Tibial

  10. Can an Ankle-Foot Orthosis Change Hearts and Minds?

    Science.gov (United States)

    2011-01-01

    ities. The most common fracture of the lower extremity is to the tibia and fibula . As opposed to prior military From 1Orthopaedic Surgery Service...patients, demonstrates that 26% of patients with extremity wounds have fractures , 82% of which are open, divided evenly between the upper and lower extrem...sustained a severe open ankle fracture and underwent irrigation and debridement with splint immobilization in theater on the day of injury. Thereafter he

  11. Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation.

    Science.gov (United States)

    Delafontaine, Arnaud; Gagey, Olivier; Colnaghi, Silvia; Do, Manh-Cuong; Honeine, Jean-Louis

    2017-01-01

    Rigid ankle-foot orthoses (AFO) are commonly used for impeding foot drop during the swing phase of gait. They also reduce pain and improve gait kinematics in patients with weakness or loss of integrity of ankle-foot complex structures due to various pathological conditions. However, this comes at the price of constraining ankle joint mobility, which might affect propulsive force generation and balance control. The present study examined the effects of wearing an AFO on biomechanical variables and electromyographic activity of tibialis anterior (TA) and soleus muscles during gait initiation (GI). Nineteen healthy adults participated in the study. They initiated gait at a self-paced speed with no ankle constraint as well as wearing an AFO on the stance leg, or bilaterally. Constraining the stance leg ankle decreased TA activity ipsilaterally during the anticipatory postural adjustment (APA) of GI, and ipsilateral soleus activity during step execution. In the sagittal plane, the decrease in the stance leg TA activity reduced the backward displacement of the center of pressure (CoP) resulting in a reduction of the forward velocity of the center of mass (CoM) measured at foot contact (FC). In the frontal plane, wearing the AFO reduced the displacement of the CoP in the direction of the swing leg during the APA phase. The mediolateral velocity of the CoM increased during single-stance prompting a larger step width to recover balance. During step execution, the CoM vertical downward velocity is normally reduced in order to lessen the impact of the swing leg with the floor and facilitates the rise of the CoM that occurs during the subsequent double-support phase. The reduction in stance leg soleus activity caused by constraining the ankle weakened the vertical braking of the CoM during step execution. This caused the absolute instantaneous vertical velocity of the CoM at FC to be greater in the constrained conditions with respect to the control condition. From a rehabilitation perspective, passively- or actively-powered assistive AFOs could correct for the reduction in muscle activity and enhance balance control during GI of patients.

  12. Reliability of movement workspace measurements in a passive arm orthosis used in spinal cord injury rehabilitation

    Science.gov (United States)

    2012-01-01

    Background Robotic and non-robotic training devices are increasingly being used in the rehabilitation of upper limb function in subjects with neurological disorders. As well as being used for training such devices can also provide ongoing assessments during the training sessions. Therefore, it is mandatory to understand the reliability and validity of such measurements when used in a clinical setting. The aim of this study was to evaluate the reliability of movement measures as assessed in the Armeo Spring system for the eventual application to the rehabilitation of patients suffering from cervical spinal cord injury (SCI). Methods Reliability (intra- and inter-rater reliability) of the movement workspace (representing multiple ranges of movement) and the influence of varying seating conditions (5 different chair conditions) was assessed in twenty control subjects. In eight patients with cervical SCI the test-retest reliability (tested twice on the same day by the same rater) was assessed as well as a correlation of the movement workspace to retrieve self-care items as scored by the spinal cord independence measure (SCIM 3). Results Analysis of workspace measures in control subjects revealed intra-class correlation coefficients (ICC) ranging from 0.747 to 0.837 for the intra-rater reliability and from 0.661 to 0.855 for the inter-rater reliability. Test-retest analysis in SCI patients showed a similar high reliability with ICC = 0.858. Also the reliability of the movement workspace between different seating conditions was good with ICCs ranging from 0.844 to 0.915. The movement workspace correlated significantly with the SCIM3 self-care items (p measures assessed in the Armeo Spring device revealed fair to good clinical reliability. These findings suggest that measures retrieved from such a training device can be used to monitor changes in upper limb function over time. The correlation between the workspace measures and SCIM3 self-care items indicates that such measures might also be valuable to document the progress of clinical rehabilitation, however further detailed studies are required. PMID:22681720

  13. EMG Pattern Classification to Control a Hand Orthosis for Functional Grasp Assistance after Stroke

    OpenAIRE

    Meeker, Cassie; Park, Sangwoo; Bishop, Lauri; Stein, Joel; Ciocarlie, Matei

    2018-01-01

    Wearable orthoses can function both as assistive devices, which allow the user to live independently, and as rehabilitation devices, which allow the user to regain use of an impaired limb. To be fully wearable, such devices must have intuitive controls, and to improve quality of life, the device should enable the user to perform Activities of Daily Living. In this context, we explore the feasibility of using electromyography (EMG) signals to control a wearable exotendon device to enable pick ...

  14. EMG pattern classification to control a hand orthosis for functional grasp assistance after stroke.

    Science.gov (United States)

    Meeker, Cassie; Park, Sangwoo; Bishop, Lauri; Stein, Joel; Ciocarlie, Matei

    2017-07-01

    Wearable orthoses can function both as assistive devices, which allow the user to live independently, and as rehabilitation devices, which allow the user to regain use of an impaired limb. To be fully wearable, such devices must have intuitive controls, and to improve quality of life, the device should enable the user to perform Activities of Daily Living. In this context, we explore the feasibility of using electromyography (EMG) signals to control a wearable exotendon device to enable pick and place tasks. We use an easy to don, commodity forearm EMG band with 8 sensors to create an EMG pattern classification control for an exotendon device. With this control, we are able to detect a user's intent to open, and can thus enable extension and pick and place tasks. In experiments with stroke survivors, we explore the accuracy of this control in both non-functional and functional tasks. Our results support the feasibility of developing wearable devices with intuitive controls which provide a functional context for rehabilitation.

  15. Rigid Ankle Foot Orthosis Deteriorates Mediolateral Balance Control and Vertical Braking during Gait Initiation

    Directory of Open Access Journals (Sweden)

    Arnaud Delafontaine

    2017-04-01

    Full Text Available Rigid ankle-foot orthoses (AFO are commonly used for impeding foot drop during the swing phase of gait. They also reduce pain and improve gait kinematics in patients with weakness or loss of integrity of ankle-foot complex structures due to various pathological conditions. However, this comes at the price of constraining ankle joint mobility, which might affect propulsive force generation and balance control. The present study examined the effects of wearing an AFO on biomechanical variables and electromyographic activity of tibialis anterior (TA and soleus muscles during gait initiation (GI. Nineteen healthy adults participated in the study. They initiated gait at a self-paced speed with no ankle constraint as well as wearing an AFO on the stance leg, or bilaterally. Constraining the stance leg ankle decreased TA activity ipsilaterally during the anticipatory postural adjustment (APA of GI, and ipsilateral soleus activity during step execution. In the sagittal plane, the decrease in the stance leg TA activity reduced the backward displacement of the center of pressure (CoP resulting in a reduction of the forward velocity of the center of mass (CoM measured at foot contact (FC. In the frontal plane, wearing the AFO reduced the displacement of the CoP in the direction of the swing leg during the APA phase. The mediolateral velocity of the CoM increased during single-stance prompting a larger step width to recover balance. During step execution, the CoM vertical downward velocity is normally reduced in order to lessen the impact of the swing leg with the floor and facilitates the rise of the CoM that occurs during the subsequent double-support phase. The reduction in stance leg soleus activity caused by constraining the ankle weakened the vertical braking of the CoM during step execution. This caused the absolute instantaneous vertical velocity of the CoM at FC to be greater in the constrained conditions with respect to the control condition. From a rehabilitation perspective, passively- or actively-powered assistive AFOs could correct for the reduction in muscle activity and enhance balance control during GI of patients.

  16. Impact of ankle-foot-orthosis on frontal plane behaviors post-stroke.

    Science.gov (United States)

    Cruz, Theresa Hayes; Dhaher, Yasin Y

    2009-10-01

    Abnormal within and across-joint synergistic behaviors have been reported in the lower limb post stroke. It is unknown, however, whether these impairments limit adaptive movement strategies in response to imposed kinematic constraints. In this context, the goal of this pilot study was to examine changes to three-dimensional swing phase kinematics of the paretic hip, knee, and ankle joints and pelvis induced by AFO use in subjects with chronic stroke. Overground gait analysis was performed on 9 ambulating hemiplegic subjects with and without their AFOs. Both the toeoff and peak ankle dorsiflexion angles were significantly decreased in the no AFO condition. Likewise, the peak and toeoff swing phase pelvic obliquity angles significantly increased when the AFO was removed (6.47 degrees (2.0 SD) vs. 8.16 degrees (2.8 SD), paired t-tests, p=0.03 and 0.8 degrees (3.1 SD) vs. 2.9 degrees (1.1 SD), paired t-test, p=0.02, respectively). These behaviors were consistent across subjects (7 of 9 subjects). The hip frontal plane, and hip and knee sagittal plane kinematics were unaffected by removal of the AFO. Finally, the minimum toe clearance was not affected by the removal of the AFO (1.39 cm+/-0.62 SD vs. 1.27 cm+/-0.47 SD, p>0.05). Taken together, these findings suggest that pelvic obliquity is the primary compensatory degree of freedom utilized to achieve toe clearance in response to impaired dorsiflexion in the stroke population. We propose that this degree of freedom is exploited as it is not constrained by synergistic torque coupling of the lower limb.

  17. Dynamic Analysis and Effectiveness Evaluation in Hemiplagic Patient with the Dream Plastic Ankle Foot Orthosis

    OpenAIRE

    Soma, Toshio; Onishi, Hideaki; Makita, Mitsuyo; Kurokawa, Yukio; Sato, Naritoshi; Manabe, Toshiro

    2004-01-01

    Muscular activities and dynamics were analyzed when a healthy adult and a patient with hemiplegia caused by stroke both wore the DP-AFO and took level-ground walk tests. The results demonstrated that the DP-AFO replicates the joint angles, joint moments, and muscular activites that are similar to those observed in normal gait. Further, a possible re-education of muscular function was suggested in the patient with late-phase hemiplegia that resulted from stroke. This is a part of the study sup...

  18. The effect of ankle foot orthosis stiffness on the energy cost of walking : A simulation study

    NARCIS (Netherlands)

    Bregman, D.J.J.; Van der Krogt, M.M.; De Groot, V.; Harlaar, J.; Wisse, M.; Collins, S.H.

    2011-01-01

    Background In stroke and multiple sclerosis patients, gait is frequently hampered by a reduced ability to push-off with the ankle caused by weakness of the plantar-flexor muscles. To enhance ankle push-off and to decrease the high energy cost of walking, spring-like carbon-composite Ankle Foot

  19. The effect of ankle foot orthosis stiffness on the energy cost of walking: A simulation study.

    NARCIS (Netherlands)

    Bregman, D.J.J.; van der Krogt, M.M.; de Groot, V.; Harlaar, J.; Wisse, M.; Collins, S.H.

    2011-01-01

    Background: In stroke and multiple sclerosis patients, gait is frequently hampered by a reduced ability to push-off with the ankle caused by weakness of the plantar-flexor muscles. To enhance ankle push-off and to decrease the high energy cost of walking, spring-like carbon-composite Ankle Foot

  20. Control Motion Approach of a Lower Limb Orthosis to Reduce Energy Consumption

    Directory of Open Access Journals (Sweden)

    Daniel Sanz-Merodio

    2012-12-01

    Full Text Available By analysing the dynamic principles of the human gait, an economic gait-control analysis is performed, and passive elements are included to increase the energy efficiency in the motion control of active orthoses. Traditional orthoses use position patterns from the clinical gait analyses (CGAs of healthy people, which are then de-normalized and adjusted to each user. These orthoses maintain a very rigid gait, and their energy cost is very high, reducing the autonomy of the user. First, to take advantage of the inherent dynamics of the legs, a state machine pattern with different gains in each state is applied to reduce the actuator energy consumption. Next, different passive elements, such as springs and brakes in the joints, are analysed to further reduce energy consumption. After an off-line parameter optimization and a heuristic improvement with genetic algorithms, a reduction in energy consumption of 16.8% is obtained by applying a state machine control pattern, and a reduction of 18.9% is obtained by using passive elements. Finally, by combining both strategies, a more natural gait is obtained, and energy consumption is reduced by 24.6% compared with a pure CGA pattern.

  1. Effect of Shoes on Stiffness and Energy Efficiency of Ankle-Foot Orthosis: Bench Testing Analysis.

    Science.gov (United States)

    Kobayashi, Toshiki; Gao, Fan; LeCursi, Nicholas; Foreman, K Bo; Orendurff, Michael S

    2017-12-01

    Understanding the mechanical properties of ankle-foot orthoses (AFOs) is important to maximize their benefit for those with movement disorders during gait. Though mechanical properties such as stiffness and/or energy efficiency of AFOs have been extensively studied, it remains unknown how and to what extent shoes influence their properties. The aim of this study was to investigate the effect of shoes on stiffness and energy efficiency of an AFO using a custom mechanical testing device. Stiffness and energy efficiency of the AFO were measured in the plantar flexion and dorsiflexion range, respectively, under AFO-alone and AFO-Shoe combination conditions. The results of this study demonstrated that the stiffness of the AFO-Shoe combination was significantly decreased compared to the AFO-alone condition, but no significant differences were found in energy efficiency. From the results, we recommend that shoes used with AFOs should be carefully selected not only based on their effect on alignment of the lower limb, but also their effects on overall mechanical properties of the AFO-Shoe combination. Further study is needed to clarify the effects of differences in shoe designs on AFO-Shoe combination mechanical properties.

  2. The smart Peano fluidic muscle : A low profile flexible orthosis actuator that feels pain

    NARCIS (Netherlands)

    Veale, Allan Joshua; Anderson, Iain Alexander; Xie, Shane Q.; Lynch, Jerome P.

    2015-01-01

    Robotic orthoses have the potential to provide effective rehabilitation while overcoming the availability and cost constraints of therapists. These orthoses must be characterized by the naturally safe, reliable, and controlled motion of a human therapist's muscles. Such characteristics are only

  3. Propulsion System with Pneumatic Artificial Muscles for Powering Ankle-Foot Orthosis

    Science.gov (United States)

    Veneva, Ivanka; Vanderborght, Bram; Lefeber, Dirk; Cherelle, Pierre

    2013-12-01

    The aim of this paper is to present the design of device for control of new propulsion system with pneumatic artificial muscles. The propulsion system can be used for ankle joint articulation, for assisting and rehabilitation in cases of injured ankle-foot complex, stroke patients or elderly with functional weakness. Proposed device for control is composed by microcontroller, generator for muscles contractions and sensor system. The microcontroller receives the control signals from sensors and modulates ankle joint flex- ion and extension during human motion. The local joint control with a PID (Proportional-Integral Derivative) position feedback directly calculates desired pressure levels and dictates the necessary contractions. The main goal is to achieve an adaptation of the system and provide the necessary joint torque using position control with feedback.

  4. How Does Ankle-foot Orthosis Stiffness Affect Gait in Patients With Lower Limb Salvage?

    Science.gov (United States)

    2014-05-10

    1.78 97.3 7.5 R LE tissue loss/trauma 4 40 1.81 81.0 9.3 L ankle fracture and osteoarthritis 5 30 1.75 79.1 9.8 L tibia/ fibula fracture 6 30 1.76 78.2...11.0 L LE neuropathy, crushed tibia/ fibula 7 36 1.78 75.5 4.4 L LE talar fracture , multiple fractures 8 22 1.64 80.3 9.0 R LE tissue loss/trauma 9 27...1.82 92.0 6.4 R equinovarus, LE tissue loss/trauma, neuropathy 10 23 1.74 84.1 5.0 L LE tibia/ fibula fracture 11 36 1.95 80.9 20.8 L LE fractures

  5. The Effect of Change in Range of Motion of Metal KAFO Ankle Joint on Balance in Patients with Postpolio Syndrome (PPS

    Directory of Open Access Journals (Sweden)

    Seyyedeh Maryam Moslehi

    2015-01-01

    Full Text Available Objective: Knee- ankle foot orthoses are the most commonly orthoses in the post-polio syndrome.Metal KAFOs are the most commonly prescribed orthoses in Iran. However, problems have been reported when using them, during walking. The purpose of the current study was to evaluate the effect of changes in range of motion of metal KAFO ankle joint on balance in patients with Post-polio syndrome. Materials & Methods: 22 post-polio syndrome patients (37-50 yr from Red Crescent Rehabilitation Center participated in this study. Data collection were performed using by the balance master system with the participants wearing the conventional KAFO and KAFO with increased range of motion of the ankle joint. Data collection was performed with a two weeks follow-up period. Result: In KAFO with increased range of motion of ankle joint, the maximal backward excursion of COG (P<0.002, movement velocity toward the backward (P<0.018 increased when compared to conventional KAFO. The time of weight transfer was reduced while wearing KAFO with increased range of motion of ankle joint in comparison with –conventional KAFO (P<0.002. No significant differences were observed at the other parameters such as limit of stability and sit to stand. Conclusion: the results of this study showed that change in ankle joint range of motion of metal KAFO can let in improvement in some indicators related to postural stability in individual with post-polio syndrome.

  6. Energy cost of ambulation in healthy and disabled Filipino children.

    Science.gov (United States)

    Luna-Reyes, O B; Reyes, T M; So, F Y; Matti, B M; Lardizabal, A A

    1988-11-01

    The energy expenditures (Ee) for locomotion by nondisabled and disabled Filipino children aged 7 to 13 were determined and compared using indirect calorimetry. Forty-one controls (20 boys and 21 girls) ambulated at a comfortable pace; 16 children (eight boys and eight girls) with lower extremity poliomyelitis of varying severity ambulated by (1) wheelchair propulsion, (2) bilateral axillary crutches, (3) unilateral lower extremity ankle-foot orthoses or knee-ankle-foot orthoses, and (4) unassisted. Disabled children, regardless of their mode of ambulation, had to expend significantly more energy to ambulate than normal children (p less than 0.05). Wheelchair propulsion cost 16% more energy than the normal gait; crutch ambulation cost 41% more than the control. Children using unilateral braces sacrificed speed to attain near-normal Ee. When they ambulated without orthoses, their Ee increased by 109% over the control. In ascending order, the least energy was expanded by normal ambulation followed by disabled ambulation with unilateral brace, disabled propelling a wheelchair, disabled ambulation with bilateral axillary crutches, and disabled ambulation without brace. Efficiency of locomotion was reflected in the values obtained for Ee in terms of kcal x 10(-3)/kg/m, as demonstrated by the lower Ee but slower ambulation of children with braces, as compared to the nondisabled children.

  7. Gait-Event-Based Synchronization Method for Gait Rehabilitation Robots via a Bioinspired Adaptive Oscillator.

    Science.gov (United States)

    Chen, Gong; Qi, Peng; Guo, Zhao; Yu, Haoyong

    2017-06-01

    In the field of gait rehabilitation robotics, achieving human-robot synchronization is very important. In this paper, a novel human-robot synchronization method using gait event information is proposed. This method includes two steps. First, seven gait events in one gait cycle are detected in real time with a hidden Markov model; second, an adaptive oscillator is utilized to estimate the stride percentage of human gait using any one of the gait events. Synchronous reference trajectories for the robot are then generated with the estimated stride percentage. This method is based on a bioinspired adaptive oscillator, which is a mathematical tool, first proposed to explain the phenomenon of synchronous flashing among fireflies. The proposed synchronization method is implemented in a portable knee-ankle-foot robot and tested in 15 healthy subjects. This method has the advantages of simple structure, flexible selection of gait events, and fast adaptation. Gait event is the only information needed, and hence the performance of synchronization holds when an abnormal gait pattern is involved. The results of the experiments reveal that our approach is efficient in achieving human-robot synchronization and feasible for rehabilitation robotics application.

  8. Design and experimental evaluation of a lightweight, high-torque and compliant actuator for an active ankle foot orthosis.

    Science.gov (United States)

    Moltedo, Marta; Bacek, Tomislav; Langlois, Kevin; Junius, Karen; Vanderborght, Bram; Lefeber, Dirk

    2017-07-01

    The human ankle joint plays a crucial role during walking. At the push-off phase the ankle plantarflexors generate the highest torque among the lower limb joints during this activity. The potential of the ankle plantarflexors is affected by numerous pathologies and injuries, which cause a decrease in the ability of the subject to achieve a natural gait pattern. Active orthoses have shown to have potential in assisting these subjects. The design of such robots is very challenging due to the contrasting design requirements of wearability (light weight and compact) and high torques capacity. This paper presents the development of a high-torque ankle actuator to assist the ankle joint in both dorsiflexion and plantarflexion. The compliant actuator is a spindle-driven MACCEPA (Mechanically Adjustable Compliance and Controllable Equilibrium Position Actuator). The design of the actuator was made to keep its weight as low as possible, while being able to provide high torques. As a result of this novel design, the actuator weighs 1.18kg. Some static characterization tests were perfomed on the actuator and their results are shown in the paper.

  9. The effect of an ankle-foot orthosis in walking ability and coordination by hd patients: A pilot study

    NARCIS (Netherlands)

    Burer, B.; Houdijk, H.; Lamoth, C.; De Boer, K.; Van Den Bogaard, S.

    2009-01-01

    Background: During the swing phase of the gait of HD patients, some patients show an irregular, uncoordinated movement of the foot, or the foot can not be held in dorsal flexion. These symptoms affect the manner of walking and therefore an individual's ability to participate in daily living. In

  10. Evaluating the Effects of Ankle-Foot Orthosis Mechanical Property Assumptions on Gait Simulation Muscle Force Results.

    Science.gov (United States)

    Hegarty, Amy K; Petrella, Anthony J; Kurz, Max J; Silverman, Anne K

    2017-03-01

    Musculoskeletal modeling and simulation techniques have been used to gain insights into movement disabilities for many populations, such as ambulatory children with cerebral palsy (CP). The individuals who can benefit from these techniques are often limited to those who can walk without assistive devices, due to challenges in accurately modeling these devices. Specifically, many children with CP require the use of ankle-foot orthoses (AFOs) to improve their walking ability, and modeling these devices is important to understand their role in walking mechanics. The purpose of this study was to quantify the effects of AFO mechanical property assumptions, including rotational stiffness, damping, and equilibrium angle of the ankle and subtalar joints, on the estimation of lower-limb muscle forces during stance for children with CP. We analyzed two walking gait cycles for two children with CP while they were wearing their own prescribed AFOs. We generated 1000-trial Monte Carlo simulations for each of the walking gait cycles, resulting in a total of 4000 walking simulations. We found that AFO mechanical property assumptions influenced the force estimates for all the muscles in the model, with the ankle muscles having the largest resulting variability. Muscle forces were most sensitive to assumptions of AFO ankle and subtalar stiffness, which should therefore be measured when possible. Muscle force estimates were less sensitive to estimates of damping and equilibrium angle. When stiffness measurements are not available, limitations on the accuracy of muscle force estimates for all the muscles in the model, especially the ankle muscles, should be acknowledged.

  11. Stair locomotion in children with spastic hemiplegia: the impact of three different ankle foot orthosis (AFOs) configurations.

    Science.gov (United States)

    Sienko Thomas, Susan; Buckon, Cathleen E; Jakobson-Huston, Sabrina; Sussman, Michael D; Aiona, Michael D

    2002-10-01

    The purpose of this study was to investigate the impact of three different ankle foot orthoses (AFO) configurations on the function and kinematics of stair locomotion in children with spastic hemiplegia. Nineteen children were evaluated barefoot and with a hinged, posterior leaf spring (PLS) and solid AFO during stair ascent and descent. Stair specific items from the Pediatric Evaluation of Disability Inventory (PEDI) were used to evaluate function, while a motion measurement system was used to evaluate kinematics. The PEDI revealed no significant differences between AFOs and barefoot, although a greater percentage of children were able to keep up with their peers while wearing a hinged AFO. At the ankle, the hinged AFO provided the greatest amount of dorsiflexion during stance. All AFOs reduced plantarflexion in comparison to barefoot. The results of this study indicate that for children with spastic hemiplegia the use of an AFO did not impair stair ambulation.

  12. Conservative treatment for equinus deformity in children with cerebral palsy using an adjustable splint-assisted ankle-foot orthosis.

    Science.gov (United States)

    Chen, Wei; Liu, Xiaoyu; Pu, Fang; Yang, Yang; Wang, Lizhen; Liu, Hong; Fan, Yubo

    2017-10-01

    A novel splint, the assisting ankle-foot orthoses (AFO), was developed to provide adjustable sustained stretching to improve conservative treatment for equinus deformities in children with cerebral palsy (CP). The treatment effect was validated by follow-up visits. This study involved subjects between 2 and 12 years old, including 28 CP children treated with splint-assisted AFO correction, 30 CP children treated with static AFO correction, and 30 normal children with typical development (TD). Quantitative pedobarographic measurements were taken to evaluate the effect of splint-assisted AFO correction. The heel/forefoot ratio was introduced to indicate the degree of the equinus deformity during treatment. The results showed that the heel/forefoot ratios were 1.41 ± 0.26 for the TD children; 0.65 ± 0.41, 1.02 ± 0.44, and 1.24 ± 0.51 for the splint-assisted AFO correction before and after 6-month and 12-month treatments; 0.59 ± 0.37, 0.67 ± 0.44, and 0.66 ± 0.42 for the static AFO correction before and after 6-month and 12-month treatments. This study suggests that correction with the adjustable splint-assisted AFO is an effective treatment for equinus deformity in CP Children.

  13. Concept and Design of a 3D Printed Support to Assist Hand Scanning for the Realization of Customized Orthosis

    Directory of Open Access Journals (Sweden)

    Gabriele Baronio

    2017-01-01

    Full Text Available In the rehabilitation field, the use of additive manufacturing techniques to realize customized orthoses is increasingly widespread. Obtaining a 3D model for the 3D printing phase can be done following different methodologies. We consider the creation of personalized upper limb orthoses, also including fingers, starting from the acquisition of the hand geometry through accurate 3D scanning. However, hand scanning procedure presents differences between healthy subjects and patients affected by pathologies that compromise upper limb functionality. In this work, we present the concept and design of a 3D printed support to assist hand scanning of such patients. The device, realized with FDM additive manufacturing techniques in ABS material, allows palmar acquisitions, and its design and test are motivated by the following needs: (1 immobilizing the hand of patients during the palmar scanning to reduce involuntary movements affecting the scanning quality and (2 keeping hands open and in a correct position, especially to contrast the high degree of hypertonicity of spastic subjects. The resulting device can be used indifferently for the right and the left hand; it is provided in four-dimensional sizes and may be also suitable as a palmar support for the acquisition of the dorsal side of the hand.

  14. Design and Characterization of a Novel High-Power Series Elastic Actuator for a Lower Limb Robotic Orthosis

    Directory of Open Access Journals (Sweden)

    Dino Accoto

    2013-10-01

    Full Text Available A safe interaction is crucial in wearable robotics in general, while in assistive and rehabilitation applications, robots may also be required to minimally perturb physiological movements, ideally acting as perfectly transparent machines. The actuation system plays a central role because the expected performance, in terms of torque, speed and control bandwidth, must not be achieved at the expense of lightness and compactness. Actuators embedding compliant elements, such as series elastic actuators, can be designed to meet the above-mentioned requirements in terms of high energy storing capacity and stability of torque control. A number of series elastic actuators have been proposed over the past 20 years in order to accommodate the needs arising from specific applications. This paper presents a novel series elastic actuator intended for the actuation system of a lower limb wearable robot, recently developed in our lab. The actuator is able to deliver 300 W and has a novel architecture making its centre of mass not co-located with its axis of rotation, for an easier integration into the robotic structure. A custom-made torsion spring with a stiffness of 272.25 N·m·rad–1 is directly connected to the load. The delivered torque is calculated from the measurement of the spring deflection, through two absolute encoders. Testing on torque measurement accuracy and torque/stiffness control are reported.

  15. Splint: the efficacy of orthotic management in rest to prevent equinus in children with cerebral palsy, a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Maas Josina C

    2012-03-01

    Full Text Available Abstract Background Range of motion deficits of the lower extremity occur in about the half of the children with spastic cerebral palsy (CP. Over time, these impairments can cause joint deformities and deviations in the children's gait pattern, leading to limitations in moblity. Preventing a loss of range of motion is important in order to reduce secondary activity limitations and joint deformities. Sustained muscle stretch, imposed by orthotic management in rest, might be an effective method of preventing a decrease in range of motion. However, no controlled study has been performed. Methods A single blind randomised controlled trial will be performed in 66 children with spastic CP, divided over three groups with each 22 participants. Two groups will be treated for 1 year with orthoses to prevent a decrease in range of motion in the ankle (either with static or dynamic knee-ankle-foot-orthoses and a third group will be included as a control group and will receive usual care (physical therapy, manual stretching. Measurements will be performed at baseline and at 3, 6, 9 and 12 months after treatment allocation. The primary outcome measure will be ankle dorsiflexion at full knee extension, measured with a custom designed hand held dynamometer. Secondary outcome measures will be i ankle and knee flexion during gait and ii gross motor function. Furthermore, to gain more insight in the working mechanism of the orthotic management in rest, morphological parameters like achilles tendon length, muscle belly length, muscle fascicle length, muscle physiological cross sectional area length and fascicle pennation angle will be measured in a subgroup of 18 participants using a 3D imaging technique. Discussion This randomised controlled trial will provide more insight into the efficacy of orthotic management in rest and the working mechanisms behind this treatment. The results of this study could lead to improved treatments. Trial Registration Number

  16. Sports medicine clinical trial research publications in academic medical journals between 1996 and 2005: an audit of the PubMed MEDLINE database.

    Science.gov (United States)

    Nichols, A W

    2008-11-01

    To identify sports medicine-related clinical trial research articles in the PubMed MEDLINE database published between 1996 and 2005 and conduct a review and analysis of topics of research, experimental designs, journals of publication and the internationality of authorships. Sports medicine research is international in scope with improving study methodology and an evolution of topics. Structured review of articles identified in a search of a large electronic medical database. PubMed MEDLINE database. Sports medicine-related clinical research trials published between 1996 and 2005. Review and analysis of articles that meet inclusion criteria. Articles were examined for study topics, research methods, experimental subject characteristics, journal of publication, lead authors and journal countries of origin and language of publication. The search retrieved 414 articles, of which 379 (345 English language and 34 non-English language) met the inclusion criteria. The number of publications increased steadily during the study period. Randomised clinical trials were the most common study type and the "diagnosis, management and treatment of sports-related injuries and conditions" was the most popular study topic. The knee, ankle/foot and shoulder were the most frequent anatomical sites of study. Soccer players and runners were the favourite study subjects. The American Journal of Sports Medicine had the highest number of publications and shared the greatest international diversity of authorships with the British Journal of Sports Medicine. The USA, Australia, Germany and the UK produced a good number of the lead authorships. In all, 91% of articles and 88% of journals were published in English. Sports medicine-related research is internationally diverse, clinical trial publications are increasing and the sophistication of research design may be improving.

  17. Six degree-of-freedom analysis of hip, knee, ankle and foot provides updated understanding of biomechanical work during human walking.

    Science.gov (United States)

    Zelik, Karl E; Takahashi, Kota Z; Sawicki, Gregory S

    2015-03-01

    Measuring biomechanical work performed by humans and other animals is critical for understanding muscle-tendon function, joint-specific contributions and energy-saving mechanisms during locomotion. Inverse dynamics is often employed to estimate joint-level contributions, and deformable body estimates can be used to study work performed by the foot. We recently discovered that these commonly used experimental estimates fail to explain whole-body energy changes observed during human walking. By re-analyzing previously published data, we found that about 25% (8 J) of total positive energy changes of/about the body's center-of-mass and >30% of the energy changes during the Push-off phase of walking were not explained by conventional joint- and segment-level work estimates, exposing a gap in our fundamental understanding of work production during gait. Here, we present a novel Energy-Accounting analysis that integrates various empirical measures of work and energy to elucidate the source of unexplained biomechanical work. We discovered that by extending conventional 3 degree-of-freedom (DOF) inverse dynamics (estimating rotational work about joints) to 6DOF (rotational and translational) analysis of the hip, knee, ankle and foot, we could fully explain the missing positive work. This revealed that Push-off work performed about the hip may be >50% greater than conventionally estimated (9.3 versus 6.0 J, P=0.0002, at 1.4 m s(-1)). Our findings demonstrate that 6DOF analysis (of hip-knee-ankle-foot) better captures energy changes of the body than more conventional 3DOF estimates. These findings refine our fundamental understanding of how work is distributed within the body, which has implications for assistive technology, biomechanical simulations and potentially clinical treatment. © 2015. Published by The Company of Biologists Ltd.

  18. Walking, orthoses and physical effort in a Swedish population with arthrogryposis.

    Science.gov (United States)

    Eriksson, Marie; Villard, Li; Bartonek, Asa

    2014-08-01

    Excessive movements during walking have been observed by gait analysis in children with arthrogryposis (AMC) using orthoses compared to children using only shoes. The aim of this study was to evaluate energy expenditure and functional exercise capacity in children with AMC. Twenty-four children with AMC and 25 typically developing (TD) children underwent oxygen measurement and the 6-minute walk test (6MWT). Children were divided into AMC1 using knee-ankle-foot orthoses with locked knee joints (KAFO-LK); AMC2 KAFOs with open knee joints (KAFO-O) or ankle-foot orthoses (AFO); and AMC3 using shoes. The net non-dimensional oxygen cost (NNcost) was lower in TD (0.308) than in AMC2 (0.455, n = 10) (p = 0.002). There were no differences in the net non-dimensional consumption (NNconsumption) or normalised walking velocity. The lowest NNconsumption (0.082), NNcost (0.385) and normalised walking velocity (0.214) were found in AMC1 (n = 3), but no statistical calculation was performed. In the 6MWT, both AMC2 (402.7, n = 11) and AMC3 (476.8, n = 10) walked shorter distances (m) than TD (565.1) (p Children with AMC using open KAFOs or AFOs (AMC2) had higher energy effort represented by significantly higher NNcost than TD, whereas AMC children requiring only shoes (AMC3) did not differ significantly from TD. To maintain the NNconsumption at an acceptable level, children using locked KAFOs (AMC1) slowed down their walking velocity. Compared to TD, the exercise capacity was lower in children with AMC using open KAFOs or AFOs and shoes, represented by lower walking velocity and shorter distance walked during the 6MWT.

  19. Single-stage multilevel soft-tissue surgery in the lower limbs with spastic cerebral palsy: Experience from a rehabilitation unit

    Directory of Open Access Journals (Sweden)

    Gupta Anupam

    2008-01-01

    Full Text Available Background: To assess the effect of single-stage multilevel soft-tissue surgery (Single Event Multiple Level Resections, SEMLR on deformities and locomotion in patients with cerebral palsy (CP with static contracture(s in lower limbs. Patients and Methods: Study included 34 patients (M:F, 23:11 with mean age of 9.53 ± 3.92 years (4-16 years. Among them 22 had diplegia and four each had quadriplegia and right and left hemiplegia. Fourteen patients (41.2% had their intelligence quotient (IQ in the normal range (IQ ≥ 80, while others had mental retardation (MR of varying severity: borderline MR (IQ = 70-79 in 12, mild MR (IQ = 50-69 in 5, and moderate MR (IQ = 35-49 in patients 3. All patients underwent surgery (total number of procedures 153, average 4.5 procedures/patient over a period of 30 months (April 2005 to September 2007. Improvement in functional abilities and locomotion was assessed using Gross Motor Functional Classification Scale (GMFCS scores and by physical examination. Results: Significant improvement in function was observed ( P = 0.000 after surgery when comparing the preoperative and postoperative GMFCS scores. All patients were maintaining ambulation at a mean follow-up duration of 13.12 ± 6.07 months (3-24 months, with five patients using knee-ankle-foot orthoses (KAFO, 22 using ankle-foot orthoses (AFO, and six patients using knee gaiters. Sixteen patients were using walker, and two were using crutches as assistive devices. Conclusion: This study suggests that CP patients with good trunk control and static contractures at multiple joints in the lower limbs can be made ambulant with single-stage multilevel soft-tissue surgery. It has to be a team effort of the surgeon and the rehabilitation team in the postoperative period for the attainment of satisfactory goal.

  20. Ilfeld abduction orthosis is an effective second-line treatment after failure of Pavlik harness for infants with developmental dysplasia of the hip.

    Science.gov (United States)

    Sankar, Wudbhav N; Nduaguba, Afamefuna; Flynn, John M

    2015-02-18

    Closed reduction and spica casting is the most commonly recommended choice for infants with developmental dysplasia of the hip (DDH) for whom Pavlik harness treatment has failed, but it requires general anesthesia in addition to the challenges of spica cast care. The purposes of this study were to evaluate the effectiveness of Ilfeld bracing for infants for whom Pavlik harness treatment is unsuccessful and to compare these results with those for a similar cohort of patients directly undergoing closed reduction and spica casting. We reviewed the cases of a consecutive series of children with DDH who had failure of Pavlik harness treatment and were subsequently managed with Ilfeld bracing (the BR cohort) and compared this cohort with a similar historical group of infants who had failure of Pavlik harness treatment but had standard closed reduction and spica casting (the CR cohort). The cohorts were compared with respect to clinical and ultrasonographic data at the time of Pavlik discontinuation. At one year, the hip stability and acetabular index were assessed; the presence of osteonecrosis was graded according to the criteria described by Salter et al. Twenty-eight hips (nineteen infants) made up the BR cohort and twenty-two hips (sixteen infants) made up the CR cohort. Ultrasonographic indices (including the alpha angle and the percentage of femoral head coverage) were comparable between the two cohorts (p=0.66 and 0.19, respectively). Following treatment, a stable reduction was achieved in twenty-three (82%) of twenty-eight hips in the BR cohort compared with twenty (91%) of twenty-two hips in the CR cohort. At one year, acetabular indices were similar between both cohorts (mean and standard deviation, 27°±6° for the BR cohort versus 27°±5° for the CR cohort; p=0.62); however, osteonecrosis developed in three hips in the CR cohort compared with none in the BR cohort. In our series of infants with DDH for whom Pavlik harness treatment had failed, Ilfeld bracing had success rates comparable with those for closed reduction and spica cast treatment. With the added advantages of avoiding general anesthesia and spica casting as well as a potentially lower rate of osteonecrosis, rigid abduction bracing should be considered as the next step for infants who have had failed Pavlik harness treatment prior to proceeding with closed reduction and spica casting. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  1. Effect of peroneal electrical stimulation versus an ankle-foot orthosis on obstacle avoidance ability in people with stroke-related foot drop.

    NARCIS (Netherlands)

    Swigchem, R. van; Duijnhoven, H.J.R. van; Boer, J. den; Geurts, A.C.H.; Weerdesteijn, V.G.M.

    2012-01-01

    BACKGROUND: Walking ability of people with foot drop in the chronic phase after stroke is better with functional electrical stimulation (FES) of the peroneal nerve than without an orthotic device. However, the literature is not conclusive on whether peroneal FES also is better than an ankle-foot

  2. Effect of Rocker Bar Ankle Foot Orthosis on Functional Mobility in Post-Stroke Hemiplegic Patients: Timed Up and Go and Gait Speed Assessments

    Directory of Open Access Journals (Sweden)

    Farzad Farmani

    2016-03-01

    Discussion: RAFO led to a significant improvement in functional mobility in hemiplegic patients post stroke. This may be due to the positive effect of rocker modification on improving push off and transferring weight during the stance phase of gait.

  3. Towards the control of an active hand orthosis for people with Duchenne muscular dystrophy : Design and Validation of a wireless sEMG sleeve

    NARCIS (Netherlands)

    Nizamis, Kostas; Ganseij, Maarten; Koopman, H.F.J.M.

    2017-01-01

    Duchenne Muscular Dystrophy (DMD) is a progressive muscular disease. Active hand orthoses can greatly improve the quality of life of people with DMD. Surface Electromyography (sEMG) is commonly used for the control of active devices. The interfacing between the human and the sensor is regularly done

  4. TOWARDS THE CONTROL OF AN ACTIVE HAND ORTHOSIS FOR PEOPLE WITH DUCHENNE MUSCULAR DYSTROPHY: DESIGN AND VALIDATION OF A WIRELESS SEMG SLEEVE

    NARCIS (Netherlands)

    Nizamis, Kostas; Ganseij, Maarten; Koopman, Hubertus F.J.M.

    2017-01-01

    Duchenne Muscular Dystrophy (DMD) is a progressive muscular disease. Active hand orthoses can greatly improve the quality of life of people with DMD. Surface Electromyography (sEMG) is commonly used for the control of active devices. The interfacing between the human and the sensor is regularly done

  5. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion

    NARCIS (Netherlands)

    Kerkum, Y.L.; Buizer, A.I.; van den Noort, J.C.; Becher, J.G.; Harlaar, J.; Brehm, M.A.

    2015-01-01

    Introduction: Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off

  6. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

    Science.gov (United States)

    Kerkum, Yvette L; Buizer, Annemieke I; van den Noort, Josien C; Becher, Jules G; Harlaar, Jaap; Brehm, Merel-Anne

    2015-01-01

    Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years) were prescribed with a ventral shell spring-hinged AFO (vAFO). The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only) and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (pchildren with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power. Dutch Trial Register NTR3418.

  7. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion.

    Directory of Open Access Journals (Sweden)

    Yvette L Kerkum

    Full Text Available Rigid Ankle-Foot Orthoses (AFOs are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP. While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A spring-like AFO may enhance push-off power, which may come at the cost of reducing the knee flexion less effectively. Optimizing this trade-off between enhancing push-off power and normalizing knee flexion in stance is expected to maximize gait efficiency. This study investigated the effects of varying AFO stiffness on gait biomechanics and efficiency in children with CP who walk with excessive knee flexion in stance. Fifteen children with spastic CP (11 boys, 10±2 years were prescribed with a ventral shell spring-hinged AFO (vAFO. The hinge was set into a rigid, or spring-like setting, using both a stiff and flexible performance. At baseline (i.e. shoes-only and for each vAFO, a 3D-gait analysis and 6-minute walk test with breath-gas analysis were performed at comfortable speed. Lower limb joint kinematics and kinetics were calculated. From the 6-minute walk test, walking speed and the net energy cost were determined. A generalized estimation equation (p<0.05 was used to analyze the effects of different conditions. Compared to shoes-only, all vAFOs improved the knee angle and net moment similarly. Ankle power generation and work were preserved only by the spring-like vAFOs. All vAFOs decreased the net energy cost compared to shoes-only, but no differences were found between vAFOs, showing that the effects of spring-like vAFOs to promote push-off power did not lead to greater reductions in walking energy cost. These findings suggest that, in this specific group of children with spastic CP, the vAFO stiffness that maximizes gait efficiency is primarily determined by its effect on knee kinematics and kinetics rather than by its effect on push-off power.Dutch Trial Register NTR3418.

  8. The effect of ankle joint mobility when using an isocentric reciprocating gait orthosis (IRGO) on energy consumption in people with spinal cord injury: preliminary results.

    Science.gov (United States)

    Arazpour, M; Hojjati, M J; Samadian, M; Bahramizadeh, M; Bani, M Ahmadi; Hutchins, S W

    2015-01-01

    The aim of this study was to evaluate the effect of walking with isocentric reciprocating gait orthoses (IRGOs) utilizing two designs of ankle foot orthoses (AFOs) on specific outcome measures in people with spinal cord injury (SCI). Four volunteer SCI subjects participated in this study, and were fitted with an IRGO equipped with either solid or dorsiflexion-assisted AFOs in a randomized order. Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance and the resulting physiological cost index (PCI) to be performed. Increased walking speed, increased distance walked and less PCI were demonstrated in walking with the IRGO incorporating dorsiflexion-assisted AFOs as compared to walking with an IRGO plus solid AFO as a control condition. This study demonstrated that people with SCI could walk at relatively higher speeds and with greater endurance and a reduced PCI when utilizing an IRGO with dorsiflexion-assisted AFO components compared to solid ones. It is therefore concluded that the IRGO incorporating dorsiflexion-assisted AFOs may be an effective alternative in helping to reduce the energy consumption experienced by people with SCI.

  9. A computational simulated control system for a high-force pneumatic muscle actuator: system definition and application as an augmented orthosis.

    Science.gov (United States)

    Gerschutz, Maria J; Phillips, Chandler A; Reynolds, David B; Repperger, Daniel W

    2009-04-01

    High-force pneumatic muscle actuators (PMAs) are used for force assistance with minimal displacement applications. However, poor control due to dynamic nonlinearities has limited PMA applications. A simulated control system is developed consisting of: (1) a controller relating an input position angle to an output proportional pressure regulator voltage, (2) a phenomenological model of the PMA with an internal dynamic force loop (system time constant information), (3) a physical model of a human sit-to-stand task and (4) an external position angle feed-back loop. The results indicate that PMA assistance regarding the human sit-to-stand task is feasible within a specified PMA operational pressure range.

  10. The Effects of Varying Ankle Foot Orthosis Stiffness on Gait in Children with Spastic Cerebral Palsy Who Walk with Excessive Knee Flexion

    NARCIS (Netherlands)

    Kerkum, Yvette L.; Buizer, Annemieke I.; van den Noort, Josien C.; Becher, Jules G.; Harlaar, Jaap; Brehm, Merel-Anne

    2015-01-01

    Rigid Ankle-Foot Orthoses (AFOs) are commonly prescribed to counteract excessive knee flexion during the stance phase of gait in children with cerebral palsy (CP). While rigid AFOs may normalize knee kinematics and kinetics effectively, it has the disadvantage of impeding push-off power. A

  11. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus

    OpenAIRE

    Kim, Moon-Hwan; Yi, Chung-Hwi; Weon, Jong-Hyuck; Cynn, Heon-Seock; Jung, Do-Young; Kwon, Oh-Yun

    2015-01-01

    [Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exerci...

  12. Ultrasound-Guided Fasciotomy for Chronic Exertional Compartment Syndrome: A Cadaveric Investigation.

    Science.gov (United States)

    Lueders, Daniel R; Sellon, Jacob L; Smith, Jay; Finnoff, Jonathan T

    2017-07-01

    Chronic exertional compartment syndrome (CECS) is a common cause of exertional leg pain. It is commonly treated with a surgical fasciotomy, which has a surgical complication rate of up to 16% and takes approximately 6-12 weeks to return to preprocedure activity levels. Therefore, the development of a less invasive, effective outpatient intervention to treat CECS is desirable. To describe and validate an ultrasound-guided (USG) fasciotomy technique for the anterior and lateral compartments of the lower limb in an unembalmed cadaveric model. Prospective, cadaveric laboratory investigation. Academic institution procedural skills laboratory. Ten unembalmed cadaveric knee-ankle-foot specimens from 1 female (2 specimens) and 7 male donors aged 62-91 years (mean 78.6 years) with body mass indices of 18.9-35.3 kg/m 2 (mean 27.1 kg/m 2 ). Two experienced operators each performed USG anterior and lateral compartment fasciotomies on 5 unembalmed cadaveric legs. A third physician subsequently dissected the legs to assess the continuity of the fasciotomies and to identify any neurovascular damage related to the procedures. Fasciotomy length (in centimeters) and classification by completeness (achieved target length or did not achieve target length) and continuity (continuous or discontinuous) based on predetermined criteria. Muscles, retinaculae, and neurovascular structures were assessed for damage. No neurovascular injuries occurred in any of the 20 USG fasciotomies. The average fasciotomy length was 22.5 cm. All 20 of the fasciotomies achieved the target length. A continuous cephalocaudal fasciotomy was accomplished in 13 of 20 fasciotomies. When a fasciotomy was not continuous, the average length and number of intact fascial bands was 1.52 cm and 2.3, respectively. USG fasciotomy of the anterior and lateral leg compartments can be safely performed in a cadaveric model and can achieve a fasciotomy length comparable to surgical fasciotomy. Most procedures successfully

  13. Comparison of postural ergonomics between laparoscopic and robotic sacrocolpopexy: a pilot study.

    Science.gov (United States)

    Tarr, Megan E; Brancato, Sam J; Cunkelman, Jacqueline A; Polcari, Anthony; Nutter, Benjamin; Kenton, Kimberly

    2015-02-01

    To compare resident, fellow, and attending urologic and gynecologic surgeons' musculoskeletal and mental strain during laparoscopic and robotic sacrocolpopexy. Prospective cohort study (Canadian Task Force classification II-2). Academic medical center. Patients who underwent robotic or laparoscopic sacrocolpopexy from October 2009 to January 2011. The Body Part Discomfort (BPD) survey was completed before cases, and the National Aeronautics and Space Administration Task Load Index and BPD survey were completed after cases. Higher scores on BPD and the National Aeronautics and Space Administration Task Load Index indicate greater musculoskeletal discomfort and mental strain. BPD scores were averaged over the following body regions: head/neck, back, hand/wrist, arms, and knees/ankles/feet. Changes in body region-specific discomfort scores were the primary outcomes. Multivariable analysis was performed using mixed-effects linear regression with surgeon as a random effect. Sixteen surgeons participated (53% fellows, 34% residents, and 13% attendings). Thirty-three robotic and 53 laparoscopic cases were analyzed, with a median surgical time of 231 minutes (interquartile range, 204-293 minutes) versus 227 minutes (interquartile range, 203-272 minutes; p = .31), a median estimated blood loss of 100 mL (interquartile range, 50-175 mL) versus 150 mL (interquartile range, 50-200 mL; p = .22), and a mean patient body mass index of 27 ± 4 versus 26 ± 4 kg/m(2) (p = .26), respectively. Robotic surgeries were associated with lower neck/shoulder (-0.19 [interquartile range, -0.32 to -0.01], T = -2.49) and back discomfort scores (-0.35 [interquartile range, -0.58 to 0], T = -2.38) than laparoscopic surgeries. Knee/ankle/foot and arm discomfort increased with case length (0.18 [interquartile range, 0.02-0.3], T = 2.81) and (0.07 [interquartile range, 0.01-0.14], p = .03), respectively. Surgeons performing minimally invasive sacrocolpopexy experienced less neck, shoulder, and

  14. The influence of foot orthoses on foot mobility magnitude and arch height index in adults with flexible flat feet.

    Science.gov (United States)

    Sheykhi-Dolagh, Roghaye; Saeedi, Hassan; Farahmand, Behshid; Kamyab, Mojtaba; Kamali, Mohammad; Gholizadeh, Hossein; Derayatifar, Amir A; Curran, Sarah

    2015-06-01

    Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height. To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet. A quasi-experimental study. The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL). Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index. Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses. Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility. © The International Society for Prosthetics and Orthotics 2014.

  15. A comparison of orthoses in the treatment of idiopathic toe walking: A randomized controlled trial.

    Science.gov (United States)

    Herrin, Kinsey; Geil, Mark

    2016-04-01

    Orthotic treatment of idiopathic toe walking is complicated by the lack of a known etiology. This study compared control of toe walking using an articulated ankle-foot orthosis versus a rigid carbon fiber footplate attached to a foot orthosis. Ascertain differences between two orthoses in the control of idiopathic toe walking. Randomized controlled trial. A total of 18 children with idiopathic toe walking were randomized to either the ankle-foot orthosis or foot orthosis treatment group in a Parallel Randomized Controlled Trial with no blinding. Prior to and after 6 weeks of treatment, participants completed three-dimensional gait assessment and the L-test of Functional Mobility. Parents completed a satisfaction survey and a subset of the Orthotic and Prosthetic User Survey after treatment. Nine participants were analyzed in each group. Both groups showed significant improvement in kinematics versus baseline with orthoses; however, when the orthoses were removed, the ankle-foot orthosis group did not immediately sustain this improvement, while the foot orthosis group did. Parents preferred the foot orthosis for donning and appearance. The ankle-foot orthosis controls idiopathic toe walking, but subjects may revert to earlier patterns following treatment. The foot orthosis does not control idiopathic toe walking as well but is less restrictive and more accepted by children and their parents, with similar out-of-brace effects. This study suggests that sequential orthotic treatment for children with idiopathic toe walking (ITW) may be beneficial. Initial treatment could include a less restrictive orthosis like a foot orthosis (FO); if this is unsuccessful within a set time frame, then the patient may require a more restrictive form of treatment such as an ankle-foot orthosis (AFO). © The International Society for Prosthetics and Orthotics 2015.

  16. Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

    Science.gov (United States)

    Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

    2018-03-23

    To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

  17. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus

    Science.gov (United States)

    Kim, Moon-Hwan; Yi, Chung-Hwi; Weon, Jong-Hyuck; Cynn, Heon-Seock; Jung, Do-Young; Kwon, Oh-Yun

    2015-01-01

    [Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus. PMID:25995546

  18. Development of body weight support gait training system using antagonistic bi-articular muscle model.

    Science.gov (United States)

    Shibata, Yoshiyuki; Imai, Shingo; Nobutomo, Tatsuya; Miyoshi, Tasuku; Yamamoto, Shin-Ichiroh

    2010-01-01

    The purpose of this study is to develop a body weight support gait training system for stroke and spinal cord injury. This system consists of a powered orthosis, treadmill and equipment of body weight support. Attachment of the powered orthosis is able to fit subject who has difference of body size. This powered orthosis is driven by pneumatic McKibben actuator. Actuators are arranged as pair of antagonistic bi-articular muscle model and two pairs of antagonistic mono-articular muscle model like human musculoskeletal system. Part of the equipment of body weight support suspend subject by wire harness, and body weight of subject is supported continuously by counter weight. The powered orthosis is attached equipment of body weight support by parallel linkage, and movement of the powered orthosis is limited at sagittal plane. Weight of the powered orthosis is compensated by parallel linkage with gas-spring. In this study, we developed system that has orthosis powered by pneumatic McKibben actuators and equipment of body weight support. We report detail of our developed body weight support gait training system.

  19. Effect of toe-spread-out exercise on hallux valgus angle and cross-sectional area of abductor hallucis muscle in subjects with hallux valgus.

    Science.gov (United States)

    Kim, Moon-Hwan; Yi, Chung-Hwi; Weon, Jong-Hyuck; Cynn, Heon-Seock; Jung, Do-Young; Kwon, Oh-Yun

    2015-04-01

    [Purpose] This study investigated whether the toe-spread-out exercise affects the hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction. [Subjects and Methods] Twenty-four subjects with hallux valgus were randomly assigned to orthosis and orthosis plus toe-spread-out exercise groups. The orthosis group wore the orthosis for 8 weeks, while the orthosis plus toe-spread-out group also performed the toe-spread-out exercise. The hallux valgus angle, the cross-sectional area of the abductor hallucis muscle, and the hallux valgus angle during active abduction were measured initially and after 8 weeks by radiography and ultrasonography. [Results] While there were no significant changes in the three parameters in the orthosis group, there were significant differences in the orthosis plus toe-spread-out exercise group after 8 weeks. In addition there were significant differences in the three measures between the two groups. [Conclusion] The toe-spread-out exercise reduces the hallux valgus angle and hallux valgus angle during active abduction, and increases the cross-sectional area of the abductor hallucis muscle. The toe-spread-out exercise is recommended for patients with mild to moderate hallux valgus.

  20. Effects of ankle-foot orthoses on mediolateral foot-placement ability during post-stroke gait.

    Science.gov (United States)

    Zissimopoulos, Angelika; Fatone, Stefania; Gard, Steven

    2015-10-01

    Accurate and precise mediolateral foot placement is important for balance during gait, but is impaired post stroke. Mediolateral foot placement may be improved with ankle-foot orthosis use. The purpose of this study was to determine whether an ankle-foot orthosis improves mediolateral foot-placement ability during post-stroke ambulation. Crossover trial with randomized order of conditions tested. The accuracy and precision of mediolateral foot placement was quantified while subjects targeted four different randomized step widths. Subjects were tested with and without their regular non-rigid ankle-foot orthosis in two separate visits (order randomized). While ankle-foot orthosis use corrected foot and ankle alignment (i.e. significantly decreased mid-swing plantar flexion, p = 0.000), effects of ankle-foot orthosis use on hip hiking (p = 0.545), circumduction (p = 0.179), coronal plane hip range of motion (p = 0.06), and mediolateral foot-placement ability (p = 0.537) were not significant. While ankle-foot orthosis-mediated equinovarus correction of the affected foot and ankle was not associated with improved biomechanics of walking (i.e. proximal ipsilateral hip kinematics or mediolateral foot-placement ability), it may affect other aspects of balance that were not tested in this study (e.g. proprioception, cerebellar, vestibular, and cognitive mechanisms). Studies that investigate the effect of ankle-foot orthosis on gait can help advance stroke rehabilitation by documenting the specific gait benefits of ankle-foot orthosis use. In this study, we investigated the effect of ankle-foot orthosis use on mediolateral foot-placement ability, an aspect of gait important for maintaining balance. © The International Society for Prosthetics and Orthotics 2014.

  1. Commande robuste référencée intention d'une orthèse active pour l'assistance fonctionnelle aux mouvements du genou

    OpenAIRE

    Mefoued, Saber

    2012-01-01

    The increasing number of elderly in the world reveals today new societal challenges, particularly in terms of healthcare and assistance services. With recent advances in technology, robotics appears as a promising solution to develop systems that improve the living conditions of this aging population. This thesis aims at proposing and validating an approach for robust control of an active orthosis, based on the subject intention. This orthosis is designed to assist flexion/ extension movement...

  2. Effect of arch support insole on plantar pressure distribution in females with mild and moderate hallux valgus

    Directory of Open Access Journals (Sweden)

    Maedeh Farzadi

    2013-10-01

    Full Text Available Objective: Hallux Valgus is one of the most foot deformities which increase plantar pressure beneath big toe and first metatarsal. The aim of this study was to assess the effect of foot orthosis on plantar pressure distribution in subjects with mild and moderate Hallux Valgus. Materials & Methods: in this quasi-experimental study, females 16 with Hallux Valgus were recruited. Plantar pressure in 8 area of foot was measured by Pedar-X insole when wearing standard shoe only shoe with foot orthosis and shoe with foot orthosis after a month of using orthosis. Data were analyzed by repeated measure analysis of variance test. Results: using foot orthosis for a month leaded to decrease pressure in the big toe (P<0/019 first metatarsal and 3-5 metatarsals (P<0.001 and also increased pressure in medial mid foot (P<0.001. Conclusion: Foot orthosis decreased peak pressure in fore foot and increased it in medial mid foot. Therefore redistribute plantar pressure to the more normal pattern in Hallux Valgus subjects. So it could be one of the effective methods to prevent the progression of this deformity in its initial steps of formation.

  3. Comparison of human and humanoid robot control of upright stance.

    Science.gov (United States)

    Peterka, Robert J

    2009-01-01

    There is considerable recent interest in developing humanoid robots. An important substrate for many motor actions in both humans and biped robots is the ability to maintain a statically or dynamically stable posture. Given the success of the human design, one would expect there are lessons to be learned in formulating a postural control mechanism for robots. In this study we limit ourselves to considering the problem of maintaining upright stance. Human stance control is compared to a suggested method for robot stance control called zero moment point (ZMP) compensation. Results from experimental and modeling studies suggest there are two important subsystems that account for the low- and mid-frequency (DC to approximately 1Hz) dynamic characteristics of human stance control. These subsystems are (1) a "sensory integration" mechanism whereby orientation information from multiple sensory systems encoding body kinematics (i.e. position, velocity) is flexibly combined to provide an overall estimate of body orientation while allowing adjustments (sensory re-weighting) that compensate for changing environmental conditions and (2) an "effort control" mechanism that uses kinetic-related (i.e., force-related) sensory information to reduce the mean deviation of body orientation from upright. Functionally, ZMP compensation is directly analogous to how humans appear to use kinetic feedback to modify the main sensory integration feedback loop controlling body orientation. However, a flexible sensory integration mechanism is missing from robot control leaving the robot vulnerable to instability in conditions where humans are able to maintain stance. We suggest the addition of a simple form of sensory integration to improve robot stance control. We also investigate how the biological constraint of feedback time delay influences the human stance control design. The human system may serve as a guide for improved robot control, but should not be directly copied because the

  4. A utilização da órtese para abdução de polegar na encefalopatia crônica não progressiva e a contribuição da Terapia Ocupacional–um estudo de caso/Use of orthosis thumb abduction in non-progressive chronic encephalopathy and contribution of OT-a case study

    Directory of Open Access Journals (Sweden)

    Talita Pedrini da Silva

    2017-04-01

    Full Text Available A Encefalopatia Crônica Não Progressiva (ECNP é um grupo de desordens do desenvolvimento motor e da postura, decorrente de distúrbio não progressivo ocorrido no Sistema Nervoso Central. Gera dificuldades na aquisição de padrões neuropsicomotores e na realização das atividades cotidianas. A órtese abdutora de polegar pode contribuir para a evolução da função manual, favorecendo o desempenho adequado em todas as áreas de ocupação humana. O objetivo desta pesquisa foi avaliar o efeito do uso da órtese abdutora de polegar em neoprene com faixa para supinação em uma criança com ECNP espástica associado à intervenção da Terapia Ocupacional. Trata-se de um estudo de caso, de caráter quali-quantitativo, com uma criança de 2 anos com diagnóstico de ECNP. Aplicou-se o instrumento de avaliação Physician Rating Scale para membros superiores, antes e após o tratamento com o uso das órteses. Os atendimentos foram realizados uma vez por semana, com duração de 20/25 minutos durante 3 meses, e as órteses utilizadas 4 vezes por semana, por 4 horas ininterruptas. Houve evolução nos aspectos físicos e funcionais. Em Membro Superior Esquerdo (MSE a evolução da funcionalidade foi significativa em relação ao Membro Superior Direito (MSD, sendo observada apenas evolução nos aspectos físicos e qualitativos. A órtese abdutora de polegar em neoprene com faixa para supinação contribui na evolução da função manual de crianças com ECNP.

  5. Comparison of owner satisfaction between stifle joint orthoses and tibial plateau leveling osteotomy for the management of cranial cruciate ligament disease in dogs.

    Science.gov (United States)

    Hart, Juliette L; May, Kimberly D; Kieves, Nina R; Mich, Patrice M; Goh, Clara S S; Palmer, Ross H; Duerr, Felix M

    2016-08-15

    OBJECTIVE To compare owner satisfaction between custom-made stifle joint orthoses and tibial plateau leveling osteotomy (TPLO) for the management of medium- and large-breed dogs with cranial cruciate ligament disease (CCLD). DESIGN Owner survey. SAMPLE 819 and 203 owners of dogs with CCLD that were managed with a custom-made stifle joint orthosis or TPLO, respectively. PROCEDURES Client databases of an orthosis provider and veterinary teaching hospital were reviewed to identify potential survey respondents. An online survey was developed to evaluate owner-reported outcomes, complications, and satisfaction associated with the nonsurgical (orthosis group) and surgical (TPLO group) interventions. Survey responses were compared between groups. RESULTS The response rate was 25% (203/819) and 37% (76/203) for the orthosis and TPLO groups, respectively. The proportion of owners who reported that their dogs had mild or no lameness and rated the intervention as excellent, very good, or good was significantly greater for the TPLO group than for the orthosis group. However, ≥ 85% of respondents in both groups reported that they would choose the selected treatment again. Of 151 respondents from the orthosis group, 70 (46%) reported skin lesions associated with the device, 16 (11%) reported that the dog subsequently underwent surgery, and 10 (7%) reported that the dog never tolerated the device. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated high owner satisfaction rates for both interventions. Owners considering nonsurgical management with an orthosis should be advised about potential complications such as persistent lameness, skin lesions, patient intolerance of the device, and the need for subsequent surgery.

  6. The effect of ankle-foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia.

    Science.gov (United States)

    Zissimopoulos, Angelika; Fatone, Stefania; Gard, Steven

    2014-04-01

    One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. Repeated measures study design. Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.

  7. A three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses.

    Science.gov (United States)

    Fatone, Stefania; Johnson, William Brett; Tucker, Kerice

    2016-04-01

    Misalignment of an articulated ankle-foot orthosis joint axis with the anatomic joint axis may lead to discomfort, alterations in gait, and tissue damage. Theoretical, two-dimensional models describe the consequences of misalignments, but cannot capture the three-dimensional behavior of ankle-foot orthosis use. The purpose of this project was to develop a model to describe the effects of ankle-foot orthosis ankle joint misalignment in three dimensions. Computational simulation. Three-dimensional scans of a leg and ankle-foot orthosis were incorporated into a link segment model where the ankle-foot orthosis joint axis could be misaligned with the anatomic ankle joint axis. The leg/ankle-foot orthosis interface was modeled as a network of nodes connected by springs to estimate interface pressure. Motion between the leg and ankle-foot orthosis was calculated as the ankle joint moved through a gait cycle. While the three-dimensional model corroborated predictions of the previously published two-dimensional model that misalignments in the anterior -posterior direction would result in greater relative motion compared to misalignments in the proximal -distal direction, it provided greater insight showing that misalignments have asymmetrical effects. The three-dimensional model has been incorporated into a freely available computer program to assist others in understanding the consequences of joint misalignments. Models and simulations can be used to gain insight into functioning of systems of interest. We have developed a three-dimensional model to assess the effect of ankle joint axis misalignments in ankle-foot orthoses. The model has been incorporated into a freely available computer program to assist understanding of trainees and others interested in orthotics. © The International Society for Prosthetics and Orthotics 2014.

  8. Gastrocnemius operating length with ankle foot orthoses in cerebral palsy.

    Science.gov (United States)

    Choi, Hwan; Wren, Tishya Anne Leong; Steele, Katherine Muterspaugh

    2017-06-01

    Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation. This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy. Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses. We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis. Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait. Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life. Clinical relevance Determining whether ankle foot orthoses stretch tight muscles can

  9. Treatment of adhesive capsulitis of the shoulder with a static progressive stretch device: a prospective, randomized study.

    Science.gov (United States)

    Ibrahim, Mahmoud I; Johnson, Aaron J; Pivec, Robert; Issa, Kimona; Naziri, Qasi; Kapadia, Bhaveen H; Mont, Michael A

    2012-01-01

    Stress relaxation and static progressive stretch (SPS) are techniques that may be used to nonoperatively restore joint range of motion in the setting of adhesive capsulitis. The purpose of this study was to prospectively compare standard physical therapy alone to a combination of physical therapy with a static progressive stretch orthosis in the treatment of shoulder adhesive capsulitis. A prospective, randomized, blinded, controlled study was conducted with a total of 60 patients diagnosed with shoulder adhesive capsulitis (30 patients in the control group, 30 patients in the treatment group). The control group received physical therapy for 4 weeks, while the experimental group received physical therapy and were treated with a static progressive stretch shoulder device for 4 weeks. Active and passive abduction, passive external rotation, DASH scores, and VAS pain scores were recorded for all patients at 4, 12, and 24 weeks follow-up. Use of a static progressive stretch orthosis compared to physical therapy alone demonstrated a significantly greater mean improvement in all range-of-motion categories. Mean passive abduction was 162° with the orthosis versus 136° with physical therapy alone. Mean active abduction was 141° and 114°, respectively. Mean external rotation was 73° and 52°, respectively. DASH scores were significantly better when a static progression stretch orthosis was used (5 vs.15 points). Use of a static progressive stretch orthosis for patients with shoulder adhesive capsulities resulted in significantly better range of motion and DASH scores within 1 month of beginning treatment than physical therapy alone.

  10. An EMG-Controlled SMA Device for the Rehabilitation of the Ankle Joint in Post-Acute Stroke

    Science.gov (United States)

    Pittaccio, S.; Viscuso, S.

    2011-07-01

    The capacity of flexing one's ankle is an indispensible segment of gait re-learning, as imbalance, wrong compensatory use of other joints and risk of falling may depend on the so-called drop-foot. The rehabilitation of ankle dorsiflexion may be achieved through active exercising of the relevant musculature (especially tibialis anterior, TA). This can be troublesome for patients affected by weakness and flaccid paresis. Thus, as needs evolve during patient's improvements, a therapeutic device should be able to guide and sustain gradual recovery by providing commensurate aid. This includes exploiting even initial attempts at voluntary motion and turns those into effective workout. An active orthosis powered by two rotary actuators containing NiTi wire was designed to obtain ankle dorsiflexion. A computer routine that analyzes the electromyographic (sEMG) signal from TA muscle is used to control the orthosis and trigger its activation. The software also provides instructions and feed-back for the patient. Tests on the orthosis proved that it can produce strokes up to 36° against resisting torques exceeding 180 Ncm. Three healthy subjects were able to control the orthosis by modulating their TA sEMG activity. The movement produced in the preliminary tests is interesting for lower limb rehabilitation, and will be further improved by optimizing body-orthosis interface. It is hoped that this device will enhance early rehabilitation and recovery of ankle mobility in stroke patients.

  11. Gait COP trajectory of left side hip-dislocation and scoliotic patient using ankle-foot orthoses

    Science.gov (United States)

    Chong, Albert K.; Alrikabi, Redha; Milburn, Peter

    2017-07-01

    Plantar pressure-sensing mats and insole plantar sensor pads are ideal low-cost alternatives to force plates for capturing plantar COP excursion during gait. The acquired COP traces, in the form of pedobarographic images are favored by many clinicians and allied health professionals for evaluation of foot loading and balance in relation to foot biomechanics, foot injury, foot deformation, and foot ulceration. Researchers have recommended the use of COP trace for the biomechanical study of the deformed foot and lower-limb to improve orthosis design and testing. A correctly designed orthoses improves mobility and reduces pain in the foot, lower limb and lower spine region during gait. The research was carried out to evaluate the performance of two types of orthosis, namely: a custom-molded orthosis and an over-the-counter molded orthosis to determine the quality of gait of an adult scoliotic patient. COP trace patterns were compared with those of a healthy adult and showed the design of the custom-molded orthosis resulted in an improved quality of movements and provided enhanced stability for the deformed left foot during gait.

  12. Do foot orthoses change lower limb muscle activity in flat-arched feet towards a pattern observed in normal-arched feet?

    Science.gov (United States)

    Murley, George S; Landorf, Karl B; Menz, Hylton B

    2010-08-01

    One of the hypothesised mechanisms by which foot orthoses obtain their clinical effect is by influencing muscle activity, however previous studies have reported highly variable findings. The aim of this study was to determine whether orthoses change muscle activity in people with flat-arched feet towards a pattern observed in people with normal-arched feet. Thirty young asymptomatic adults with flat-arched feet were recruited. Foot posture was classified using two clinical measurements and four skeletal alignment measurements from weight-bearing foot x-rays. Electromyographic activity was recorded while walking from tibialis posterior and peroneus longus via in-dwelling wire electrodes, and from tibialis anterior and medial gastrocnemius via surface electrodes. Four experimental conditions were assessed: (i) barefoot, (ii) shoe only, (iii) a heat-moulded (modified) prefabricated foot orthosis, and (iv) a 20-degree inverted-style customised foot orthosis. During the contact phase of gait, tibialis posterior electromyographic amplitude decreased significantly with the prefabricated orthosis (peak amplitude - 19% decrease, P=0.007; RMS amplitude--22% decrease, P=0.002) and the customised orthosis (peak amplitude--12% decrease, Pfoot orthoses significantly altered tibialis posterior and peroneus longus electromyographic amplitude. However, only the modified prefabricated orthosis changed peroneus longus electromyographic amplitude towards a pattern observed with normal-arched feet. Otherwise, few differences were found between the modified prefabricated and customised orthoses. Further research is required to determine whether these changes in muscle function are associated with clinical outcomes. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  13. Contoured in-shoe foot orthoses increase mid-foot plantar contact area when compared with a flat insert during cycling.

    Science.gov (United States)

    Bousie, Jaquelin A; Blanch, Peter; McPoil, Thomas G; Vicenzino, Bill

    2013-01-01

    To determine the effect of contouring of an in-shoe foot orthosis on plantar contact area and surface pressure, as well as perceived comfort and support at the foot-orthosis interface during stationary cycling. A randomised, repeated measures control study. Twelve cyclists performed steady-state seated cycling at a cadence of 90 rpm using a contoured orthosis and a flat insert of similar hardness. Contact area (CA) and plantar mean pressure (PP) were measured using the PEDAR® system, determined for seven discrete plantar regions and represented as the percentage of the total CA and PP respectively (CA% and PP%). Perceived comfort and support were rated using a visual analogue scale (VAS). The contoured orthosis produced a significantly greater CA% at the medial midfoot (p=0.001) and lateral midfoot (p=0.009) with a standardised mean difference (SMD) of 1.3 and 0.9 respectively. The contoured orthosis also produced a significantly greater PP% at the hallux (p=0.003) compared to the flat insert with a SMD of 1.1. There was a small non-significant effect (SMDfoot by increasing contact area as well as a perception of greater support at the midfoot while increasing relative pressure through the hallux when compared to a flat insert during stationary cycling. No difference in perceived comfort was noted. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  14. Vestibular humanoid postural control.

    Science.gov (United States)

    Mergner, Thomas; Schweigart, Georg; Fennell, Luminous

    2009-01-01

    Many of our motor activities require stabilization against external disturbances. This especially applies to biped stance since it is inherently unstable. Disturbance compensation is mainly reactive, depending on sensory inputs and real-time sensor fusion. In humans, the vestibular system plays a major role. When there is no visual space reference, vestibular-loss clearly impairs stance stability. Most humanoid robots do not use a vestibular system, but stabilize upright body posture by means of center of pressure (COP) control. We here suggest using in addition a vestibular sensor and present a biologically inspired vestibular sensor along with a human-inspired stance control mechanism. We proceed in two steps. First, in an introductory review part, we report on relevant human sensors and their role in stance control, focusing on own models of transmitter fusion in the vestibular sensor and sensor fusion in stance control. In a second, experimental part, the models are used to construct an artificial vestibular system and to embed it into the stance control of a humanoid. The robot's performance is investigated using tilts of the support surface. The results are compared to those of humans. Functional significance of the vestibular sensor is highlighted by comparing vestibular-able with vestibular-loss states in robot and humans. We show that a kinematic body-space sensory feedback (vestibular) is advantageous over a kinetic one (force cues) for dynamic body-space balancing. Our embodiment of human sensorimotor control principles into a robot is more than just bionics. It inspired our biological work (neurorobotics: 'learning by building', proof of principle, and more). We envisage a future clinical use in the form of hardware-in-the-loop simulations of neurological symptoms for improving diagnosis and therapy and designing medical assistive devices.

  15. BioMot exoskeleton - Towards a smart wearable robot for symbiotic human-robot interaction.

    Science.gov (United States)

    Bacek, Tomislav; Moltedo, Marta; Langlois, Kevin; Prieto, Guillermo Asin; Sanchez-Villamanan, Maria Carmen; Gonzalez-Vargas, Jose; Vanderborght, Bram; Lefeber, Dirk; Moreno, Juan C

    2017-07-01

    This paper presents design of a novel modular lower-limb gait exoskeleton built within the FP7 BioMot project. Exoskeleton employs a variable stiffness actuator in all 6 joints, a directional-flexibility structure and a novel physical humanrobot interfacing, which allows it to deliver the required output while minimally constraining user's gait by providing passive degrees of freedom. Due to modularity, the exoskeleton can be used as a full lower-limb orthosis, a single-joint orthosis in any of the three joints, and a two-joint orthosis in a combination of any of the two joints. By employing a simple torque control strategy, the exoskeleton can be used to deliver user-specific assistance, both in gait rehabilitation and in assisting people suffering musculoskeletal impairments. The result of the presented BioMot efforts is a low-footprint exoskeleton with powerful compliant actuators, simple, yet effective torque controller and easily adjustable flexible structure.

  16. An Alternate Conservative Management of Shoulder Dislocations and Subluxations

    Science.gov (United States)

    Sawa, Thomas M.

    1992-01-01

    This paper presents clinical observations/results of the application of an alternate method to traditional conservative management of subluxations and dislocations of the glenohumeral joint on major junior hockey players. The proposed program involves three stages: 1) rest and nutrition, 2) interferential current and faradic muscle stimulation, and 3) a traditional progressive-resistance weight-training program in conjunction with a specially designed orthosis. Current scientific theory on soft tissue healing and repair is reviewed as the backdrop to the proposed regimen. The resulting 100% success rate is compared to the success rate of conventional conservative therapeutic programs. The orthosis is a potentially useful therapeutic device permitting safe ranges of shoulder movement during the healing process, but scientific investigation is needed to determine the precise effect of the orthosis within the proposed therapy program. PMID:16558196

  17. Early functional outcome of two different orthotic concepts in ankle sprains: a randomized controlled trial.

    Science.gov (United States)

    Best, Raymond; Böhle, Caroline; Schiffer, Thorsten; Petersen, Wolf; Ellermann, Andree; Brueggemann, Gert Peter; Liebau, Christian

    2015-07-01

    Purpose of the study was the evaluation of the early functional outcome of patients with an acute ankle sprain treated either with a semirigid, variable, phase-adapted modular ankle orthosis or an invariable orthotic reference device. Forty-seven patients with acute ankle sprain grade II or more were included. In addition, 77 healthy controls as a reference were investigated. The injured subjects were treated with one of the two devices by random for 6 weeks. Ankle scores (FAOS, AOFAS) were taken at baseline after injury, 1 and 3 months after injury. Functional performance tests (balance platform, zig zag run, shuttle run, vertical drop jump) were performed at 1 and 3 months after injury. No significant score differences could be found between the two intervention groups except for achieving a preinjury activity level after 3 months only in the modular orthosis group. Postural functional performances (balance test) also showed no significant differences whereas the results of the agility tests revealed small but significant better results in the modular orthosis group in comparison to the invariable orthosis group. Cohen's effect sizes were high. Differences between the two intervention groups were marginal and very small but significant and--regarding Cohen's effect sizes--effective. Especially relating to functional performance, this might be a careful indication that a more effective strategy for promoting a protected, rapid recovery to physical activity after ankle sprains might be achieved by applying a phase-adapted ankle orthosis. Especially in athletic patients, phase-adapted orthosis should be further investigated and considered to ensure fully protected ligament healing as well as to regain early functional recovery.

  18. Biomechanics of the immediate impact of wearing a rigid thoracolumbar corset on gait kinematics and spatiotemporal parameters

    Directory of Open Access Journals (Sweden)

    Taiar Redha

    2018-01-01

    Full Text Available The corset support is a device classified as orthosis. It compensates a functional deficiency with means of protection, recovery, correction, maintenance, and support or contention. There are two types of orthosis 1 rest orthosis and 2 corrective orthosis. Rest orthosis maintains joints in a defined position to avoid deformities or to relieve a pain at joints. Corrective orthosis adjusts joint deformity either passively or actively. Corset is used in various pathological use, thoracic-lumbar fracture, scoliosis, Scheuermann’s disease or spinal dystrophy. The purpose of this study was 1 to determine the immediate impact of wearing a semi-rigid thoracolumbar corset, the Lombax® Dorso on gait kinematics and 2 spatiotemporal parameters in 6 adults. These parameters were recorded using the optoelectronic system Vicon® on treadmill gait subjects with and without corset for the comparison. The results showed that wearing a corset significantly decrease the rotation amplitudes of the scapular and pelvic girdles (p<0.05 in the frontal plane. The movement of the pelvis and hip in this same plane was decreased also when comparing with and without a corset effects (p<0.05. The corset significantly increased the range of flexion-extension of the hip during the gait cycle. At the conclusion of this study the discriminate parameters of wearing a corset was quantified. The results and in association with manufacturer will help to improve materials for better optimization support. Comparable perspectives and after improvement of materials will aim to experiment with patients on real daily life situation.

  19. Augmenting Locomotion in an Anthropomorphic System

    Directory of Open Access Journals (Sweden)

    Derek Wight

    2005-02-01

    Full Text Available A powered orthosis has applications ranging from assisting the elderly to augmenting astronauts. An assistive control scheme is developed that uses the force from a slave actuator to augment the force of a master actuator. This can be used to augment a closed-loop control scheme applied to the master actuator. Initially, actuator augmentation is explored both theoretically and experimentally using a simple mechanical system. The control scheme is then applied to a scale model of human lower limbs on a stationary bicycle to investigate the feasibility of a powered orthosis using pneumatic muscle actuators.

  20. Multidisciplinary conservative management in classical Volkmann's contracture: A case report

    NARCIS (Netherlands)

    Reinders, M.F.; Geertzen, J.H.B.; Eisma, W.H.

    1996-01-01

    This clinical note describes the case of a nine-year-old girl with classical Volkmann's contracture of the left forearm. The report demonstrates the results and follow-up of conservative orthotic management used as a mode of treatment by a multidisciplinary team. When using an orthosis it is

  1. Wartime Orthopaedic Residency: A Resident’s Perspective

    Science.gov (United States)

    2013-04-01

    unique ability to make a gestalt assessment of the salvageability of blast-related mangled limbs in a timely fashion. Free flaps are being performed...Patzkowski JC, Blanck RV, Owens JG, et al. Comparative effect of orthosis design on functional performance. J Bone Joint Surg. 2012; 94-A:507--515

  2. Human Walk Modeled by PCPG to Control a Lower Limb Neuroprosthesis by High-Level Commands

    Directory of Open Access Journals (Sweden)

    Matthieu Duvinage

    2012-06-01

    Full Text Available Current active leg prostheses do not integrate the most recent advances in Brain-Computer Interfaces (BCI and bipedal robotics. Moreover, their actuators are seldom driven by the subject’s intention. This paper aims at showing a summary of our current results in the field of human gait rehabilitation. In a first prototype, the main focus was on people suffering from foot drop problems, i.e. people who are unable to lift their feet. However, current work is focusing on a full active ankle orthosis. The approach is threefold: a BCI system, a gait model and an orthosis. Thanks to the BCI system, patients are able to generate high-level commands. Typically, a command could represent a speed modification. Then, a gait model based on a programmable central pattern generator is used to generate the adequate kinematics. Finally, the orthosis is tracking this kinematics when the foot is in the air, whereas, the orthosis is mimicking a spring when the foot is on the ground.

  3. The effects of two spinal orthoses on balance in elderly people with thoracic kyphosis.

    Science.gov (United States)

    Azadinia, Fatemeh; Kamyab, Mojtaba; Behtash, Hamid; Maroufi, Nader; Larijani, Bagher

    2013-10-01

    Hyperkyphosis increases the risk of falls for elderly people by reducing postural balance. Spinomed orthosis and the posture-training support are two available options for improving postural balance but have never been compared. To compare the effect of the Spinomed orthosis and the posture-training support on balance in elderly people with thoracic hyperkyphosis. This study is a clinical trial on an accessible sample of elderly people with thoracic kyphosis. Eighteen participants (16 women and 2 men), aged 60-80 years, with thoracic kyphosis greater than 50°, completed the study procedure. Subjects were randomly allocated to two groups, namely, Spinomed orthosis and the posture-training support groups. Sensory organization test and limits of stability were assessed using the EquiTest system and the Balance Master system, respectively. Balance score, directional control, and reaction time were measured to evaluate balance with and without orthosis in a random order. In the posture-training support group, significant changes were observed in the studied balance parameters: balance score (p elderly with thoracic hyperkyphosis in a similar manner.

  4. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness

    NARCIS (Netherlands)

    Ploeger, Hilde E.; Bus, Sicco A.; Nollet, Frans; Brehm, Merel-Anne

    2017-01-01

    The objective was to identify gait patterns in polio survivors with calf muscle weakness and associate them to underlying lower extremity impairments, which are expected to help in the search for an optimal orthosis. Unilaterally affected patients underwent barefoot 3D-gait analyses. Gait pattern

  5. Postoperative braces for degenerative lumbar diseases

    NARCIS (Netherlands)

    Machado, Andre N.; Ayala, Ana Patricia; Rubinstein, Sidney M.; El Dib, Regina; Rodrigues, Luciano M.; Gotfryd, Alberto Ofenhejm; Tamaoki, Marcel Jun; Belloti, João Carlos

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective is to evaluate the effectiveness of orthosis following lumbar spinal surgery for people with degenerative disease on pain reduction and improvement of functional status. Secondary objectives

  6. Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy

    NARCIS (Netherlands)

    Brehm, M.A.; Harlaar, J.; Schwartz, M.

    2008-01-01

    Objective: To determine the effect of ankle-foot orthoses on walking efficiency and gait in a heterogeneous group of children with cerebral palsy, using barefoot walking as the control condition. Design: A retrospective study. Methods: Barefoot and ankle-foot orthosis data for 172 children with

  7. Effect of ankle-foot orthoses on walking efficiency and gait in children with cerebral palsy

    NARCIS (Netherlands)

    Brehm, Merel-Anne; Harlaar, Jaap; Schwartz, Michael

    2008-01-01

    OBJECTIVE: To determine the effect of ankle-foot orthoses on walking efficiency and gait in a heterogeneous group of children with cerebral palsy, using barefoot walking as the control condition. DESIGN: A retrospective study. METHODS: Barefoot and ankle-foot orthosis data for 172 children with

  8. 2018-03-01T15:24:45Z https://www.ajol.info/index.php/all/oai oai:ojs ...

    African Journals Online (AJOL)

    Post polio paralysis is a grave complication if poliomyelitis. The victims can be rehabilitated to ambulate erect by reconstructive operations, use of orthosis and physiotherapy. This study assesses the problems of post polio paralysis, rehabilitative interventions and calls for a surgical reawakening in this regard. Patients and ...

  9. Functional electrical stimulation-assisted walking for persons with incomplete spinal injuries

    DEFF Research Database (Denmark)

    Ladouceur, M.; Barbeau, H.

    2000-01-01

    This study investigated the changes in maximal overground walking speed (MOWS) that occurred during; walking training with a functional electrical stimulation (FES) orthosis by chronic spinal cord injured persons with incomplete motor function loss. The average walking: speed over a distance of 10...

  10. Functional outcome after peroneal nerve injury

    NARCIS (Netherlands)

    de Bruijn, I.; Geertzen, J.H.; Dijkstra, P.U.

    2007-01-01

    The objective of this study was to describe muscle strength, ankle-foot orthosis (AFO) use, walking ability, participation and quality of life in patients with peroneal nerve injury. A historic cohort study (n = 27) was performed with a median follow-up time of 61 months (inter quartile range

  11. Three dimensional analysis of brace biomechanical efficacy for patients with AIS

    DEFF Research Database (Denmark)

    Lebel, David E; Al-Aubaidi, Zaid; Shin, Eyun-Jung

    2013-01-01

    Corrective three dimensional (3D) effect of different braces is debatable. We evaluated differences in in-brace radiographic correction comparing a custom thoracic-lumbo-sacral-orthosis (TLSO) (T) brace to a Chêneau type TLSO (C) brace using 3D EOS reconstruction technology. Our primary research ...

  12. Anterior Transfer of Tibialis Posterior through the Interosseous ...

    African Journals Online (AJOL)

    Postoperative plaster of Paris cast for 6 weeks and ankle foot orthosis were used. We evaluated for correction and ability of the transferred tendon to actively dorsiflex at the ankle joint. Nineteen patients had good results 8 fair and 3 poor there was no neurovascular deficit. The purpose of this paper is to outline our outcome ...

  13. Post Polio Paralysis: A Clarion Call For Surgical Re-Awakening ...

    African Journals Online (AJOL)

    Back ground. Post polio paralysis is a grave complication if poliomyelitis. The victims can be rehabilitated to ambulate erect by reconstructive operations, use of orthosis and physiotherapy. This study assesses the problems of post polio paralysis, rehabilitative interventions and calls for a surgical reawakening in this regard.

  14. Bra.Di.P.O. and P.I.G.R.O.: Innovative Devices for Motor Learning Programs

    Directory of Open Access Journals (Sweden)

    Guido Belforte

    2014-01-01

    Full Text Available Two mechatronics prototypes, useful for robotic neurotreatments and new clinical trainings, are here presented. P.I.G.R.O. (pneumatic interactive gait rehabilitation orthosis is an active exoskeleton with an electropneumatic control. It imposes movements on lower limbs in order to produce in the patient’s brain proper motor cortex activation. Bra.Di.P.O. (brain discovery pneumatic orthosis is an MR-compatible device, designed to improve fMRI (functional magnetic resonance imaging analysis. The two devices are presented together because both are involved in the study of new robotic treatments of patients affected by ictus or brain stroke or in some motor learning experimental investigations carried out on healthy subjects.

  15. Augmenting Locomotion in an Anthropomorphic System

    OpenAIRE

    Derek Wight; Eric Kubica; David Wang

    2005-01-01

    A powered orthosis has applications ranging from assisting the elderly to augmenting astronauts. An assistive control scheme is developed that uses the force from a slave actuator to augment the force of a master actuator. This can be used to augment a closed-loop control scheme applied to the master actuator. Initially, actuator augmentation is explored both theoretically and experimentally using a simple mechanical system. The control scheme is then applied to a scale model of human lower l...

  16. Proprioceptive feedback and brain computer interface (BCI based neuroprostheses.

    Directory of Open Access Journals (Sweden)

    Ander Ramos-Murguialday

    Full Text Available Brain computer interface (BCI technology has been proposed for motor neurorehabilitation, motor replacement and assistive technologies. It is an open question whether proprioceptive feedback affects the regulation of brain oscillations and therefore BCI control. We developed a BCI coupled on-line with a robotic hand exoskeleton for flexing and extending the fingers. 24 healthy participants performed five different tasks of closing and opening the hand: (1 motor imagery of the hand movement without any overt movement and without feedback, (2 motor imagery with movement as online feedback (participants see and feel their hand, with the exoskeleton moving according to their brain signals, (3 passive (the orthosis passively opens and closes the hand without imagery and (4 active (overt movement of the hand and rest. Performance was defined as the difference in power of the sensorimotor rhythm during motor task and rest and calculated offline for different tasks. Participants were divided in three groups depending on the feedback receiving during task 2 (the other tasks were the same for all participants. Group 1 (n = 9 received contingent positive feedback (participants' sensorimotor rhythm (SMR desynchronization was directly linked to hand orthosis movements, group 2 (n = 8 contingent "negative" feedback (participants' sensorimotor rhythm synchronization was directly linked to hand orthosis movements and group 3 (n = 7 sham feedback (no link between brain oscillations and orthosis movements. We observed that proprioceptive feedback (feeling and seeing hand movements improved BCI performance significantly. Furthermore, in the contingent positive group only a significant motor learning effect was observed enhancing SMR desynchronization during motor imagery without feedback in time. Furthermore, we observed a significantly stronger SMR desynchronization in the contingent positive group compared to the other groups during active and

  17. The BADER Consortium

    Science.gov (United States)

    2017-10-01

    their condition in relation to others – The quality of their healthcare and resources – The orthosis/prosthesis itself – Self - esteem /body image...biomechanics of athletes with uni- lateral transtibial amputations (affected and unaffected leg) and non -amputees differ from those of athletes with bilateral...lengths. Intuitively, athletes with longer legs take longer steps during running, yet non -amputees exhibit a very weak association between leg length

  18. Orthotic treatment of positional brachycephaly associated with osteogenesis imperfecta.

    Science.gov (United States)

    Matarazzo, Carolina G; Schreen, Gerd; Lago-Rizzardi, Camilla D do; Peccin, Maria Stella; Pinto, Fernando Cg

    2017-12-01

    Osteogenesis imperfecta is an inherited disorder of the connective tissue characterized primarily by fractures with no or small causal antecedents and extremely variable clinical presentation. The disorder requires a global and, therefore, multidisciplinary therapeutic approach that should aim, among other aspects, at the prevention and treatment of deformities resulting from osteogenesis imperfecta. Due to limitations related to bony deformities, it can be difficult to place these infants in a variety of positions that would help remediate skull deformities, so a cranial orthosis becomes the therapy of choice. The aim of this study was to demonstrate the results obtained during treatment with a cranial remolding orthosis (helmet) in babies with osteogenesis imperfecta. Case Description and Methods: For the first time in the scientific literature, this study describes the use of a cranial orthosis for the treatment of infants with osteogenesis imperfecta. Both children had severe asymmetrical brachycephaly documented by laser digital scanning and were submitted to treatment with a cranial remolding orthosis. Outcomes and Conclusion: The study showed that there was a significant improvement in cranial proportion and symmetry, with a reduction in the cephalic index at reevaluation. It is concluded that the orthotic therapy is an effective therapeutic modality to improve the proportion and minimize the asymmetry in children with osteogenesis imperfecta. Clinical relevance The clinical relevance of such a description is that children with osteogenesis imperfecta may have numerous deformities and minimizing them can be an important factor. This report showed a beneficial result as the orthotic therapy modality improved the proportions and minimized the asymmetry. This treatment offers too high levels of satisfaction to parents and brings these children closer to normal indices.

  19. Disuse induced by the spine rectification vest: experimental study

    OpenAIRE

    Guirro, Rinaldo Roberto de Jesus; Arruda, Eder João; Silva, Carlos Alberto da

    2014-01-01

    The spine is the main support and movement axis of the locomotor system, and numberless clinical conditions may require that this structure be submitted to functional restriction. Among the non-invasive treatments used in spinal or appendicular skeleton injuries, the immobilization of the spine is used as a rehabilitation strategy. Because of the functional restrictions generated by restraining devices used on the spine, the proposal of this study was to adapt a spinal orthosis on rats, thus ...

  20. Atrophy of calf muscles by unloading results in an increase of tissue sodium concentration and fat fraction decrease: a23Na MRI physiology study.

    Science.gov (United States)

    Gerlach, D A; Schopen, K; Linz, P; Johannes, B; Titze, J; Zange, J; Rittweger, J

    2017-08-01

    23 Na MRI demonstrated increased tissue sodium concentrations in a number of pathologies. Acute atrophy results in muscle fibre volume shrinking that may result in a relative increase of extracellular volume and might affect sodium concentration. Thus, we hypothesized that local unloading of the calf muscles would lead to a decrease in muscle volume and an increase in muscle tissue sodium concentration. One lower leg of 12 healthy male subjects was submitted to a 60 day long period of unloading using the Hephaistos orthosis, while the other leg served as control. 23 Na MRI and 2D PD-weighted Dixon turbo spin echo were obtained from the control and orthosis leg using a 3T scanner. For quantification, a sodium reference phantom was used with 10, 20, 30, and 40 mmol/L NaCl solution. Tissue sodium concentration (TSC) increased as an effect of unloading in the orthosis leg. Relative increases were 17.4 ± 16.8% (P = 0.005) in gastrocnemius medialis muscle, 11.1 ± 12.5 (P = 0.037) in gastrocnemius lateralis muscle, 16.2 ± 4.7% (P muscle, 10.0 ± 10.5% (P = 0.009) in the ventral muscle group, and 10.7 ± 10.0% (P = 0.003) in the central muscle group, respectively. TSC in the control leg did not significantly change. In the orthosis leg, muscle volume decreased as follows: medial gastrocnemius muscle: -5.4 ± 8.3% (P = 0.043) and soleus muscle: -7.8 ± 15.0% (P = 0.043). Unloading atrophy is associated with an increase in muscle sodium concentration. 23 Na MRI is capable of detecting these rather small changes.

  1. The influence of sole wedges on frontal plane knee kinetics, in isolation and in combination with representative rigid and semi-rigid ankle-foot-orthoses.

    Science.gov (United States)

    Schmalz, Thomas; Blumentritt, Siegmar; Drewitz, Heiko; Freslier, Marie

    2006-07-01

    In earlier stages of knee osteoarthritis orthotic treatments with knee orthoses or modified footwear are often considered. Although the load reducing effects of knee orthoses have been well established, wearing modified footwear would be more comfortable for the patient and less encumbering. The effect of modified footwear on the frontal load of the knee is controversial. This article describes the effect of medial or lateral shoe wedges alone or together with two different types of ankle-stabilizing orthoses. The effect on frontal knee loading was measured during standing and walking with medially and laterally placed wedges under the sole of the shoe. The wedges were also combined with two types of orthotic devices - an Ankle-Foot-Orthosis that was rigid in the frontal plane but allowed unrestricted sagittal plane motion and an ankle support that was semi-rigid in the frontal plane. Joint loading of 10 healthy persons (mean (standard deviation): age 34 (9) years, height 178 (4)cm, mass 73 (9)kg) was investigated by means of a special measuring device that accurately determines static loads (Lasar Posture) and with instrumented gait analysis (Vicon/Kistler). Using a lateral wedge under the sole of the shoe (without orthotic support) showed no significant reduction in the mean maximal knee moment in the frontal plane. Adding an Ankle-Foot-Orthosis that is rigid in the frontal plane resulted in significant reduction in the maximal frontal moment from 0.54 Nm/kg to 0.38Nm/kg (p0.01). Using a medial wedge, without and with Ankle-Foot-Orthosis, produced a significant increase in the maximal frontal moment to 0.59 Nm/kg (p0.05) or 0.67 Nm/kg (p0.01), respectively. These results suggest that the application of a sole wedge significantly influences frontal knee loading when used in combination with an Ankle-Foot-Orthosis that is rigid in the frontal plane.

  2. Standardized voluntary force measurement in a lower extremity rehabilitation robot

    OpenAIRE

    Bolliger, M; Banz, R; Dietz, V; Lünenburger, L

    2008-01-01

    Abstract Background Isometric force measurements in the lower extremity are widely used in rehabilitation of subjects with neurological movement disorders (NMD) because walking ability has been shown to be related to muscle strength. Therefore muscle strength measurements can be used to monitor and control the effects of training programs. A new method to assess isometric muscle force was implemented in the driven gait orthosis (DGO) Lokomat. To evaluate the capabilities of this new measureme...

  3. Insurance status and delay in orthotic treatment in children.

    Science.gov (United States)

    Skaggs, David L; Oda, Jon E; Lerman, Larry; McGoldrick, Erik; Rice, Christie; Weiss, Jennifer; Kay, Robert M

    2007-01-01

    To determine if the type of health insurance is associated with a delay in children obtaining orthoses. The medical records of 60 children who were prescribed an ankle-foot orthosis (AFO) or thoracolumbosacral orthosis (TLSO) were retrospectively reviewed. Ten children were randomly chosen with either of 3 types of insurance (government, health maintenance organizations [HMOs], and preferred provider organizations [PPOs]) with an orthosis provided by a single supplier. The time interval between prescription and insurance company authorization was recorded, as well as the interval between prescription and procurement of the orthosis. There were significant differences in the time from prescription to authorization of orthoses between insurance types (P = 0.001) and time from authorization until brace procurement between insurance types (P = 0.01). Children with PPO insurance received authorization for an AFO faster than children with government insurance or an HMO (P Children with government insurance received authorization for a TLSO significantly later than children with PPO insurance (P = 0.004) or HMO insurance (P = 0.03). The difference in time between authorization and procurement of a TLSO in children with PPO insurance (36 days) was strikingly different from that of children with government insurance (123 days) (P = 0.003). This study documents that children with government insurance face delays in obtaining orthotic treatment compared with children with PPO insurance. The delay in the procurement of the more expensive brace (TLSO is approximately 4 times the cost of an AFO) correlated to more striking delays in the government-insured population.

  4. Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet

    OpenAIRE

    Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Yoon, Sung-Won; Yun, Hyun-Ju; Jeong, Tae-Ho

    2015-01-01

    Objective To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. Method A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic techni...

  5. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review.

    Science.gov (United States)

    Nadler, M; Pauls, Mmh

    2017-04-01

    To determine whether shoulder orthoses prevent or reduce gleno-humeral subluxation and hemiplegic shoulder pain. OVID SP, MEDLINE, AMED, CINAHL, PEDro and the Cochrane Central Register of Controlled Trials. We included: randomised or quasi-randomised controlled trials, controlled before and after studies and observational studies. Two reviewers independently screened, critically appraised papers using the PEDro tool, and extracted data. A descriptive synthesis was performed as there were insufficient data for meta-analysis. Eight studies were included, totalling 186 participants: One randomised controlled trial with 41 participants, one quasi-randomised with 14 participants, one before and after controlled study with 40 participants and five observational studies with 91 participants met the inclusion criteria. Findings suggest that applying an orthosis to an already subluxed shoulder immediately reduced vertical subluxation on X-ray but improvements were not maintained when orthosis was removed. Orthoses with both proximal and distal attachments improved shoulder pain in the majority of stroke patients when worn for four weeks (starting several days or weeks post-stroke). There was no increase in adverse effects of contracture, spasticity or hand oedema when compared to no orthosis. Orthoses were generally well-tolerated and most patients rated the orthosis as comfortable to wear. Observational studies suggest that orthoses reduce vertical subluxation whilst in-situ. Available evidence from heterogeneous studies after stroke suggests that orthoses may reduce pain and are well-tolerated with prolonged use. No studies have tested whether subluxation and pain can be prevented by immediate post-stroke application of orthoses.

  6. Patient Response to an Integrated Orthotic and Rehabilitation Initiative for Traumatic Injuries for the Military Treatment Facilities (PRIORITI-MTF)

    Science.gov (United States)

    2015-07-01

    information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE July 2015 2...KEYWORDS: Dynamic Ankle Foot Orthosis, Extremity War Injuries, IDEO, rehabilitation 3. BODY Overall Progress This annual report reflects progress...mtf.org/ ) to identify potential patients. The website also houses an initial questionnaire that pre-screens participants. Respondents who screen ‘in’ as

  7. Effect of surgical shoes on brake response time after first metatarsal osteotomy?a prospective cohort study

    OpenAIRE

    Dammerer, Dietmar; Braito, Matthias; Biedermann, Rainer; Ban, Michael; Giesinger, Johannes; Haid, Christian; Liebensteiner, Michael C.; Kaufmann, Gerhard

    2016-01-01

    Background The aim of this study is to assess patients? driving ability when wearing surgical shoes following right-sided first metatarsal osteotomy. Methods From August 2013 to August 2015, 42 consecutive patients (mean age 54.5?years) with right-sided hallux valgus deformity underwent first metatarsal osteotomy. Patients were tested for brake response time (BRT) 1?day preoperatively (control run) and at 2 and 6?weeks postoperatively. Two different types of foot orthosis were investigated. B...

  8. A Hybrid Neuromechanical Ambulatory Assist System

    Science.gov (United States)

    2016-08-01

    Systems Inc., Shirley, NY, USA) arm as shown in Figure 4. The dynamometer arm was set in passive mode and passive resistance (torque) was Table 1... arm and HKC mechanism was subtracted from the total measured torque to determine the resistive torque due to fluid flow in the hydraulic circuit. The...orthosis – Part I: Spring parameters. Applied Bionics and Biomechanics, 9:303-316, 2012. a) b) Figure 10. a) Passive resistance at 30° of hip

  9. The use of upper limb orthoses in patients with rheumatoid arthritis: a literature review in the field of occupational therapy

    Directory of Open Access Journals (Sweden)

    Talita Silvério de Souza Silva

    2015-09-01

    Full Text Available Introduction: Rheumatoid arthritis is a chronic systemic disease that most often affects smaller joints such as hands and wrists. It may cause deformities that jeopardize hand function, thus impacting the subject occupational performance. In order to assist the hand function restoration, occupational therapists often use orthosis to improve autonomy and/or independence to perform daily activities in patients with rheumatoid arthritis. Objective: This study aimed to identify the upper limb’s orthoses used in patients with rheumatoid arthritis, who were assisted by the Occupational Therapy, featuring the population, the type of research and the outcomes obtained. Method: This study is literature review and its selection criteria consists of publications in English, Spanish and Portuguese published within the last ten years, divided between experimental, observational and case studies, all with diagnosis of rheumatoid arthritis and assisted by an occupational therapist. Twelve articles were selected for review. Findings: The literature review points out the benefits achieved through the use of the orthosis to manual dexterity, grip strength, pain relief and aspects related to comfort and patient satisfaction. Conclusion: In this context, the orthosis appears as an important assistive technology resource to keep function and restore compromised activities.

  10. Biomechanic and Energetic Effects of a Quasi-Passive Artificial Gastrocnemius on Transtibial Amputee Gait

    Directory of Open Access Journals (Sweden)

    Michael F. Eilenberg

    2018-01-01

    Full Text Available State-of-the-art transtibial prostheses provide only ankle joint actuation and thus do not provide the biarticular function of the amputated gastrocnemius muscle. We develop a prosthesis that actuates both knee and ankle joints and then evaluate the incremental effects of this prosthesis as compared to ankle actuation alone. The prosthesis employs a quasi-passive clutched-spring knee orthosis, approximating the largely isometric behavior of the biological gastrocnemius, and utilizes a commercial powered ankle-foot prosthesis for ankle joint functionality. Two participants with unilateral transtibial amputation walk with this prosthesis on an instrumented treadmill, while motion, force, and metabolic data are collected. Data are analyzed to determine differences between the biarticular condition with the activation of the knee orthosis and the monoarticular condition with the orthosis behaving as a free-joint. As hypothesized, the biarticular system is shown to reduce both affected-side knee and hip moment impulse and positive mechanical work in both participants during the late stance knee flexion phase of walking, compared to the monoarticular condition. The metabolic cost of walking is also reduced for both participants. These very preliminary results suggest that biarticular functionality may provide benefits beyond even those of the most advanced monoarticular prostheses.

  11. [Survey of carbon fiber reinforced plastic orthoses and occupational and medical problems based on a questionnaire administered to companies involved in the manufacture of prosthetics and orthotics].

    Science.gov (United States)

    Kaneshiro, Yuko; Furuta, Nami; Makino, Kenichiro; Wada, Futoshi; Hachisuka, Kenji

    2011-09-01

    We surveyed carbon fiber reinforced plastic orthoses (carbon orthoses) and their associated occupational and medical problems based on a questionnaire sent to 310 companies which were members of the Japan Orthotics and Prosthetics Association. Of all the companies, 232 responded: 77 of the 232 companies dealt with ready-made carbon orthoses, 52 dealt with fabricated custom-made orthoses, and 155 did not dealt with carbon orthoses. Although the total number of custom-made carbon ortheses in Japan was 829/ 5 years, there was a difference by region, and one company fabricated only 12 (per 5 years) custom-made carbon orthoses on average. The advantages of the carbon orthosis were the fact that it was "light weight", "well-fitted", had a "good appearance", and "excellent durability", while the disadvantages were that it was "expensive", "high cost of production", of "black color", and required a "longer time for completion", and "higher fabrication techniques". From the standpoint of industrial medicine, "scattering of fine fragments of carbon fibers", "itching on the skin" and "health hazards" were indicated in companies that manufacture the orthosis. In order to make the carbon orthosis more popular, it is necessary to develop a new carbon material that is easier to fabricate at a lower cost, to improve the fabrication technique, and to resolve the occupational and medical problems.

  12. Wearable Monitoring Devices for Assistive Technology: Case Studies in Post-Polio Syndrome

    Directory of Open Access Journals (Sweden)

    Giuseppe Andreoni

    2014-01-01

    Full Text Available The correct choice and customization of an orthosis are crucial to obtain the best comfort and efficiency. This study explored the feasibility of a multivariate quantitative assessment of the functional efficiency of lower limb orthosis through a novel wearable system. Gait basographic parameters and energetic indexes were analysed during a Six-Minute Walking Test (6-MWT through a cost-effective, non-invasive polygraph device, with a multichannel wireless transmission, that carried out electro-cardiograph (ECG; impedance-cardiograph (ICG; and lower-limb accelerations detection. Four subjects affected by Post-Polio Syndrome (PPS were recruited. The wearable device and the semi-automatic post-processing software provided a novel set of objective data to assess the overall efficiency of the patient-orthosis system. Despite the small number of examined subjects, the results obtained with this new approach encourage the application of the method thus enlarging the dataset to validate this promising protocol and measuring system in supporting clinical decisions and out of a laboratory environment.

  13. Mechanical instability after acute ankle ligament injury: randomized prospective comparison of two forms of conservative treatment

    Directory of Open Access Journals (Sweden)

    Marcelo Pires Prado

    2013-08-01

    Full Text Available OBJECTIVE: This trial has the objective to investigate the incidence of mechanical ankle instability after the conservative treatment of first episode, severe ankle ligamentar lesions. This common lesion affects young, professional and physical active patients, causing important personal and economic consequences. There are difficulties related to adequate diagnosis and treatment for these lesions. METHOD: 186 patients with severe ankle ligament lesions were included in this trial. They were randomized in two treatment options. In group A patients were treated using ankle long orthoosis, weight bearing allowed as confortable, pain care, ice, elevation with restricted joint mobilization for three weeks. After that they were maintained in short, functional orthosis (air cast, starting the reabilitation program. In group B patients were immobilized using a functional orthosis (air cast, following the same other sequences that patients in group A. RESULTS: We did not find significant differences in relation to the residual mechanical ankle instability between both groups. We did not find differences in the intensity of pain, but the functional evaluation using AOFAS score system showed better results in the functional treatment group. CONCLUSION: The functional treatment (Group B had better AOFAS score and few days off their professional activities, comparing with patients treated with rigid orthosis (Group A, without increased chance in developing ankle mechanical instability.

  14. The Physiological Benefits and Problems Associated With Using Standing and Walking Orthoses in Individuals With Spinal Cord Injury—A Meta-analytic Review

    Directory of Open Access Journals (Sweden)

    Mohammad Karimi Taghi

    2012-06-01

    Full Text Available Spinal cord injury (SCI patients use two transportation systems that include orthosis and wheelchair. It was claimed that standing and walking bring some benefits for SCI patients, such as decreasing bone osteoporosis, preventing pressure sores, and improving various physiological functions. The main question posted here is as follows: Is there enough evidence to support the effect of walking with orthosis on the health status of the patients with SCI? A review of the relevant literature was carried out in Bioengineering Unit of Strathclyde University. The benefits of orthoses were evaluated. Evidence reported in the literature regarding the effectiveness of orthoses for improving the health condition of SCI patients is conflicting. The benefits that were mentioned in various research studies regarding using the orthosis include decreasing bone osteoporosis, preventing joint deformity, improving bowl and bladder function, improving digestive system function, decreasing muscle spasm, improving independent living, improving respiratory and cardiovascular systems function. Improvement of independence living and physiological health of the patients are the only two benefits that are supported by strong evidence. Unfortunately, conflicting results in the literature have led to criticism of most hypotheses based on theoretical grounds, with the effects of using orthoses on the health status remaining a matter of considerable debate.

  15. What variables influence the ability of an AFO to improve function and when are they indicated?

    Science.gov (United States)

    Malas, Bryan S

    2011-05-01

    Children with spina bifida often present with functional deficits of the lower limb associated with neurosegmental lesion levels and require orthotic management. The most used orthosis for children with spina bifida is the ankle-foot orthosis (AFO). The AFO improves ambulation and reduces energy cost while walking. Despite the apparent benefits of using an AFO, limited evidence documents the influence of factors predicting the ability of an AFO to improve function and when they are indicated. These variables include AFO design, footwear, AFO-footwear combination, and data acquisition. When these variables are not adequately considered in clinical decision-making, there is a risk the AFO will be abandoned prematurely or the patient's stability, function, and safety compromised. The purposes of this study are to (1) describe the functional deficits based on lesion levels; (2) identify and describe variables that influence the ability of an AFO to control deformities; and (3) describe what variables are indicated for the AFO to control knee flexion during stance, hyperpronation, and valgus stress at the knee. A selective literature review was undertaken searching MEDLINE and Cochrane databases using terms related to "orthosis" and "spina bifida." Based on previous studies and gait analysis data, suggestions can be made regarding material selection/geometric configuration, sagittal alignment, footplate length, and trim lines of an AFO for reducing knee flexion, hyperpronation, and valgus stress at the knee. Further research is required to determine what variables allow an AFO to improve function.

  16. Can lumbosacral orthoses cause trunk muscle weakness? A systematic review of literature.

    Science.gov (United States)

    Azadinia, Fatemeh; Ebrahimi, Esmaeil; Kamyab, Mojtaba; Parnianpour, Mohamad; Cholewicki, Jacek; Maroufi, Nader

    2017-04-01

    Wearing lumbosacral orthosis (LSO) is one of the most common treatments prescribed for conservative management of low back pain. Although the results of randomized controlled trials suggest effectiveness of LSO in reducing pain and disability in these patients, there is a concern that prolonged use of LSO may lead to trunk muscle weakness and atrophy. The present review aimed to evaluate available evidence in literature to determine whether LSO results in trunk muscle weakness or atrophy. This is a systematic review. A systematic search of electronic databases including PubMed, Scopus, ScienceDirect, and Medline (via Ovid) followed by hand search of journals was performed. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the effect of lumbar orthosis on trunk muscle activity, muscle thickness, strength or endurance, spinal force, and intra-abdominal pressure in healthy subjects or in patients with low back pain, were included. Methodological quality of selected studies was assessed by using the modified version of Downs and Black checklist. This research had no funding source, and the authors declare no conflicts of interest-associated biases. Thirty-five studies fulfilled the eligibility criteria. The mean and standard deviation of the quality score was 64±9.7%. Most studies investigating the effect of lumbar orthosis on electromyographic activity (EMG) of trunk muscles demonstrated a decrease or no change in the EMG parameters. A few studies reported increased muscle activity. Lumbosacral orthosis was found to have no effect on muscle strength in some studies, whereas other studies demonstrated increased muscle strength. Only one study, which included ultrasound assessment of trunk muscle stabilizers, suggested reduced thickness of the abdominal muscles and reduced cross-sectional area of the multifidus muscles. Out of eight studies that investigated spinal compression load, the load was reduced in four

  17. The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running

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    Michaela Hähni

    2016-11-01

    Full Text Available Abstract Background Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia. One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP and forefoot cushioning (FC. The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running. Methods Twenty-three (13 female, 10 male asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC conditions and a control (C condition on a treadmill (2.78 ms−1 for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100 after each running trial. The primary outcome was tested using the Friedman test (α = 0.05. Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR. Results Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315 compared to both C (313 ± 69, 95%-CI: 283–343; p = .003 and MP (315 ± 80, 95%-CI: 280–350; p = .001. No significant difference was found between C and MP (p = .858. Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64. Conclusions In contrast to the metatarsal pad orthosis, the

  18. Antagonistic Mono- and Bi-Articular Lower-Limb Muscle Activities’ Model Characterization at Different Speeds

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    Dzahir M.A.M

    2017-01-01

    Full Text Available Nowadays, medical rehabilitation system has become a requirement due to increment in national rehabilitation centres and medical hospitals. An assistive rehabilitation orthosis becomes essential and was used for rehabilitation therapy, condition monitoring, and physical strengthening. This study focused on the lower limb assistive rehabilitation orthosis development using pneumatic artificial muscle. To successfully control this orthosis system which consists of antagonistic mono- and biarticular muscle actuators, it is necessary to construct a reliable control algorithm. The suitable control scheme and strategy to manoeuvre this orthosis system similar to human musculoskeletal system have yet to be fully developed and established. Based on the review study, it is said that the co-contraction controls of anterior-posterior pneumatic muscles was able to improve the joint stiffness and stability of the orthosis as well as good manoeuvrability. Therefore, a characterization model of an antagonistic mono- and bi-articular muscles activities of human's lowerlimb during walking motion will be necessary. A healthy young male subject was used as test subject to obtain the sEMG muscle activities for antagonistic mono- and bi-articular muscles (i.e., Vastus Medialis-VM, Vastus Lateralis-VL, Rectus Femoris-RF, and Bicep Femoris-BF. The tests were carried out at different speeds of 2km/h, 3km/h, and 4km/h for one minute walking motion on a treadmill. Then, the patterns of the sEMG muscle activities were modelled and characterised using fifth order polynomial equation. Based on the results, it is shown that the anterior and posterior muscles were exhibited a muscle synergy in-between multiple anterior or posterior muscles and muscle co-contraction between anteriorposterior muscles in order to control the movements at the joints during walking motion. As conclusion, it is proven that the sEMG muscle activities of the antagonistic mono- and bi

  19. SpineCor treatment for Juvenile Idiopathic Scoliosis: SOSORT award 2010 winner.

    Science.gov (United States)

    Coillard, Christine; Circo, Alin B; Rivard, Charles H

    2010-11-10

    Juvenile idiopathic scoliosis is a condition used to describe patients who are least 4 years of age but younger than 10 when the deformity is first identified. In these patients, the condition is usually progressive and those that are diagnosed at five years or younger have a high chance of progression to a large curve, with additional pulmonary and cardiac complications. The main form of conservative treatment for juvenile scoliosis is the use of a bracing system. This prospective interventional study was conducted to evaluate the effectiveness of the Dynamic SpineCor orthosis for juvenile idiopathic scoliosis as well as to evaluate the stability of the spine after the weaning point. For this study, 150 juvenile patients were treated by the SpineCor orthosis between 1993 and 2009. Of these, 67 patients had a definite outcome and 83 are still actively being treated. To determine the effectiveness of the brace the OUTCOME criteria recommended by the SRS was used. The results from our study showed that of the 67 patients with a definite outcome, 32.9% corrected their Cobb angle by at least 5° and 10.5% had a stabilization of their Cobb angle. Within the patients with a definite outcome, 37.3% of patients where recommended for surgery before authorized end of treatment. For this group of patients, surgery was postponed. Looking at the stability of the curves 2 years after the end of the treatment, we found 12.5% of the patients continued their correction without the brace being used and 71.4% remained stable. From our study we can clearly see that the effectiveness of the SpineCor orthosis in obtaining and maintaining the neuromuscular integration of the corrective movement can be achieved effectively for juvenile patients. Over 75% of all patients that finished the treatment had remained stable with a few continuing to correct their Cobb angle after the use of the SpineCor orthosis was discontinued. Our conclusion from this study is that the SpineCor orthosis is a

  20. SpineCor treatment for Juvenile Idiopathic Scoliosis: SOSORT award 2010 winner

    Directory of Open Access Journals (Sweden)

    Circo Alin B

    2010-11-01

    Full Text Available Introduction Juvenile idiopathic scoliosis is a condition used to describe patients who are least 4 years of age but younger than 10 when the deformity is first identified. In these patients, the condition is usually progressive and those that are diagnosed at five years or younger have a high chance of progression to a large curve, with additional pulmonary and cardiac complications. The main form of conservative treatment for juvenile scoliosis is the use of a bracing system. This prospective interventional study was conducted to evaluate the effectiveness of the Dynamic SpineCor orthosis for juvenile idiopathic scoliosis as well as to evaluate the stability of the spine after the weaning point. Material and Methods For this study, 150 juvenile patients were treated by the SpineCor orthosis between 1993 and 2009. Of these, 67 patients had a definite outcome and 83 are still actively being treated. To determine the effectiveness of the brace the OUTCOME criteria recommended by the SRS was used. Results The results from our study showed that of the 67 patients with a definite outcome, 32.9% corrected their Cobb angle by at least 5° and 10.5% had a stabilization of their Cobb angle. Within the patients with a definite outcome, 37.3% of patients where recommended for surgery before authorized end of treatment. For this group of patients, surgery was postponed. Looking at the stability of the curves 2 years after the end of the treatment, we found 12.5% of the patients continued their correction without the brace being used and 71.4% remained stable. Discussion From our study we can clearly see that the effectiveness of the SpineCor orthosis in obtaining and maintaining the neuromuscular integration of the corrective movement can be achieved effectively for juvenile patients. Over 75% of all patients that finished the treatment had remained stable with a few continuing to correct their Cobb angle after the use of the SpineCor orthosis was

  1. Design and analysis of an original powered foot clearance creator mechanism for walking in patients with spinal cord injury.

    Science.gov (United States)

    Maleki, Maryam; Badri, Samaneh; Shayestehepour, Hamed; Arazpour, Mokhtar; Farahmand, Farzam; Mousavi, Mohamad Ebrahim; Abdolahi, Ehsan; Farkhondeh, Hasan; Head, John S; Golchin, Navid; Mardani, Mohammad Ali

    2018-03-12

    The aim of this study was to assess the performance of an original powered foot clearance creator (PFCC) mechanism worn in conjunction with an isocentric reciprocal gait orthosis (IRGO) and evaluate its effect on trunk compensatory movements and spatiotemporal parameters in nine healthy subjects. A PFCC motorized mechanism was designed that incorporated twin sole plates, the movements of which enabled increased toe to floor clearance during swing phase. A prototype was constructed in combination with an IRGO, and hence was re-named as an IRGO-PFCC orthosis. The effects of IRGO-PFCC usage on the spatiotemporal parameters and trunk compensatory movements during walking were then analyzed under two conditions, firstly with the PFCC 'active' i.e., with the motorized device functioning, and secondly inactive, where floor clearance was standard. Ambulating with IRGO-PFCC orthosis resulted in reduction in the spatiotemporal parameters of gait (speed of walking, cadence and stride length) in nine healthy subjects. Walking with IRGO-PFCC orthosis led to significant differences in lateral (p = .007) and vertical (p = .008) trunk compensatory movements. In other words, through using IRGO-PFCC orthosis, the lateral and vertical trunk compensatory movements decreased by 51.32% and 42.7%, respectively. An adapted PFCC mechanism, with a relatively small motor and power supply could effectively increase toe to floor clearance during swing phase and thereby decrease trunk compensatory motions and potentially improve energy consumption. Implications for rehabilitations •The High rejection rates of reciprocal gait orthoses are related to the increasing in energy expenditure and burden loads on the upper limb joints during walking following trunk compensatory movements.•An original powered foot clearance creator mechanism was designed and constructed to assisting floor clearance capability and reduce trunk compensatory movements in subjects with spinal cord injury during

  2. Reducing trial length in force platform posturographic sleep deprivation measurements

    Science.gov (United States)

    Forsman, P.; Hæggström, E.; Wallin, A.

    2007-09-01

    Sleepiness correlates with sleep-related accidents, but convenient tests for sleepiness monitoring are scarce. The posturographic test is a method to assess balance, and this paper describes one phase of the development of a posturographic sleepiness monitoring method. We investigated the relationship between trial length and accuracy of the posturographic time-awake (TA) estimate. Twenty-one healthy adults were kept awake for 32 h and their balance was recorded, 16 times with 30 s trials, as a function of TA. The balance was analysed with regards to fractal dimension, most common sway amplitude and time interval for open-loop stance control. While a 30 s trial allows estimating the TA of individual subjects with better than 5 h accuracy, repeating the analysis using shorter trial lengths showed that 18 s sufficed to achieve the targeted 5 h accuracy. Moreover, it was found that with increasing TA, the posturographic parameters estimated the subjects' TA more accurately.

  3. Gait biomechanics following lower extremity trauma: Amputation vs. reconstruction.

    Science.gov (United States)

    Russell Esposito, Elizabeth; Stinner, Daniel J; Fergason, John R; Wilken, Jason M

    2017-05-01

    Surgical advances have substantially improved outcomes for individuals sustaining traumatic lower extremity injury. Injuries once requiring lower limb amputation are now routinely managed with limb reconstruction surgery. However, comparisons of functional outcomes between the procedures are inconclusive. To compare gait biomechanics after lower limb reconstruction and transtibial amputation. Twenty-four individuals with unilateral lower limb reconstruction wearing a custom ankle-foot orthosis (Intrepid Dynamic Exoskeletal Orthosis), 24 with unilateral, transtibial amputation, and 24 able-bodied control subjects underwent gait analysis at a standardized Froude speed based on leg length. Lower extremity joint angles, moments, and powers, and ground reaction forces were analyzed on the affected limb of patients and right limb of able-bodied individuals. ANOVA with Tukeys post-hoc tests determined differences among groups and post-hoc paired t-tests with Bonferroni-Holm corrections determined differences between limbs. The ankle, knee, and hip exhibited significant kinematic differences between amputated, reconstructed and able-bodied limbs. The reconstruction group exhibited less ankle power and range of motion while the amputee group exhibited lower knee flexor and extensor moments and power generation. Gait deficiencies were more pronounced at the ankle following limb reconstruction with orthosis use and at the knee following transtibial amputation with prosthesis use. Although both groups in the cohorts tested can replicate many key aspects of normative gait mechanics, some deficiencies still persist. These results add to the growing body of literature comparing amputation and limb reconstruction and provide information to inform the patient on functional expectations should either procedure be considered. Copyright © 2017. Published by Elsevier B.V.

  4. Functionally optimized orthoses for early rheumatoid arthritis foot disease: a study of mechanisms and patient experience.

    Science.gov (United States)

    Gibson, Kellie S; Woodburn, James; Porter, Duncan; Telfer, Scott

    2014-10-01

    To investigate the mode-of-action and patient experience of functionally optimized foot orthoses in patients with early rheumatoid arthritis (RA). We conducted an investigation of 2 functionally optimized foot orthoses (selective laser sintering [SLS] and fused deposition modelling [FDM]) in 15 patients with RA of <2 years duration. The novel devices were optimized for 3 biomechanistic targets exploiting computer-aided design and additive manufacturing. A third standard device was used as the comparator (standard foot orthosis [SFO]). Foot and ankle biomechanical effects were compared. Adverse reactions, orthotic fit and comfort, and short-term symptom benefits were also monitored. Both FDM (P = 0.028) and SLS (P < 0.0001) orthoses significantly reduced peak rearfoot motion in comparison to shod. The average ankle internal moment was significantly decreased in the SFO (P = 0.010) and approached significance in the SLS (P = 0.052) orthosis. SFO, FDM, and SLS orthoses significantly increased the peak height of the medial foot arch between 3.6 to 4.4 mm (P < 0.001). Peak pressures in the medial (P = 0.018) and lateral forefoot (P = 0.022) regions of interest were significantly reduced for the SLS orthosis. SFO, FDM, and SLS orthoses significantly increased midfoot contact area (P < 0.001 for all conditions). In comparison to SFO, SLS and FDM orthoses provided equivalent or better patient experience. No adverse reactions were reported. Functional optimization is a feasible approach for orthoses prescription in early RA and has the potential to provide superior mode-of-action responses for biomechanical therapeutic targets compared to standard devices. Copyright © 2014 by the American College of Rheumatology.

  5. Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series.

    Science.gov (United States)

    Crowell, Michael S; Deyle, Gail D; Owens, Johnny; Gill, Norman W

    2016-02-01

    Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. Three consecutive male patients, aged 21-23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function.

  6. IpsiHand Bravo: an improved EEG-based brain-computer interface for hand motor control rehabilitation.

    Science.gov (United States)

    Holmes, Charles Damian; Wronkiewicz, Mark; Somers, Thane; Liu, Jenny; Russell, Elizabeth; Kim, DoHyun; Rhoades, Colleen; Dunkley, Jason; Bundy, David; Galboa, Elad; Leuthardt, Eric

    2012-01-01

    Stroke and other nervous system injuries can damage or destroy hand motor control and greatly upset daily activities. Brain computer interfaces (BCIs) represent an emerging technology that can bypass damaged nerves to restore basic motor function and provide more effective rehabilitation. A wireless BCI system was implemented to realize these goals using electroencephalographic brain signals, machine learning techniques, and a custom designed orthosis. The IpsiHand Bravo BCI system is designed to reach a large demographic by using non-traditional brain signals and improving on past BCI system pitfalls.

  7. Prediction of Lower Extremity Movement by Cyclograms

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    P. Kutilek

    2012-01-01

    Full Text Available Human gait is nowadays undergoing extensive analysis. Predictions of leg movements can be used for orthosis and prosthesis programming, and also for rehabilitation. Our work focuses on predicting human gait with the use of angle-angle diagrams, also called cyclograms. In conjunction with artificial intelligence, cyclograms offer a wide area of medical applications. We have identified cyclogram characteristics such as the slope and the area of the cyclogram for a neural network learning algorithm. Neural networks learned by cyclograms offer wide applications in prosthesis control systems.

  8. The WalkTrainer--a new generation of walking reeducation device combining orthoses and muscle stimulation.

    Science.gov (United States)

    Stauffer, Y; Allemand, Y; Bouri, M; Fournier, J; Clavel, R; Metrailler, P; Brodard, R; Reynard, F

    2009-02-01

    This paper presents a novel reeducation device for paraplegics that combines hybrid orthoses and closed-loop electrical muscle stimulation. Based on the so called Cyberthosis concept, the WalkTrainer enables an active muscular participation of the subject in the walking reeducation process by the mean of closed-loop muscle stimulation. The WalkTrainer is also equipped with a leg and pelvic orthosis, an active bodyweight support, and motorized wheels to allow true over ground deambulation. This paper will focus on the development of the WalkTrainer, the presentation of the control strategies, and also give some preliminary results of the first clinical trials.

  9. Órtese dinâmica integrando manufatura aditiva e robótica cooperativa/Dynamic orders integrating additive manufacture and cooperative robotics

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    Valéria Meirelles Carril Elui

    2017-09-01

    Full Text Available A evolução da artrite reumatoide (AR leva a perda da capacidade se estender ativamente os dedos. Nos casos avançados uma órtese mecânica passiva pode não ser satisfatória. Este trabalho apresenta a integração com um sistema motor aumentando o alcance da órtese na funcionalidade de indivíduo. Foi desenvolvido um projeto conceito de órtese assistida por servo motor que após otimizações avaliadas em bancada e com portador da deformidade apresentou resultados promissores quanto ao controle do motor e opinião positiva quanto ao uso da mão. Abstract The evolution of rheumatoid arthritis (RA leads to loss of the ability to actively extend the fingers. In advanced cases the mechanical orthosis may not be satisfactory. This work presents the integration with a motor system increasing the reach of the orthosis in the individual functionality. It was developed a concept project of servo-assisted orthosis that after optimizations evaluated in the bench and with deformity bearer presented promising results regarding the motor control and positive opinion regarding the use of the hand.Keywords: Orthosis, 3D Printing, Rheumatoid Arthritis, Servo motor, Rehabilitation ResumenLa evolución de la artritis reumatoide (AR lleva a la pérdida de la capacidad de extender activamente los dedos. En los casos avanzados la órtesis mecánica puede no ser satisfactoria. Este trabajo presenta la integración con un sistema motor aumentando el alcance de la órtesis en la funcionalidad de individuo. Se desarrolló un proyecto concepto de órtesis asistida por servo motor que después de optimizaciones evaluadas en bancada y con portador de la deformidad presentó resultados prometedores en cuanto al control del motor y opinión positiva en cuanto al uso de la mano.Palabras clave: Órtesis, Impresión 3D, Artritis reumatoide, Servo motor, Rehabilitación.

  10. The rehabilitative approach in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    N. Pappone

    2011-09-01

    Full Text Available The rehabilitative approach for the patient with rheumatoid arthritis should be early, global and complementary to an early pharmacological therapy, in the context of a multidisciplinary approach, that should include physicians with different specialties and other health professionals. Evaluation scales assessing disability and quality of life are necessary for the rehabilitative approach. These can be classified in 2 groups: specific tools and generic tools, each evaluating different components of the health status. After the evaluation and the definition of the aims of the rehabilitation, a rehabilitative project, potentially including physical therapies, therapeutic exercises, occupational therapy and orthosis should be defined.

  11. [Therapeutic uses of ortho-podiatry in the diabetic foot].

    Science.gov (United States)

    López Herranz, Marta; Bas Caro, Pedro; Carabantes Alarcón, David; Padín Galea, José Manuel

    2011-10-01

    The neuropathic diabetic foot ulcers are a major public health problem given by different situations: the chronic nature of the injury, a low response to treatment, relapse rates, etc. Therefore pose a serious personal, family health and social, with a significant expenditure of human and material resources. Treatment requires a multidisciplinary team which integrates a podiatrist as part of it. He will address especially the pre-ulcers, and have a singular care in diabetic foot by treatment with orthosis. Since your question can be seen changes in the feet of diabetic patients could be treated on an outpatient basis.

  12. Complete Atlantooccipital Assimilation with Basilar Invagination and Atlantoaxial Subluxation Treated Non-Surgically: A Case Report.

    Science.gov (United States)

    Electricwala, Ali J; Harsule, Amita; Chavan, Vishwajeet; Electricwala, Jaffer T

    2017-06-09

    Atlantooccipital assimilation is a partial or complete congenital fusion between the atlas and the base of the occiput. Most patients with atlas assimilation are asymptomatic, but some may present with neurological problems such as myelopathy. We present the case of a 37-year-old woman who presented with neck and occipital pain, episodic neck stiffness, and dizziness. Medical imaging revealed complete atlantooccipital assimilation associated with basilar invagination, atlantoaxial subluxation, and predisposing anterior spinal cord compression. The patient was treated non-operatively with medications, cervical interferential therapy, and a rigid cervical orthosis.

  13. Effects of Prefabricated Ankle Orthoses on Postural Stability in Basketball Players with Chronic Ankle Instability

    OpenAIRE

    Faraji, Elahe; Daneshmandi, Hassan; Atri, Ahmad Ebrahimi; Onvani, Vahid; Namjoo, Faride Rezaee

    2012-01-01

    Purpose Ankle sprain is one of the most common injuries among athletes and instability and injury to this joint is responsible for long time loss of physical and recreational activity. Also, it can impose high costs to sport teams. Prevention of this injury is an important concern of practice and rehabilitation. One way of reducing the possibility of ankle joint injury is using an ankle orthosis. The present study aimed at inspecting the effects of two ankle orthoses on dynamic and semi-dynam...

  14. Robotic Assistance of Human Motion Using Active-Backdrivability on a Geared Electromagnetic Motor

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    Mario Jorge Claros

    2016-03-01

    Full Text Available In this research, we describe an actuation and control system designed for geared electromagnetic motors, which is characterized by its simple implementation, fast response to external input loads, reliable human-machine interaction features, no need for previous set-up or calibration from user to user and high portability due to the reduction of weight and space used. By the implementation of the proposed system, an electromagnetic motor can become a multitasking, wearable actuation system capable of: detecting the user's intentions regarding motion, tracking the limbs with minimal force interaction within a wide bandwidth and also providing controllable assistance and resistance forces to the user's movements, without the use of any biological signal. Validation of the proposed approach is shown by the construction of a powered orthosis for the knee, used to test the system's performance under real human motion conditions. The proposed system was tested on one healthy subject by measuring electromyographic levels both with and without the orthosis, under controlled flexion and extension cycles. Experimental results demonstrate the effectiveness of the proposed approach in detecting the user's intentions regarding motion, reducing and increasing muscular activity when configured for assistance and resistance, respectively, and also increasing the transparency of the actuation system when perfect tracking of the limbs is needed.

  15. Results of treatment of clubfoot by Ponseti′s technique in 40 cases : Pitfalls and problems in the Indian scenario

    Directory of Open Access Journals (Sweden)

    Bhaskar Atul

    2006-01-01

    Full Text Available Background : Though described long back, there has been a renewed interest towards Ponseti method of conservative treatment of clubfoot recently. Methods : Forty children with idiopathic clubfeet were treated by Ponseti technique. The median age at presentation was 9 days. Twenty-six children with bilateral and 12 children with unilateral clubfeet were graded by the Pirani method at the commencement of treatment and then at the final follow-up. Feet were graded as excellent if the Pirani score was zero, fair, if the sum of mid-foot and hind-foot score was one or less and poor, if the score was more than one. Thirty four children need a heel cord tenotomy and all children received conventional ankle-foot orthosis (AFO and foot-abduction orthosis (FAO to maintain correction. Results : Twenty-eight children had excellent correction, four had a fair outcome and eight cases had relapse in their deformity. Poor splint compliance and fitting along with incomplete correction of the deformity were identified as the chief causes leading to a poor result. Conclusion : A strict protocol and parent education can improve the outcome for all cases with the Ponseti technique. Key-words: Clubfoot; Congenital talipes equinovarus; Ponseti technique.

  16. Recurrent parotid swelling secondary to masseter muscle hypertrophy: a multidisciplinary diagnostic and therapeutic approach.

    Science.gov (United States)

    Capaccio, Pasquale; Gaffuri, Michele; Pignataro, Lorenzo; Assandri, Fausto; Pereira, Pollyanna; Farronato, Giampietro

    2016-11-01

    To present a patient with an atypical recurrent parotid swelling due to masseter muscle hypertrophy and the diagnostic/therapeutic assessment to treat this condition. A patient referring recurrent right facial swelling underwent a complete multidisciplinary assessment of the parotid region that revealed masseter muscle hypertrophy, confirmed by means of clinical (otolaryngological and gnathological evaluation), radiological (utrasonography, dynamic magnetic resonance imaging, and cone beam computed tomography), instrumental (electromyography to evaluate the right masseter muscle function and kinesiography to evaluate maximum right deflection - MaxRDefl and maximum opening - MaxMO) and sialendoscopy assessment where T0 indicates the pre-treatment values. All electromyographic and kinesiographic parameters were evaluated six months after the orthodontic application of a neuromuscular orthosis at T1. At T1, the effectiveness of the orthodontic therapy was demonstrated by the complete resolution of symptoms, and instrumental results documented more efficient muscle activity at rest and during clenching and a better mandibular position. At EMG T1, the resting and post-TENS values were, respectively, 1.2 and 1.8 microV. At kinesiography, MaxRDefl increased from 10.2 (T0) to 10.5 mm (T1); maxMO increased from 41.2 (T0) to 48 mm (T1). The proposed multidisciplinary assessment based on otolaryngological, gnathological, and radiological evaluation may be useful in the case of recurrent parotid swelling secondary to masseter muscle hypertrophy to plan an appropriate management with a removable neuromuscular orthosis.

  17. Open Fracture Management in Low-Resource Settings: A Medical Training Experience in Cambodian Hospitals.

    Science.gov (United States)

    Tajsic, Nenad B; Sambath, Puon; Nguon, Sophy; Sokh, Vannara; Chheang, Virak; Landsem, Gaute; Zaletel, Ivan; Husum, Hans

    2017-12-01

    A prospective interventional study has been carried out on the teaching effect and sustainability of low-cost trauma training program in open tibia fracture management for health workers. In 2007, an external fixator and a patella-bearing orthosis were developed at a rural workshop in Cambodia. From 2010 to 2016, a core group of nine Cambodian health workers was trained in open fracture management by Norwegian senior surgeons, using the locally made fixator and brace. The training outcome was also assessed by a questionnaire comprising of assertions regarding theoretical understanding, technical skills and self-confidence in understanding the biomechanical properties of locally made external fixator and its application; the use of handmade orthosis and principle in covering of soft-tissue defects. The students managed 23 cases with the new technique with a primary healing rate of 70% (95% CI 48.1-85.5). A significant increase in self-reported technical skills, understanding, and self-confidence was reported. This study demonstrates that the capacity building of reconstructive surgery in low-resource settings by local doctors and paramedics is clearly a reasonable option that may substantially reduce amputation of the limbs.

  18. Rat hindlimb joint immobilization with acrylic resin orthoses

    Directory of Open Access Journals (Sweden)

    C.A. da Silva

    2006-07-01

    Full Text Available The objective of the present study was to propose an orthosis of light material that would be functional for the animal and that would maintain only the ankle joint immobilized. Male Wistar rats (3 to 4 months old, 250-300 g were divided into 2 groups (N = 6: control and immobilized for 7 days. Rats were anesthetized with sodium pentobarbital (40 mg/kg weight and the left hindlimb was immobilized with the orthoses composed of acrylic resin model, abdominal belt and lateral supports. The following analyses were performed: glycogen content of the soleus, extensor digitorum longus, white gastrocnemius, red gastrocnemius, and tibialis anterior muscles by the phenol sulfuric method, and the weight, fiber area and intramuscular connective tissue of the soleus by the planimetric system. Data were analyzed statistically by the Kolmogorov-Smirnov, Student t and Wilcoxon tests. Immobilization decreased glycogen in all muscles (P < 0.05; soleus: 31.6%, white gastrocnemius: 56.6%, red gastrocnemius: 39%, extensor digitorum longus: 41.7%, tibialis anterior: 45.2% in addition to reducing soleus weight by 34% (P < 0.05. Furthermore, immobilization promoted reduction of the fiber area (43%, P < 0.05 and increased the connective tissue (200%, P < 0.05. The orthosis model was efficient comparing with another alternative immobilization model, like plaster casts, in promoting skeletal muscle alterations, indicating that it could be used as a new model in other studies related to muscle disuse.

  19. Effect of patellar strap and sports tape on jumper's knee symptoms: protocol of a randomised controlled trial.

    Science.gov (United States)

    de Vries, Astrid J; van den Akker-Scheek, Inge; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

    2013-12-01

    Patellar straps or sports tapes are commonly used by athletes with patellar tendinopathy in order to reduce pain and to continue sports participation. Currently, there is no scientific evidence for the effectiveness of a patellar strap or sports tape in the management of this common injury. To investigate the effect of the use of a patellar strap and sports tape on pain and sports participation in subjects with patellar tendinopathy. The study is divided into two parts: a randomised controlled crossover experiment and a randomised controlled trial (parallel group design). 140 patients diagnosed with patellar tendinopathy recruited from sports medical centres and physiotherapist practices. In the first part of the study, participants serve as their own control by performing three functional tests under four different conditions (patellar strap, sports tape, placebo tape, and no orthosis). In the second part, participants keep a log for two weeks (control week and intervention week) about the pain experienced during and after sports and their level of sports participation. In the intervention week participants will use the orthosis assigned to them during training and competition. The amount of pain (both parts of the study) and sports participation (second part only) will be measured. To analyse the effects of the orthoses a Linear Mixed Model will be used. The knowledge gained in this study can be used by practitioners in their advice for athletes with patellar tendinopathy about using patellar strap and sports tape during sports. Copyright © 2013 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

  20. Conservative treatment of lumbar spondylolysis in young soccer players.

    Science.gov (United States)

    Alvarez-Díaz, Pedro; Alentorn-Geli, Eduard; Steinbacher, Gilbert; Rius, Marta; Pellisé, Ferran; Cugat, Ramón

    2011-12-01

    The purpose of this study was to report the functional outcomes of young active soccer players with lumbar spondylolysis undergoing conservative treatment. Between 2002 and 2004, all soccer players diagnosed with spondylolysis with a minimum 2-year follow-up were retrospectively reviewed. All patients were treated nonoperatively with cessation of sports activity and rehabilitation for 3 months. The rehabilitation protocol was identical for all patients and emphasized strengthening of abdominal muscles, stretching of the hamstrings, "core" stability exercises, and trunk rotational movements in a pain-free basis. Those patients with pain at rest and with daily life activities were also treated with a thoracolumbar orthosis. Symptomatic patients or those with positive SPECT were not allowed to return to sports and continued the rehabilitation protocol for 3 more months. The mean time of cessation of sports activity was 3.9 months (SD 0.8) and 5.2 months (SD 2.1) for a complete return to sports. At the 2-year follow-up, 28 patients (82%) obtained excellent results, 4 (12%) good results, 1 patient (3%) a fair result, and 1 patient (3%) a poor result. Conservative treatment of spondylolysis in young soccer players with cessation of sports and rehabilitation, with or without thoracolumbar orthosis, was associated with excellent functional results in terms of return to sports and level of achievable physical activity.

  1. Knee orthoses for treating patellofemoral pain syndrome.

    Science.gov (United States)

    Smith, Toby O; Drew, Benjamin T; Meek, Toby H; Clark, Allan B

    2015-12-08

    does comprise intensive exercise regimens. All five trials were at high risk of bias, including performance bias reflecting the logistical problems in these trials of blinding of participants and care providers. As assessed using the GRADE approach, the available evidence for all reported outcomes is 'very low' quality. This means that we are very uncertain about the results.The trials covered three different types of comparison: knee orthosis and exercises versus exercises alone; one type of orthosis versus another; and knee orthosis versus exercises. No trials assessed the mode of knee orthosis use, such as whether the orthosis was worn all day or only during physical activity. Two trials had two groups; two trials had three groups; and one trial had four groups.All five trials compared a knee orthosis (knee sleeve, knee brace, or patellar strap) versus a 'no treatment' control group, with all participants receiving exercises, either through a military training programme or a home-based exercise programme. There is very low quality evidence of no clinically important differences between the two groups in short-term (2 to 12 weeks follow-up) knee pain based on the visual analogue scale (0 to 10 points; higher scores mean worse pain): MD -0.46 favouring knee orthoses, 95% CI -1.16 to 0.24; P = 0.19; 234 participants, 3 trials). A similar lack of clinically important difference was found for knee function (183 participants, 2 trials). None of the trials reported on quality of life measures, resource use or participant satisfaction. Although two trials reported on the impact on sporting or occupational participation, one trial (35 participants) did not provide data split by treatment group on the resumption of sport activity and the other reported only on abandonment of military training due to knee pain (both cases were allocated a knee orthosis). One trial (59 participants, 84 affected knees) recording only adverse events in the two knee orthoses (both were knee

  2. Design of splints based on the NiTi alloy for the correction of joint deformities in the fingers.

    Science.gov (United States)

    Puértolas, Sergio; Pérez-García, José M; Gracia, Luis; Cegoñino, José; Ibarz, Elena; Puértolas, José A; Herrera, Antonio

    2010-09-13

    The proximal interphalange joint (PIP) is fundamental for the functional nature of the hand. The contracture in flexion of the PIP, secondary to traumatisms or illnesses leads to an important functional loss. The use of correcting splints is the common procedure for treating this problem. Its functioning is based on the application of a small load and a prolonged stress which can be dynamic, static progressive or static serial.It is important that the therapist has a splint available which can release a constant and sufficient force to correct the contracture in flexion. Nowadays NiTi is commonly used in bio-engineering, due to its superelastical characteristics. The experience of the authors in the design of other devices based on the NiTi alloy, makes it possible to carry out a new design in this work--the production of a finger splint for the treatment of the contracture in flexion of the PIP joint. Commercial orthosis have been characterized using a universal INSTRON 5565 machine. A computational simulation of the proposed design has been conducted, reproducing its performance and using a model "ad hoc" for the NiTi material. Once the parameters have been adjusted, the design is validated using the same type of test as those carried out on commercial orthosis. For commercial splint the recovering force falls to excessively low values as the angle increases. Angle curves for different lengths and thicknesses of the proposed design have been obtained, with a practically constant recovering force value over a wide range of angles that vary between 30° and 150° in every case. Then the whole treatment is possible with only one splint, and without the need of progressive replacements as the joint recovers. A new model of splint based on NiTi alloy has been designed, simulated and tested comparing its behaviour with two of the most regularly used splints. Its uses is recommended instead of other dynamic orthosis used in orthopaedics for the PIP joint. Besides, its

  3. EFFECT OF ORTHOTIC SUBTALAR ALIGNMENT WITH CO-ACTIVATION EXERCISE FOR ALTERATION IN GAIT ENDURANCE IN A CHILD WITH CEREBRAL PALSYSINGLE CASE STUDY

    Directory of Open Access Journals (Sweden)

    K. Vadivelan

    2016-10-01

    Full Text Available Background: Energy cost of walking is two times higher in children with cerebral palsy when compared with normal children; this may be due to gait abnormalities.There is a negative influence on physical activity and early onsets of fatigue in activities of daily living are evident in cerebral palsy children and the reason for this is increase in energy cost of walking. Therefore, the treatment techniques which targets on correction of gait abnormalities and Energy conservation during walking are important to maintain orimprove independent functioning.The aim is to find out the effects of using Supra Malleolar Orthosis (SMO along with co-activation exercise in the increase of gait endurance and also to encourage independent skills and abilities in cerebral palsy child. Methods: A 14 years child with spastic hemiplegic cerebral palsy was treated with custom made supra malleolar orthotic which was designed with an orthotic support followed with specific exercises, co-activating dorsiflexors and plantar flexors actively and with assistance. The subject was made to do the co-activation exercises 3 days per week for 8 weeks. Step length, stride length, cadence, navicular drop test, medial arch height and calcaneal eversion were measured before starting the treatment and at the end of 8th week. Results: the results of treatment shows that there is an improvement in 2 minutes’ walk test from 7(pre-test to 13, step length from 22 (pre-test to 32,stride length from 36(pre-test to 47,cadence from 39 (pretest to 37 after the use of Supra Malleolar Orthosis (SMO and a co-activation exercises intervention. There was a clear and significant improvement noted in navicular drop test, medial arch height and calcaneal eversion after a period of 8 weeks use of orthosis and exercise intervention when compared with pre-test value. Conclusion: Orthotic subtalar alignment with co-acticvation exercises for alteration in gait endurance in a child is showing

  4. A simple idea for reducing the cost and weight of plaster-cast orthoses Uma ideia simples para diminuir custo e peso das talas gessadas

    Directory of Open Access Journals (Sweden)

    André Esmanhotto

    2013-01-01

    Full Text Available OBJECTIVE: To reduce the cost and weight of plaster molded orthosis (increasing patient comfort, keeping the same resistance. METHODS: 22 plaster orthosis were analysed, 11 with conventional shape and 11 with pyramidal shape. It was compared, in theory (mathematcally and practice, the change of weight (and consequently cost and flexion resistance between conventional shape and pyramidal shape. RESULTS: Theorical analysis: weight and cost decrease of 26.7%-38.9%, according to the layers disposition of the cast. Laboratorial analysis: cast´s weight decrease of 34.5% (p = 0.000005 and resistance increase of 26.7% (p = 0.03. CONCLUSION: plaster molded orthosis made in a pyramidal shape, have a statistically significant decrease of weight (and consequently cost and statistically significant increase of resistance if compared with traditional shape. OBJETIVO: Diminuir o custo e o peso (aumentando o conforto para o paciente das talas gessadas, mantendo resistência semelhante. MÉTODOS: Foram analisadas 22 talas de gesso, 11 com formato convencional e 11 com formato piramidal. Foi feita comparação, teórica (matemática e prática, entre as talas convencionais e as piramidais quanto à mudança de peso (e consequentemente de custo e à resistência à flexão. RESULTADOS: Análise matemática – diminuição peso e custo entre 26,7% e 38,9%, variando conforme a disposição das camadas da tala. Análise prática – diminuição do peso em 34,5% (p = 0,000005 e resistência aumentada em 26,7% (p = 0,03. CONCLUSÃO: A tala gessada com formato piramidal apresenta diminuição estatisticamente significativa de peso (e consequentemente de custo, com aumento estatisticamente significativo da resistência, se comparada à tala de formato convencional.

  5. Can an integrated orthotic and rehabilitation program decrease pain and improve function after lower extremity trauma?

    Science.gov (United States)

    Bedigrew, Katherine M; Patzkowski, Jeanne C; Wilken, Jason M; Owens, Johnny G; Blanck, Ryan V; Stinner, Daniel J; Kirk, Kevin L; Hsu, Joseph R

    2014-10-01

    Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation over time is unknown. (1) Does an 8-week integrated orthotic and rehabilitation initiative improve physical performance, pain, and outcomes in patients with lower extremity functional deficits or pain? (2) Is the magnitude of recovery different if enrolled more than 2 years after their injury versus earlier? (3) Does participation decrease the number considering late amputation? We prospectively evaluated 84 service members (53 less than and 31 > 2 years after injury) who enrolled in the initiative. Fifty-eight sustained fractures, 53 sustained nerve injuries with weakness, and six had arthritis (there was some overlap in the patients with fractures and nerve injuries, which resulted in a total of > 84). They completed 4 weeks of physical therapy without the orthosis followed by 4 weeks with it. Testing was conducted at Weeks 0, 4, and 8. Validated physical performance tests and patient-reported outcome surveys were used as well as questions pertaining to whether patients were considering an amputation. By 8 weeks, patients improved in all physical performance measures and all relevant patient-reported outcomes. Patients less than and greater than 2 years after injury improved similarly. Forty-one of 50 patients initially considering amputation favored limb salvage at the end of 8 weeks. We found this integrated orthotic and rehabilitation initiative improved physical performance, pain, and patient-reported outcomes in patients with severe, traumatic lower extremity deficits and that these improvements were sustained for > 2 years after injury. Efforts are underway to determine whether the Return to Run clinical pathway with the Intrepid Dynamic Exoskeletal

  6. Volition-adaptive control for gait training using wearable exoskeleton: preliminary tests with incomplete spinal cord injury individuals.

    Science.gov (United States)

    Rajasekaran, Vijaykumar; López-Larraz, Eduardo; Trincado-Alonso, Fernando; Aranda, Joan; Montesano, Luis; Del-Ama, Antonio J; Pons, Jose L

    2018-01-03

    Gait training for individuals with neurological disorders is challenging in providing the suitable assistance and more adaptive behaviour towards user needs. The user specific adaptation can be defined based on the user interaction with the orthosis and by monitoring the user intentions. In this paper, an adaptive control model, commanded by the user intention, is evaluated using a lower limb exoskeleton with incomplete spinal cord injury individuals (SCI). A user intention based adaptive control model has been developed and evaluated with 4 incomplete SCI individuals across 3 sessions of training per individual. The adaptive control model modifies the joint impedance properties of the exoskeleton as a function of the human-orthosis interaction torques and the joint trajectory evolution along the gait sequence, in real time. The volitional input of the user is identified by monitoring the neural signals, pertaining to the user's motor activity. These volitional inputs are used as a trigger to initiate the gait movement, allowing the user to control the initialization of the exoskeleton movement, independently. A Finite-state machine based control model is used in this set-up which helps in combining the volitional orders with the gait adaptation. The exoskeleton demonstrated an adaptive assistance depending on the patients' performance without guiding them to follow an imposed trajectory. The exoskeleton initiated the trajectory based on the user intention command received from the brain machine interface, demonstrating it as a reliable trigger. The exoskeleton maintained the equilibrium by providing suitable assistance throughout the experiments. A progressive change in the maximum flexion of the knee joint was observed at the end of each session which shows improvement in the patient performance. Results of the adaptive impedance were evaluated by comparing with the application of a constant impedance value. Participants reported that the movement of the

  7. Brain oscillatory signatures of motor tasks.

    Science.gov (United States)

    Ramos-Murguialday, Ander; Birbaumer, Niels

    2015-06-01

    Noninvasive brain-computer-interfaces (BCI) coupled with prosthetic devices were recently introduced in the rehabilitation of chronic stroke and other disorders of the motor system. These BCI systems and motor rehabilitation in general involve several motor tasks for training. This study investigates the neurophysiological bases of an EEG-oscillation-driven BCI combined with a neuroprosthetic device to define the specific oscillatory signature of the BCI task. Controlling movements of a hand robotic orthosis with motor imagery of the same movement generates sensorimotor rhythm oscillation changes and involves three elements of tasks also used in stroke motor rehabilitation: passive and active movement, motor imagery, and motor intention. We recorded EEG while nine healthy participants performed five different motor tasks consisting of closing and opening of the hand as follows: 1) motor imagery without any external feedback and without overt hand movement, 2) motor imagery that moves the orthosis proportional to the produced brain oscillation change with online proprioceptive and visual feedback of the hand moving through a neuroprosthetic device (BCI condition), 3) passive and 4) active movement of the hand with feedback (seeing and feeling the hand moving), and 5) rest. During the BCI condition, participants received contingent online feedback of the decrease of power of the sensorimotor rhythm, which induced orthosis movement and therefore proprioceptive and visual information from the moving hand. We analyzed brain activity during the five conditions using time-frequency domain bootstrap-based statistical comparisons and Morlet transforms. Activity during rest was used as a reference. Significant contralateral and ipsilateral event-related desynchronization of sensorimotor rhythm was present during all motor tasks, largest in contralateral-postcentral, medio-central, and ipsilateral-precentral areas identifying the ipsilateral precentral cortex as an integral

  8. Brain oscillatory signatures of motor tasks

    Science.gov (United States)

    Birbaumer, Niels

    2015-01-01

    Noninvasive brain-computer-interfaces (BCI) coupled with prosthetic devices were recently introduced in the rehabilitation of chronic stroke and other disorders of the motor system. These BCI systems and motor rehabilitation in general involve several motor tasks for training. This study investigates the neurophysiological bases of an EEG-oscillation-driven BCI combined with a neuroprosthetic device to define the specific oscillatory signature of the BCI task. Controlling movements of a hand robotic orthosis with motor imagery of the same movement generates sensorimotor rhythm oscillation changes and involves three elements of tasks also used in stroke motor rehabilitation: passive and active movement, motor imagery, and motor intention. We recorded EEG while nine healthy participants performed five different motor tasks consisting of closing and opening of the hand as follows: 1) motor imagery without any external feedback and without overt hand movement, 2) motor imagery that moves the orthosis proportional to the produced brain oscillation change with online proprioceptive and visual feedback of the hand moving through a neuroprosthetic device (BCI condition), 3) passive and 4) active movement of the hand with feedback (seeing and feeling the hand moving), and 5) rest. During the BCI condition, participants received contingent online feedback of the decrease of power of the sensorimotor rhythm, which induced orthosis movement and therefore proprioceptive and visual information from the moving hand. We analyzed brain activity during the five conditions using time-frequency domain bootstrap-based statistical comparisons and Morlet transforms. Activity during rest was used as a reference. Significant contralateral and ipsilateral event-related desynchronization of sensorimotor rhythm was present during all motor tasks, largest in contralateral-postcentral, medio-central, and ipsilateral-precentral areas identifying the ipsilateral precentral cortex as an integral

  9. Visualisation to enhance biomechanical tuning of ankle-foot orthoses (AFOs in stroke: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Carse Bruce

    2011-12-01

    Full Text Available Abstract Background There are a number of gaps in the evidence base for the use of ankle-foot orthoses for stroke patients. Three dimensional motion analysis offers an ideal method for objectively obtaining biomechanical gait data from stroke patients, however there are a number of major barriers to its use in routine clinical practice. One significant problem is the way in which the biomechanical data generated by these systems is presented. Through the careful design of bespoke biomechanical visualisation software it may be possible to present such data in novel ways to improve clinical decision making, track progress and increase patient understanding in the context of ankle-foot orthosis tuning. Methods A single-blind randomised controlled trial will be used to compare the use of biomechanical visualisation software in ankle-foot orthosis tuning against standard care (tuning using observation alone. Participants (n = 70 will have experienced a recent hemiplegia (1-12 months and will be identified by their care team as being suitable candidates for a rigid ankle-foot orthosis. The primary outcome measure will be walking velocity. Secondary outcome measures include; lower limb joint kinematics (thigh and shank global orientations & kinetics (knee and hip flexion/extension moments, ground reaction force FZ2 peak magnitude, step length, symmetry ratio based on step length, Modified Ashworth Scale, Modified Rivermead Mobility Index and EuroQol (EQ-5D. Additional qualitative measures will also be taken from participants (patients and clinicians at the beginning and end of their participation in the study. The main aim of the study is to determine whether or not the visualisation of biomechanical data can be used to improve the outcomes of tuning ankle-foot orthoses for stroke patients. Discussion In addition to answering the primary research question the broad range of measures that will be taken during this study are likely to contribute to a

  10. [Locked retrograde fibula nail for the surgical treatment of unstable ankle fractures].

    Science.gov (United States)

    Förch, S; Franz, U; Mayr, E

    2017-12-01

    Minimally invasive surgical stabilization of ankle fractures allowing postoperative full weight bearing. Unstable ankle fractures type Weber B and C in the geriatric patients or with a critical soft tissue situation. Ankle fractures in young patients and patients with high demands (relative contraindication). Closed reduction, retrograde insertion of the intramedullary nail into the fibula via a small incision, insertion of up to four locking screws using an aiming device and small incisions. Full weight bearing in an ankle joint orthosis. In 34 patients who were treated with a retrograde fibula nail, a 6-month follow-up was possible in 18 patients. Osseous consolidation was achieved without any soft tissue complications or infections in all 18 cases. The patients regained their preoperative level of mobility (Parker Mobility Score 4.2 preoperative vs 4.3 postoperative).

  11. [Selection of treatment modalities in patients with spasticity].

    Science.gov (United States)

    Ota, Tetsuo

    2014-09-01

    Spasticity is the most common abnormality of muscle tone. Typically, oral antispastic drugs, phenol blocks, motor-point blocks, selective dorsal rhizotomies, and selective peripheral neurotomies are used to reduce muscle tone and/or improve ranges of motion. Recently, botulinum toxin injections and intrathecal baclofen have been used as treatment modalities. The selection of the most appropriate treatment modality by doctors treating patients with spasticity is critical. Furthermore, rehabilitation techniques, such as physiotherapy, occupational therapy, therapeutic electrical nerve stimulation, and orthosis, are useful as combination therapy for the treatment of spasticity. The purpose of this study was to outline the various modalities that are currently used for the treatment of spasticity. Regardless of the modality selected, it is imperative that treatment goals are carefully identified. The reduction of spasticity is not an appropriate treatment goal. Appropriate goals include improving gait, activities of daily living, and the quality of life.

  12. Multiple giant mid-thoracic esophageal diverticula in a teenager

    Directory of Open Access Journals (Sweden)

    Moo Cho

    2017-12-01

    Full Text Available Esophageal diverticula in the pediatric population are rare. The etiologies and presentations can vary widely which can make it difficult to diagnose without imaging or direct visualization. We are reporting a case of a 14-year-old male with history of asthma, anorexia, weight loss, and chest discomfort. CXR findings of mediastinal widening prompted a more extensive evaluation. He was found to have two esophageal diverticula, phlegmonous changes, and osteomyelitis of the T5 and T6 vertebra. He was initially treated with IV antibiotic therapy, bypassing the affected area with nasogastric enteric tube feedings, and a cervical thoracic orthosis brace for spine stability. He regained his lost weight and became asymptomatic, returning to a regular diet. The family has declined to pursue surgical intervention at present.

  13. Minimally invasive central corpectomy for ossified posterior longitudinal ligament in the cervical spine.

    Science.gov (United States)

    Hirano, Yoshitaka; Mizuno, Junichi; Nakagawa, Hiroshi; Itoh, Yasunobu; Kubota, Keiichi; Watanabe, Sadayoshi; Matsuoka, Hidenori; Numazawa, Shinichi; Tomii, Masato; Watanabe, Kazuo

    2011-01-01

    Minimally invasive central corpectomy (MICC) for cervical segmental ossified posterior longitudinal ligament (OPLL) is described. The procedure of MICC includes upper- or lower-half central corpectomy of the involved cervical spine, transdiscal decompression of the adjacent disc level, dissection and partial removal of the OPLL, removal of the OPLL behind the vertebral body via these windows, and fusion with cylindrical titanium cages. Anterior plate fixation is not necessary. From January 2008 to December 2009 we surgically treated three patients with cervical OPLL by MICC. All three patients showed remarkable improvement of their symptoms within a few days after the operation. No neurological or radiological complication was observed during that period. MICC is beneficial in avoiding complete corpectomy and long fusion, usage of an anterior plate, and usage of a large external orthosis. MICC also reduces the risk of postoperative esophageal perforation due to a screw backing out of the plate. 2010 Elsevier Ltd. All rights reserved.

  14. Atraumatic Pantalar Avascular Necrosis in a Patient With Alcohol Dependence.

    Science.gov (United States)

    Callachand, Fayaz; Milligan, David; Wilson, Alistair

    2016-01-01

    In the United States, an estimated 10,000 to 20,000 new cases of avascular necrosis are diagnosed each year. We present an unusual case of atraumatic avascular necrosis with widespread hindfoot and midfoot involvement. A 62-year-old female with a history of alcohol dependence and smoking, who had previously been treated for avascular necrosis of the knee, presented with right-sided foot pain and difficulty weightbearing. Imaging studies revealed extensive avascular necrosis of the hindfoot and midfoot, which precluded simple surgical intervention. The patient was followed up for 18 months. In the last 8 months of the 18-month period, the patient managed her symptoms using an ankle-foot orthosis. A diagnosis of avascular necrosis should be considered in patients with atraumatic foot and ankle pain, especially in the presence of risk factors such as alcohol excess and smoking. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Chance fracture of the lumbar spine in an amateur snowboarder: a case report.

    Science.gov (United States)

    Hakozaki, M; Otani, K; Kikuchi, S; Konno, S

    2010-06-01

    "Chance fracture" is an unusual type of spinal fracture caused by flexion-distraction of the back. We describe herein a rare case of a male amateur snowboarder who suffered lumbar Chance fracture caused by a fall after freestyle jumping. Radiological findings of plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a loss of vertebral height in the anterior L1 vertebral body with a horizontal splitting fracture extending across the vertebral body, bilateral pedicles, and lamina. On the basis of the aforementioned findings, the diagnosis of Chance fracture of the L1 vertebra was established. The fracture healed without any subsequent disabilities following conservative medical management with a thoracolumbar orthosis, and no impairments to activities of daily living were encountered, including job or sports performance. Although Chance fracture caused by a fall is rare, particularly in sports, the possibility of this fracture should be considered when diagnosing spinal injuries in snowboarders.

  16. The unusual chance fracture: case report & literature review.

    Science.gov (United States)

    Karargyris, O; Morassi, Lg; Zafeiris, C; Evangelopoulos, Ds; Pneumaticos, Sg

    2013-01-01

    The Chance fracture represents a spinal lesion caused by a flexion-distraction injury pattern. We describe a rare case of a male driver admitted at the Emergencies of our Institution, level A Trauma center. The was involved in an automobile accident without wearing a seatbelt. Radiological findings of plain radiography and computed tomography (CT) demonstrated a horizontal fracture extending across the vertebral body to the posterior elements with loss of vertebral height at the anterior aspect of T12. Based on these findings, the diagnosis of a T12 Chance fracture was established. The patient was treated conservatively with a thoracolumbar orthosis, without any subsequent disabilities. Although Chance fractures are rare lesions, they should always be considered in spinal injuries, even in cases of motor-vehicle accidents where no seatbelt is used.

  17. Common injuries in volleyball. Mechanisms of injury, prevention and rehabilitation.

    Science.gov (United States)

    Briner, W W; Kacmar, L

    1997-07-01

    Volleyball has become an extremely popular participation sport worldwide. Fortunately, the incidence of serious injury is relatively low. The sport-specific activity most commonly associated with injury is blocking. Ankle sprains are the most common acute injury. Recurrent sprains may be less likely to occur if an ankle orthosis is worn. Patellar tendinitis represents the most common overuse injury, although shoulder tendinitis secondary to the overhead activities of spiking and serving is also commonly seen. An unusual shoulder injury involving the distal branch of the suprascapular nerve which innervates the infraspinatus muscle has been increasingly described in volleyball players in recent years. Hand injuries, usually occurring while blocking, are the next most common group of injuries. Fortunately, severe knee ligament injuries are rare in volleyball. However, anterior crutiate ligament injury is more likely to occur in female players. Many of these injuries may be preventable with close attention to technique in sport-specific skills and some fairly simple preventive interventions.

  18. Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide

    Directory of Open Access Journals (Sweden)

    Naohisa Miyakoshi

    2015-01-01

    Full Text Available Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12° and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.

  19. In-vivo analysis of ankle joint movement for patient-specific kinematic characterization.

    Science.gov (United States)

    Ferraresi, Carlo; De Benedictis, Carlo; Franco, Walter; Maffiodo, Daniela; Leardini, Alberto

    2017-09-01

    In this article, a method for the experimental in-vivo characterization of the ankle kinematics is proposed. The method is meant to improve personalization of various ankle joint treatments, such as surgical decision-making or design and application of an orthosis, possibly to increase their effectiveness. This characterization in fact would make the treatments more compatible with the specific patient's joint physiological conditions. This article describes the experimental procedure and the analytical method adopted, based on the instantaneous and mean helical axis theories. The results obtained in this experimental analysis reveal that more accurate techniques are necessary for a robust in-vivo assessment of the tibio-talar axis of rotation.

  20. Ankle and subtalar synovitis in a ball-and-socket ankle joint causing posterolateral painful coarse crepitus: a case report.

    Science.gov (United States)

    Fan, Ka Yuk; Lui, Tun Hing

    2014-01-01

    A 17-year-old girl with bilateral ball-and-socket ankles reported left medial heel pain. Her left heel had gone into a varus position on tiptoeing, and a painful clunk had occurred when returning to normal standing. The clunk persisted after physiotherapy and treatment with an orthosis. Subtalar arthroscopy and peroneal tendoscopy showed mild diffuse synovitis of the ankle joint, especially over the posterior capsule, and a patch of inflamed and fibrotic synovium at the posterolateral corner of the subtalar joint. The clunk subsided immediately after arthroscopic synovectomy and had not recurred during 5 years of follow-up. We found no other reported cases of ankle and subtalar synovitis occurring in patients with a ball-and-socket ankle joint. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Slow walking model for children with multiple disabilities via an application of humanoid robot

    Science.gov (United States)

    Wang, ZeFeng; Peyrodie, Laurent; Cao, Hua; Agnani, Olivier; Watelain, Eric; Wang, HaoPing

    2016-02-01

    Walk training research with children having multiple disabilities is presented. Orthosis aid in walking for children with multiple disabilities such as Cerebral Palsy continues to be a clinical and technological challenge. In order to reduce pain and improve treatment strategies, an intermediate structure - humanoid robot NAO - is proposed as an assay platform to study walking training models, to be transferred to future special exoskeletons for children. A suitable and stable walking model is proposed for walk training. It would be simulated and tested on NAO. This comparative study of zero moment point (ZMP) supports polygons and energy consumption validates the model as more stable than the conventional NAO. Accordingly direction variation of the center of mass and the slopes of linear regression knee/ankle angles, the Slow Walk model faithfully emulates the gait pattern of children.

  2. [Ankle braces prevent ligament injuries].

    Science.gov (United States)

    Karlsson, Jon

    2002-09-05

    The Cochrane collaboration has performed a meta-analysis of all studies found on the prevention of ankle ligament injuries, frequent in sports like soccer, European handball and basketball. Interventions include the use of modified footwear and associated supports, training programmes and health education. Five randomized trials totalling 3,954 participants were included. With the exception of ankle disc training, all prophylactic interventions entailed the application of an external ankle support in the form of a semi-rigid orthosis, air-cast or high top shoes. The studies showed a significant reduction in the number of ankle sprains in individuals allocated to external ankle support. This reduction was greater for those with a previous history of ankle sprains.

  3. Effect of surgical shoes on brake response time after first metatarsal osteotomy--a prospective cohort study.

    Science.gov (United States)

    Dammerer, Dietmar; Braito, Matthias; Biedermann, Rainer; Ban, Michael; Giesinger, Johannes; Haid, Christian; Liebensteiner, Michael C; Kaufmann, Gerhard

    2016-01-20

    The aim of this study is to assess patients' driving ability when wearing surgical shoes following right-sided first metatarsal osteotomy. From August 2013 to August 2015, 42 consecutive patients (mean age 54.5 years) with right-sided hallux valgus deformity underwent first metatarsal osteotomy. Patients were tested for brake response time (BRT) 1 day preoperatively (control run) and at 2 and 6 weeks postoperatively. Two different types of foot orthosis were investigated. BRT was assessed using a custom-made driving simulator. Preoperative BRT was 712 msec (standard deviation (SD), 221 msec). BRT was significantly slower at all tested postoperative times than preoperatively (p shoes. Mean global American Orthopaedic Foot and Ankle Society (AOFAS) outcome score and AOFAS pain and alignment subscores increased postoperatively (p shoe after bunionectomy. However, patients should have sufficient recovery, exercise, and training before resuming driving a car, because safety is always a priority. ClinicalTrials.gov, NCT02354066.

  4. Technologies for Medical Sciences

    CERN Document Server

    Tavares, João; Barbosa, Marcos; Slade, AP

    2012-01-01

    This book presents novel and advanced technologies for medical sciences in order to solidify knowledge in the related fields and define their key stakeholders.   The fifteen papers included in this book were written by invited experts of international stature and address important technologies for medical sciences, including: computational modeling and simulation, image processing and analysis, medical imaging, human motion and posture, tissue engineering, design and development medical devices, and mechanic biology. Different applications are treated in such diverse fields as biomechanical studies, prosthesis and orthosis, medical diagnosis, sport, and virtual reality.   This book is of interest to researchers, students and manufacturers from  a wide range of disciplines related to bioengineering, biomechanics, computational mechanics, computational vision, human motion, mathematics, medical devices, medical image, medicine and physics.

  5. Design of active orthoses for a robotic gait rehabilitation system

    Science.gov (United States)

    Villa-Parra, A. C.; Broche, L.; Delisle-Rodríguez, D.; Sagaró, R.; Bastos, T.; Frizera-Neto, A.

    2015-09-01

    An active orthosis (AO) is a robotic device that assists both human gait and rehabilitation therapy. This work proposes portable AOs, one for the knee joint and another for the ankle joint. Both AOs will be used to complete a robotic system that improves gait rehabilitation. The requirements for actuator selection, the biomechanical considerations during the AO design, the finite element method, and a control approach based on electroencephalographic and surface electromyographic signals are reviewed. This work contributes to the design of AOs for users with foot drop and knee flexion impairment. However, the potential of the proposed AOs to be part of a robotic gait rehabilitation system that improves the quality of life of stroke survivors requires further investigation.

  6. The health belief model and factors associated with adherence to treatment recommendations for positional plagiocephaly.

    Science.gov (United States)

    Lam, Sandi; Luerssen, Thomas G; Hadley, Caroline; Daniels, Bradley; Strickland, Ben A; Brookshier, Jim; Pan, I-Wen

    2017-03-01

    OBJECTIVE This study aimed to examine factors associated with adherence to recommended treatment among pediatric patients with positional skull deformity by reviewing a single-institution experience (2007-2014) with the treatment of positional plagiocephaly. METHODS A retrospective chart review was conducted. Risk factors, treatment for positional head shape deformity, and parent-reported adherence were recorded. Univariate and multivariate analyses were used to assess the impact of patient clinical and demographic characteristics on adherence. RESULTS A total of 991 patients under age 12 months were evaluated for positional skull deformity at the Texas Children's Hospital Cranial Deformity Clinic between 2007 and 2014. According to an age- and risk factor-based treatment algorithm, patients were recommended for repositioning, physical therapy, or cranial orthosis therapy or crossover from repositioning/physical therapy into cranial orthosis therapy. The patients' average chronological age at presentation was 6.2 months; 69.3% were male. The majority were white (40.7%) or Hispanic (32.6%); 38.7% had commercial insurance and 37.9% had Medicaid. The most common initial recommended treatment was repositioning or physical therapy; 85.7% of patients were adherent to the initial recommended treatment. Univariate analysis showed differences in adherence rates among subgroups. Children's families with Medicaid were less likely to be adherent to treatment recommendations (adherence rate, 80.2%). Families with commercial insurance were more likely to be adherent to the recommended treatment (89.6%). Multivariate logistic regression confirmed that factors associated with parent-reported adherence to recommended treatment included primary insurance payer, diagnosis (plagiocephaly vs brachycephaly), and the nature of the recommended treatment. Families were less likely to be adherent if they had Medicaid, a child with a diagnosis of brachycephaly, or were initially recommended

  7. Electrical Resistivity-Based Study of Self-Sensing Properties for Shape Memory Alloy-Actuated Artificial Muscle

    Directory of Open Access Journals (Sweden)

    Jian-Ying Zhu

    2013-09-01

    Full Text Available Shape memory alloy (SMA has great potential to develop light and compact artificial muscle (AM due to its muscle-like high power-to-weight ratio, flexibility and silent operation properties. In this paper, SMA self-sensing properties are explored and modeled in depth to imitate the integrated muscle-like functions of actuating and self-sensing for SMA-AM based on the investigation of SMA electrical resistivity (ER. Firstly, an ER transformation kinetics model is proposed based on the simulation of SMA differential scanning calorimetry (DSC curves. Then a series of thermal-electrical-mechanical experiments are carried out to verify the validity of the ER model, whereby the SMA-AM self-sensing function is well established under different stress conditions. Finally the self-sensing capability is further demonstrated by its application to a novel SMA-AM-actuated active ankle-foot orthosis (AAFO.

  8. Stance disturbance in multiple sclerosis: brainstem lesions and posturographic assessment

    Directory of Open Access Journals (Sweden)

    Peter Schalek

    2012-01-01

    Full Text Available

    Background. Balance disorders are commonly evidenced during the course of multiple sclerosis (MS. The aim of this study is to report characteristics of MS patient stance control disorders, measured by means of posturography and related to the brainstem lesions.

    Methods. Thirty-eight patients affected by MS, mildly to moderately disable according to Kurtzke’s Expanded Disability Status Scale, underwent a complete clinical neurological and vestibular evaluation and brain MRI scanning. All patients were then tested on a static posturography platform (Tetrax, Israel in four conditions: eyes open and closed standing on a firm surface and on a foam pad.

    Results. Clinical and/or MRI evidence of brainstem involvement was observed in 55.3 % of patients. When brainstem lesion was detected, Fourier analysis showed a typical pattern characterized by inversion of the  0- 0.1 Hz and  0.1 - 0.25 Hz. frequency bands.

    Conclusions. MS leads to pervasive postural disturbances in the majority of subjects, including the visuo-vestibular loops and proprioception involving vestibulo-spinal pathways in at least 55.3 % of patients. Our results may also suggest the presence of Fourier inversion in patients with brainstem lesions.


  9. Inducing self-selected human engagement in robotic locomotion training.

    Science.gov (United States)

    Collins, Steven H; Jackson, Rachel W

    2013-06-01

    Stroke leads to severe mobility impairments for millions of individuals each year. Functional outcomes can be improved through manual treadmill therapy, but high costs limit patient exposure and, thereby, outcomes. Robotic gait training could increase the viable duration and frequency of training sessions, but robotic approaches employed thus far have been less effective than manual therapy. These shortcomings may relate to subconscious energy-minimizing drives, which might cause patients to engage less actively in therapy when provided with corrective robotic assistance. We have devised a new method for gait rehabilitation that harnesses, rather than fights, least-effort tendencies. Therapeutic goals, such as increased use of the paretic limb, are made easier than the patient's nominal gait through selective assistance from a robotic platform. We performed a pilot test on a healthy subject (N = 1) in which altered self-selected stride length was induced using a tethered robotic ankle-foot orthosis. The subject first walked on a treadmill while wearing the orthosis with and without assistance at unaltered and voluntarily altered stride length. Voluntarily increasing stride length by 5% increased metabolic energy cost by 4%. Robotic assistance decreased energy cost at both unaltered and voluntarily increased stride lengths, by 6% and 8% respectively. We then performed a test in which the robotic system continually monitored stride length and provided more assistance if the subject's stride length approached a target increase. This adaptive assistance protocol caused the subject to slowly adjust their gait patterns towards the target, leading to a 4% increase in stride length. Metabolic energy consumption was simultaneously reduced by 5%. These results suggest that selective-assistance protocols based on targets relevant to rehabilitation might lead patients to self-select desirable gait patterns during robotic gait training sessions, possibly facilitating better

  10. Patient specific ankle-foot orthoses using rapid prototyping.

    Science.gov (United States)

    Mavroidis, Constantinos; Ranky, Richard G; Sivak, Mark L; Patritti, Benjamin L; DiPisa, Joseph; Caddle, Alyssa; Gilhooly, Kara; Govoni, Lauren; Sivak, Seth; Lancia, Michael; Drillio, Robert; Bonato, Paolo

    2011-01-12

    Prefabricated orthotic devices are currently designed to fit a range of patients and therefore they do not provide individualized comfort and function. Custom-fit orthoses are superior to prefabricated orthotic devices from both of the above-mentioned standpoints. However, creating a custom-fit orthosis is a laborious and time-intensive manual process performed by skilled orthotists. Besides, adjustments made to both prefabricated and custom-fit orthoses are carried out in a qualitative manner. So both comfort and function can potentially suffer considerably. A computerized technique for fabricating patient-specific orthotic devices has the potential to provide excellent comfort and allow for changes in the standard design to meet the specific needs of each patient. In this paper, 3D laser scanning is combined with rapid prototyping to create patient-specific orthoses. A novel process was engineered to utilize patient-specific surface data of the patient anatomy as a digital input, manipulate the surface data to an optimal form using Computer Aided Design (CAD) software, and then download the digital output from the CAD software to a rapid prototyping machine for fabrication. Two AFOs were rapidly prototyped to demonstrate the proposed process. Gait analysis data of a subject wearing the AFOs indicated that the rapid prototyped AFOs performed comparably to the prefabricated polypropylene design. The rapidly prototyped orthoses fabricated in this study provided good fit of the subject's anatomy compared to a prefabricated AFO while delivering comparable function (i.e. mechanical effect on the biomechanics of gait). The rapid fabrication capability is of interest because it has potential for decreasing fabrication time and cost especially when a replacement of the orthosis is required.

  11. Patient specific ankle-foot orthoses using rapid prototyping

    Directory of Open Access Journals (Sweden)

    Sivak Seth

    2011-01-01

    Full Text Available Abstract Background Prefabricated orthotic devices are currently designed to fit a range of patients and therefore they do not provide individualized comfort and function. Custom-fit orthoses are superior to prefabricated orthotic devices from both of the above-mentioned standpoints. However, creating a custom-fit orthosis is a laborious and time-intensive manual process performed by skilled orthotists. Besides, adjustments made to both prefabricated and custom-fit orthoses are carried out in a qualitative manner. So both comfort and function can potentially suffer considerably. A computerized technique for fabricating patient-specific orthotic devices has the potential to provide excellent comfort and allow for changes in the standard design to meet the specific needs of each patient. Methods In this paper, 3D laser scanning is combined with rapid prototyping to create patient-specific orthoses. A novel process was engineered to utilize patient-specific surface data of the patient anatomy as a digital input, manipulate the surface data to an optimal form using Computer Aided Design (CAD software, and then download the digital output from the CAD software to a rapid prototyping machine for fabrication. Results Two AFOs were rapidly prototyped to demonstrate the proposed process. Gait analysis data of a subject wearing the AFOs indicated that the rapid prototyped AFOs performed comparably to the prefabricated polypropylene design. Conclusions The rapidly prototyped orthoses fabricated in this study provided good fit of the subject's anatomy compared to a prefabricated AFO while delivering comparable function (i.e. mechanical effect on the biomechanics of gait. The rapid fabrication capability is of interest because it has potential for decreasing fabrication time and cost especially when a replacement of the orthosis is required.

  12. Comparison of plantar pressure distribution in CAD-CAM and prefabricated foot orthoses in patients with flexible flatfeet.

    Science.gov (United States)

    Khodaei, Banafsheh; Saeedi, Hassan; Jalali, Maryam; Farzadi, Maede; Norouzi, Ehsan

    2017-12-01

    The effect of foot orthoses on plantar pressure distribution has been proven by researchers but there are some controversies about advantages of custom-made foot orthoses to less expensive prefabricated foot orthoses. Nineteen flatfeet adults between 18 and 45 participated in this study. CAD-CAM foot orthoses were made for these patients according to their foot scan. Prefabricated foot orthoses were prepared according to their foot size. Plantar pressure, force and contact area were measured using pedar ® -x in-shoe system wearing shoe alone, wearing CAD-CAM foot orthoses and wearing prefabricated foot orthoses. Repeated measures ANOVA model with post-hoc, Bonferroni comparison were used to test differences. CAD-CAM and prefabricated foot orthoses both decreased pressure and force under 2nd, 3-5 metatarsal and heel regions comparing to shoe alone condition. CAD-CAM foot orthosis increased pressure under lateral toe region in comparison to shoe alone and prefabricated foot orthosis. Both foot orthoses increased pressure and contact area in medial midfoot region comparing to shoe alone condition. Increased forces were seen at hallux and lateral toes by prefabricated foot orthoses in comparison with CAD-CAM foot orthoses and control condition, respectively. According to the results, both foot orthoses could decrease the pressure under heel and metatarsal area. It seems that the special design of CAD-CAM foot orthoses could not make great differences in plantar pressure distribution in this sample. Further research is required to determine whether these results are associated with different scan systems or design software. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Research of the spatial-temporal gait parameters and pressure characteristic in spastic diplegia children.

    Science.gov (United States)

    Pauk, Jolanta; Ihnatouski, Mikhail; Daunoraviciene, Kristina; Laskhousky, Uladimir; Griskevicius, Julius

    2016-01-01

    Spastic diplegia is the most common form of cerebral palsy. It presents with symmetric involvement of the lower limbs and upper limbs. Children with spastic diplegia frequently experience problems with motor control, spasticity, and balance which lead to gait abnormalities. The aim of this study is twofold. Firstly, to determine the differences in spatial-temporal gait parameters and magnitude of plantar pressure distribution between children with spastic diplegia (CP) and typical children. Secondly, to compare and evaluate main changes of plantar pressure and spatial-temporal gait parameters instead of data between spastic diplegia children with prescribed ankle - solid foot orthosis (AFOs) and without using AFOs. The evaluation was carried out on 20 spastic diplegia children and 10 agematched children as a control group aged 6-15 years. Twenty children with spastic diplegia CP were divided into two groups: ten subjects with prescribed AFOs and ten subjects without use of assistive device. Patients used the AFOs orthosis for one year. Measurements included in-shoe plantar pressure distribution and spatial-temporal gait parameters. Spatial-temporal gait parameters showed meaningful difference between study groups in velocity, stride length, step length and cadence ( p 0.05). Significant differences between typical and spastic diplegia children with AFOs were observed in the magnitude of plantar pressure under the toes, the metatarsal heads, the medial arch, and the heel ( p spastic diplegia patients with AFOs and without it. In conclusion, our current results showed that the use of AFOs, prescribed on a clinical basis by doctors improves gait patterns and gait stability in children with spastic cerebral palsy.

  14. Early Ankle Mobilization Promotes Healing in a Rabbit Model of Achilles Tendon Rupture.

    Science.gov (United States)

    Jielile, Jiasharete; Asilehan, Batiza; Wupuer, Aikeremu; Qianman, Bayixiati; Jialihasi, Ayidaer; Tangkejie, Wulanbai; Maimaitiaili, Abudouheilil; Shawutali, Nuerai; Badelhan, Aynaz; Niyazebieke, Hadelebieke; Aizezi, Adili; Aisaiding, Amuding; Bakyt, Yerzat; Aibek, Rakimbaiev; Wuerliebieke, Jianati

    2016-01-01

    The use of early mobilization of the ankle joint without orthosis in the treatment of Achilles tendon rupture has been advocated as the optimal management. The goal of this study was to compare outcomes in a postoperative rabbit model of Achilles tendon rupture between early mobilization and immobilized animals using a differential proteomics approach. In total, 135 rabbits were randomized into the control group (n=15), the postoperative cast immobilization (PCI) group (n=60), and the early mobilization (EM) group (n=60). A rupture of the Achilles tendon was created in each animal model and repaired microsurgically, and tendon samples were removed at 3, 7, 14, and 21 days postoperatively. Proteins were separated using 2-dimensional polyacrylamide gel electrophoresis and identified using peptide mass fingerprinting, tandem mass spectrometry, NCBI database searches, and bioinformatics analyses. A series of differentially expressed proteins were identified between groups, some of which may play an important role in Achilles tendon healing. Notable candidate proteins that were upregulated in the EM group were identified, such as CRMP-2, galactokinase 1, tropomyosin-4, and transthyretin. The healing of ruptured Achilles tendons appears to be affected at the level of protein expression with the use of early mobilization. The classic postoperative treatment of Achilles tendon rupture with an orthosis ignored the self-protecting instinct of humans. With a novel operative technique, the repaired tendon can persist the load that comes from traction in knee and ankle joint functional movement. In addition, kinesitherapy provided an excellent experimental outcome via a mechanobiological mechanism. Copyright 2016, SLACK Incorporated.

  15. Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children.

    Science.gov (United States)

    Brütsch, Karin; Schuler, Tabea; Koenig, Alexander; Zimmerli, Lukas; -Koeneke, Susan Mérillat; Lünenburger, Lars; Riener, Robert; Jäncke, Lutz; Meyer-Heim, Andreas

    2010-04-22

    Virtual reality (VR) offers powerful therapy options within a functional, purposeful and motivating context. Several studies have shown that patients' motivation plays a crucial role in determining therapy outcome. However, few studies have demonstrated the potential of VR in pediatric rehabilitation. Therefore, we developed a VR-based soccer scenario, which provided interactive elements to engage patients during robotic assisted treadmill training (RAGT). The aim of this study was to compare the immediate effect of different supportive conditions (VR versus non-VR conditions) on motor output in patients and healthy control children during training with the driven gait orthosis Lokomat*. A total of 18 children (ten patients with different neurological gait disorders, eight healthy controls) took part in this study. They were instructed to walk on the Lokomat in four different, randomly-presented conditions: (1) walk normally without supporting assistance, (2) with therapists' instructions to promote active participation, (3) with VR as a motivating tool to walk actively and (4) with the VR tool combined with therapists' instructions. The Lokomat gait orthosis is equipped with sensors at hip and knee joint to measure man-machine interaction forces. Additionally, subjects' acceptance of the RAGT with VR was assessed using a questionnaire. The mixed ANOVA revealed significant main effects for the factor CONDITIONS (p VR scenario compared with the baseline measurement "normal walking" (p VR scenario used here induces an immediate effect on motor output to a similar degree as the effect resulting from verbal instructions by the therapists. Further research needs to focus on the implementation of interactive design elements, which keep motivation high across and beyond RAGT sessions, especially in pediatric rehabilitation.

  16. Ankle-foot orthoses in children with cerebral palsy: a cross sectional population based study of 2200 children.

    Science.gov (United States)

    Wingstrand, Maria; Hägglund, Gunnar; Rodby-Bousquet, Elisabet

    2014-10-02

    Ankle-foot orthosis (AFO) is the most frequently used type of orthosis in children with cerebral palsy (CP). AFOs are designed either to improve function or to prevent or treat muscle contractures. The purpose of the present study was to analyse the use of, the indications for, and the outcome of using AFO, relative to age and gross motor function in a total population of children with cerebral palsy. A cross-sectional study was performed of 2200 children (58% boys, 42% girls), 0-19 years old (median age 7 years), based on data from the national Swedish follow-up programme and registry for CP. To analyse the outcome of passive ankle dorsiflexion, data was compared between 2011 and 2012. The Gross motor classification system (GMFCS) levels of included children was as follows: I (n = 879), II (n = 357), III (n = 230), IV (n = 374) and V (n = 355). AFOs were used by 1127 (51%) of the children. In 215 children (10%), the indication was to improve function, in 251 (11%) to maintain or increase range of motion, and 661 of the children (30%) used AFOs for both purposes. The use of AFOs was highest in 5-year-olds (67%) and was more frequent at lower levels of motor function with 70% at GMFCS IV-V. Physiotherapists reported achievement of functional goals in 73% of the children using AFOs and maintenance or improvement in range of ankle dorsiflexion in 70%. AFOs were used by half of the children with CP in Sweden. The treatment goals were attained in almost three quarters of the children, equally at all GMFCS levels. AFOs to improve range of motion were more effective in children with a more significant decrease in dorsiflexion at baseline.

  17. Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children

    Directory of Open Access Journals (Sweden)

    Zimmerli Lukas

    2010-04-01

    Full Text Available Abstract Background Virtual reality (VR offers powerful therapy options within a functional, purposeful and motivating context. Several studies have shown that patients' motivation plays a crucial role in determining therapy outcome. However, few studies have demonstrated the potential of VR in pediatric rehabilitation. Therefore, we developed a VR-based soccer scenario, which provided interactive elements to engage patients during robotic assisted treadmill training (RAGT. The aim of this study was to compare the immediate effect of different supportive conditions (VR versus non-VR conditions on motor output in patients and healthy control children during training with the driven gait orthosis Lokomat®. Methods A total of 18 children (ten patients with different neurological gait disorders, eight healthy controls took part in this study. They were instructed to walk on the Lokomat in four different, randomly-presented conditions: (1 walk normally without supporting assistance, (2 with therapists' instructions to promote active participation, (3 with VR as a motivating tool to walk actively and (4 with the VR tool combined with therapists' instructions. The Lokomat gait orthosis is equipped with sensors at hip and knee joint to measure man-machine interaction forces. Additionally, subjects' acceptance of the RAGT with VR was assessed using a questionnaire. Results The mixed ANOVA revealed significant main effects for the factor CONDITIONS (p Conclusions The VR scenario used here induces an immediate effect on motor output to a similar degree as the effect resulting from verbal instructions by the therapists. Further research needs to focus on the implementation of interactive design elements, which keep motivation high across and beyond RAGT sessions, especially in pediatric rehabilitation.

  18. Balance and walking involvement in facioscapulohumeral dystrophy: a pilot study on the effects of custom lower limb orthoses.

    Science.gov (United States)

    Aprile, I; Bordieri, C; Gilardi, A; Lainieri Milazzo, M; Russo, G; De Santis, F; Frusciante, R; Iannaccone, E; Erra, C; Ricci, E; Padua, L

    2013-04-01

    Autosomal dominant facioscapulohumeral dystrophy (FSHD), the third most common muscular dystrophy, is characterised by asymmetric and highly variable muscle weakness. In FSHD patients, the coupling of the ankle muscles impairment with the knee, hip and abdominal muscles impairment, causes complex alterations of balance and walking with deterioration of quality of life (QoL). The aim of this pilot study is to evaluate the effects of custom orthoses (foot orthosis-FO and ankle foot orthosis-AFO) on balance, walking and QoL of FSHD patients through a multidimensional approach. Pilot study. Outpatient Rehabilitation Department of Don Gnocchi Foundation. Fifteen patients with facioscapulohumeral muscular dystrophy were studied. On 15 FSHD patients clinical evaluation (Manual Muscle Test-MMT, Clinical Severity Score), performance tests (10 meter Walking test-10mWT and 2 minute Walking Test-2minWT), instrumental assessment (stabilometric evaluation), disability (Rivermead Mobility Index- RMI, Berg Balance Scale-BBS) and patient-oriented (Medical Outcome Study 36-item Short Form-SF-36, North American Spine Society-NASS and Visual Analogue Scale-VAS) measures were performed. Patients were evaluated first, wearing their shoes and then wearing their shoes plus orthoses. This evaluation was performed 1 month after wearing the orthoses. The shoes plus orthoses evaluation, performed after one month in which the patients daily wore the custom lower limb orthoses, showed a significant improvement of walking performance (10-mWT pstudy shows that in FSHD patients' custom lower limb orthoses (foot-orthoses and ankle-foot-orthoses); evaluated by using a multidimensional approach, improve walking, balance and QoL. These preliminary results suggest that custom lower limb orthoses could reduce the risk of falling with a positive effect on our patients' safety. Our results should encourage the scientific community to do efficacy study on this hot topic.

  19. The effects of orthoses, footwear, and walking aids on the walking ability of children and adolescents with spina bifida: A systematic review using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as a reference framework.

    Science.gov (United States)

    Ivanyi, Barbara; Schoenmakers, Marja; van Veen, Natasja; Maathuis, Karel; Nollet, Frans; Nederhand, Marc

    2015-12-01

    To date no review has been published that analyzes the efficacy of assistive devices on the walking ability of ambulant children and adolescents with spina bifida and, differentiates between the effects of treatment on gait parameters, walking capacity, and walking performance. To review the literature for evidence of the efficacy of orthotic management, footwear, and walking aids on gait and walking outcomes in ambulant children and adolescents with spina bifida. Systematic literature review. A systematic literature search was performed to identify studies that evaluated the effect of any type of lower limb orthoses, orthopedic footwear, or walking aids in ambulant children (≤18 years old) with spina bifida. Outcome measures and treatment results for gait parameters, walking capacity, and walking performance were identified using International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) as the reference framework. Six case-crossover studies met the criteria and were included in this systematic review. Four studies provided indications of the efficacy of the ankle-foot orthosis in improving a number of kinematic and kinetic properties of gait, stride characteristics, and the oxygen cost of walking. Two studies indicated that walking with forearm crutches may have a favorable effect on gait. The evidence level of these studies was low, and none of the studies assessed the efficacy of the intervention on walking capacity and walking performance. Some data support the efficacy of using ankle-foot orthosis and crutches for gait and walking outcomes at the body functions and structures level of the ICF-CY. Potential benefits at the activities and participation level have not been investigated. This is the first evidence-based systematic review of the efficacy of assistive devices for gait and walking outcomes for children with spina bifida. The ICF-CY is used as a reference framework to differentiate the effects of treatment

  20. Residual Upper Arm Motor Function Primes Innervation of Paretic Forearm Muscles in Chronic Stroke after Brain-Machine Interface (BMI) Training.

    Science.gov (United States)

    Curado, Marco Rocha; Cossio, Eliana Garcia; Broetz, Doris; Agostini, Manuel; Cho, Woosang; Brasil, Fabricio Lima; Yilmaz, Oezge; Liberati, Giulia; Lepski, Guilherme; Birbaumer, Niels; Ramos-Murguialday, Ander

    2015-01-01

    Abnormal upper arm-forearm muscle synergies after stroke are poorly understood. We investigated whether upper arm function primes paralyzed forearm muscles in chronic stroke patients after Brain-Machine Interface (BMI)-based rehabilitation. Shaping upper arm-forearm muscle synergies may support individualized motor rehabilitation strategies. Thirty-two chronic stroke patients with no active finger extensions were randomly assigned to experimental or sham groups and underwent daily BMI training followed by physiotherapy during four weeks. BMI sessions included desynchronization of ipsilesional brain activity and a robotic orthosis to move the paretic limb (experimental group, n = 16). In the sham group (n = 16) orthosis movements were random. Motor function was evaluated with electromyography (EMG) of forearm extensors, and upper arm and hand Fugl-Meyer assessment (FMA) scores. Patients performed distinct upper arm (e.g., shoulder flexion) and hand movements (finger extensions). Forearm EMG activity significantly higher during upper arm movements as compared to finger extensions was considered facilitation of forearm EMG activity. Intraclass correlation coefficient (ICC) was used to test inter-session reliability of facilitation of forearm EMG activity. Facilitation of forearm EMG activity ICC ranges from 0.52 to 0.83, indicating fair to high reliability before intervention in both limbs. Facilitation of forearm muscles is higher in the paretic as compared to the healthy limb (parm FMA scores predict facilitation of forearm muscles after intervention in both groups (significant correlations ranged from R = 0.752, p = 0.002 to R = 0.779, p = 0.001), but only in the experimental group upper arm FMA scores predict changes in facilitation of forearm muscles after intervention (R = 0.709, p = 0.002; R = 0.827, parm motor function primes recruitment of paralyzed forearm muscles in chronic stroke patients and predicts changes in their recruitment after BMI training. This

  1. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

    Science.gov (United States)

    Murphy, M.; Connolly, P.; O’Byrne, J.

    2008-01-01

    We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66–93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1–9 years) and mean in-hospital stay was 10 days (2–90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with

  2. Analysis of Interrelationships among Voluntary and Prosthetic Leg Joint Parameters Using Cyclograms

    Directory of Open Access Journals (Sweden)

    Nur Azah Hamzaid

    2017-04-01

    Full Text Available The walking mechanism of a prosthetic leg user is a tightly coordinated movement of several joints and limb segments. The interaction among the voluntary and mechanical joints and segments requires particular biomechanical insight. This study aims to analyze the inter-relationship between amputees' voluntary and mechanical coupled leg joints variables using cyclograms. From this analysis, the critical gait parameters in each gait phase were determined and analyzed if they contribute to a better powered prosthetic knee control design. To develop the cyclogram model, 20 healthy able-bodied subjects and 25 prosthesis and orthosis users (10 transtibial amputees, 5 transfemoral amputees, and 10 different pathological profiles of orthosis users walked at their comfortable speed in a 3D motion analysis lab setting. The gait parameters (i.e., angle, moment and power for the ankle, knee and hip joints were coupled to form 36 cyclograms relationship. The model was validated by quantifying the gait disparities of all the pathological walking by analyzing each cyclograms pairs using feed-forward neural network with backpropagation. Subsequently, the cyclogram pairs that contributed to the highest gait disparity of each gait phase were manipulated by replacing it with normal values and re-analyzed. The manipulated cyclograms relationship that showed highest improvement in terms of gait disparity calculation suggested that they are the most dominant parameters in powered-knee control. In case of transfemoral amputee walking, it was identified using this approach that at each gait sub-phase, the knee variables most responsible for closest to normal walking were: knee power during loading response and mid-stance, knee moment and knee angle during terminal stance phase, knee angle and knee power during pre-swing, knee angle at initial swing, and knee power at terminal swing. No variable was dominant during mid-swing phase implying natural pendulum effect of the

  3. Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial.

    Science.gov (United States)

    Valkering, Kars P; Aufwerber, Susanna; Ranuccio, Francesco; Lunini, Enricomaria; Edman, Gunnar; Ackermann, Paul W

    2017-06-01

    Functional weight-bearing mobilization may improve repair of Achilles tendon rupture (ATR), but the underlying mechanisms and outcome were unknown. We hypothesized that functional weight-bearing mobilization by means of increased metabolism could improve both early and long-term healing. In this prospective randomized controlled trial, patients with acute ATR were randomized to either direct post-operative functional weight-bearing mobilization (n = 27) in an orthosis or to non-weight-bearing (n = 29) plaster cast immobilization. During the first two post-operative weeks, 15°-30° of plantar flexion was allowed and encouraged in the functional weight-bearing mobilization group. At 2 weeks, patients in the non-weight-bearing cast immobilization group received a stiff orthosis, while the functional weight-bearing mobilization group continued with increased range of motion. At 6 weeks, all patients discontinued immobilization. At 2 weeks, healing metabolites and markers of procollagen type I (PINP) and III (PIIINP) were examined using microdialysis. At 6 and 12 months, functional outcome using heel-rise test was assessed. Healing tendons of both groups exhibited increased levels of metabolites glutamate, lactate, pyruvate, and of PIIINP (all p bearing mobilization group demonstrated significantly higher concentrations of glutamate compared to the non-weight-bearing cast immobilization group (p = 0.045).The upregulated glutamate levels were significantly correlated with the concentrations of PINP (r = 0.5, p = 0.002) as well as with improved functional outcome at 6 months (r = 0.4; p = 0.014). Heel-rise tests at 6 and 12 months did not display any differences between the two groups. Functional weight-bearing mobilization enhanced the early healing response of ATR. In addition, early ankle range of motion was improved without the risk of Achilles tendon elongation and without altering long-term functional outcome. The relationship between

  4. Severe obstructive sleep apnea treatment with oral appliance: the impact on obstructive, central and mixed events.

    Science.gov (United States)

    de Lourdes Rabelo Guimarães, Maria; Hermont, Ana Paula; de Azevedo, Pedro Guimarães; Bastos, Poliana Lima; de Oliveira, Millena Teles Portela; de Melo, Iracema Matos; Ottoboni, Guilherme Salles; Vedolin, Gabriela; Caram, Jorge Machado

    2018-03-01

    The aim of this study is to evaluate the effectiveness of two types of oral appliance (OA) in the treatment of severe obstructive sleep apnea syndrome (OSAS) and their impact on the reduction of obstructive, central and mixed apneas. Forty-eight patients suffering from severe OSAS with a history of non-adherence to positive airway pressure therapy were treated with OA (lingual orthosis and combined orthosis). Polysomnography exams were performed before and after treatment. Computed tomography and cephalometric radiography were requested for all patients to evaluate the titrated position of the OA and the airspace obtained. Statistical tests used the Minitab, version 17, program. The level of statistical significance was 5%. Before treatment, the mean AHI was 56.3 ± 19.1 events/h. It decreased to 8.1 ± 5.2 after the OA titration (p ≤ 0.001). There was a significant reduction in obstructive events from 43.0 ± 20.2 to 7.1 ± 4.6 events/h (p ≤ 0.001). The reduction in central events after OA treatment was also significant (from 5.1 ± 9.3 to 0.8 ± 1.9 events/h; p ≤ 0.001), whereas that in mixed events decreased from 6.4 ± 9.5 to 0.1 ± 0.3 events/h (p ≤ 0.001). The minimum oxygen saturation also showed significant improvement after treatment (p ≤ 0.001). There was no statistically significant difference between both OA with respect to central events (p = 0.22) or mixed events (p = 0.98). The treatment was effective in reducing obstructive events which were evaluated through the AHI and minimum oxygen saturation. The oral appliances also normalized central and mixed events among patients with severe OSAS.

  5. Efeitos do uso de órtese na mobilidade funcional de crianças com paralisia cerebral The effects of the use of orthoses on the functional mobility of children with cerebral palsy

    Directory of Open Access Journals (Sweden)

    VCR Cury

    2006-01-01

    Full Text Available Objetivo:Comparar o desempenho motor de crianças com paralisia cerebral (PC em duas condições: com órtese e sem órtese. Métodos:Vinte crianças PC foram avaliadas utilizando-se o teste Gross Motor Function Measure (GMFM, a versão modificada da avaliação da marcha Physicians Rating Scale (PRS e entrevista com os pais para avaliar o uso de órteses na rotina diária. Resultados:O teste ANOVA que foi utilizado para avaliar o efeito do uso órtese na mobilidade das crianças revelou médias significantemente superiores na condição com órtese durante o desempenho motor grosso e na marcha. Entrevistas informaram que o uso de órteses estava inserido na rotina diária e os pais demonstraram percepção positiva com relação ao uso desse dispositivo. Conclusão: As órteses promoveram o desempenho de tarefas motoras da rotina diária de crianças com PC, podendo orientar os processos de avaliação e de intervenção dos profissionais que trabalham com essa clientela.Objective:To compare the motor performance of children with cerebral palsy (CP under two conditions: with and without orthoses. Method:Twenty children with CP were evaluated using the Gross Motor Function Measure test (GMFM, a modified version of the Physicians Rating Scale (PRS locomotion assessment, and an interview with their parents to evaluate the use of orthoses in their daily routine. Results:The ANOVA test was used to evaluate the effect of orthosis use on the children's mobility, and it revealed that, when orthosis was used, the means for gross motor function and gait assessments were significantly higher. The interviews confirmed that the use of orthoses was included in the daily routine, and the parents demonstrated positive perceptions regarding the use of such devices. Conclusion: Orthoses improved the performance of routine daily motor tasks among the children with CP, and this finding may serve to guide the assessment and intervention processes of professionals

  6. A computational model of human-robot load sharing during robot-assisted arm movement training after stroke.

    Science.gov (United States)

    Reinkensmeyer, David J; Wolbrecht, Eric; Bobrow, James

    2007-01-01

    An important goal in robot-assisted movement therapy after neurologic injury is to provide an optimal amount of mechanical assistance to patients as they complete motor tasks. This paper presents a computational model of how humans interact with robotic therapy devices for the task of lifting a load to a desired height. The model predicts that an adaptive robotic therapy device will take over performance of the lifting task if the human motor control system contains a slacking term (i.e. a term that tries to the reduce force output of the arm when error is small) but the robot does not. We present experimental data from people with a chronic stroke as they train with a robotic arm orthosis that confirms this prediction. We also show that incorporating a slacking term into the robot overcomes this problem, increasing load sharing by the patient while still keeping kinematic errors small. These results provide insight into the computational mechanisms of human motor adaptation during rehabilitation therapy, and provide a framework for optimizing robot-assisted therapy.

  7. Virtual Reality to control active participation in a subacute stroke patient during robot-assisted gait training.

    Science.gov (United States)

    Bergmann, J; Krewer, C; Müller, F; Koenig, A; Riener, R

    2011-01-01

    Virtual Reality (VR) provides a promising medium to enrich robot assisted rehabilitation. VR applications present the opportunity to engage patients in therapy and control participation. The aim of this study was to investigate two strategies to control active participation of a stroke patient focusing on the involvement of the paretic leg in task solution. A subacute stroke patient with a severe hemiparesis performed two experiments on the driven gait orthosis Lokomat. Patient activity was quantified by weighted interaction torques measured in both legs (experiment A) and the paretic leg only (experiment B). The patient was able to successfully implement both the bilateral and unilateral control modality. Both control modes increased the motor output of the paretic leg, however the paretic leg control mode resulted in a much more differentiated regulation of the activity in the leg. Both control modes are appropriate approaches to enhance active participation and increase motor output in the paretic leg. Further research should evaluate the therapeutic benefit of patients with hemiparesis using the unilateral control mode depending on the severity of their impairment. © 2011 IEEE

  8. Isoforce: A new outrigger system for static progressive orthotic interventions of the proximal interphalangeal joint with constant force transmission-Results of a biomechanical study.

    Science.gov (United States)

    Marrel, Marion; Jörn Good, Ulla; Marks, Miriam; Herren, Daniel B; Goldhahn, Jörg

    Bench research-biomechanical study. Static progressive orthotic devices are efficient in treating contractures. However, current outriggers are unable to keep force transmission and the force application angle (FAA) constant. To evaluate the biomechanical performance of the Isoforce outrigger, a novel extension orthosis. A hand model was used to measure the required force at the outrigger and FAA, while simulating resolution of different contracture angles. We also tested feasibility in a small patient series. The force required with the Isoforce device never exceeded 2.4 N, and the FAA did not change more than 6°. Corresponding figures for the reference devices exceeded 16 N and 20°. The 7 patients testing the Isoforce extension device showed an extension deficit that decreased from 40° at baseline to 25° at 6 weeks. They rated the device as very comfortable to wear. Isoforce maintains constant force transmission and FAA throughout the full range of motion, promotes the lengthening of contracted structures, and is comfortable to wear. Not applicable. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  9. The Effects of Hip and Spine Orthoses on Braking Parameters: A Simulated Study With Healthy Subjects.

    Science.gov (United States)

    Hofmann, Ulf Krister; Thumm, Stefan; Jordan, Maurice; Walter, Christian; Rondak, Ina-Christine; Ipach, Ingmar

    2016-01-01

    Although a person's fitness to drive has gained more attention over the past few years, investigations have focused mainly on postsurgical (eg, hip arthroplasty) driving performance. Few data are available on how orthoses affect the ability to perform an emergency stop. To determine whether common lumbar and hip orthoses impair driving performance by increasing brake response time and weakening brake force (BF). Crossover repeated measures design. University hospital. A crossover, repeated-measures design was used to test 30 healthy volunteers with and without each of the orthoses in random order. A custom-made simulator was created from a car cabin fitted with measurement equipment to record braking parameters under realistic spatial constraints. Reaction time (RT), foot transfer time (FTT) (these 2 together: brake response time), and maximum BF. Although spine orthoses lead to statistically significant increases in RT (Vertebradyn-Strong, P = .002; Horizon 637 LSO, P = .32; and SofTec Dorso, P = .013), this effect was not observed in hip orthoses, where instead FTT was prolonged (DynaCox and Hohmann-like orthosis, P braking performance should be sufficient to continue driving. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  10. A multichannel-near-infrared-spectroscopy-triggered robotic hand rehabilitation system for stroke patients.

    Science.gov (United States)

    Lee, Jongseung; Mukae, Nobutaka; Arata, Jumpei; Iwata, Hiroyuki; Iramina, Keiji; Iihara, Koji; Hashizume, Makoto

    2017-07-01

    There is a demand for a new neurorehabilitation modality with a brain-computer interface for stroke patients with insufficient or no remaining hand motor function. We previously developed a robotic hand rehabilitation system triggered by multichannel near-infrared spectroscopy (NIRS) to address this demand. In a preliminary prototype system, a robotic hand orthosis, providing one degree-of-freedom motion for a hand's closing and opening, is triggered by a wireless command from a NIRS system, capturing a subject's motor cortex activation. To examine the feasibility of the prototype, we conducted a preliminary test involving six neurologically intact participants. The test comprised a series of evaluations for two aspects of neurorehabilitation training in a real-time manner: classification accuracy and execution time. The effects of classification-related factors, namely the algorithm, signal type, and number of NIRS channels, were investigated. In the comparison of algorithms, linear discrimination analysis performed better than the support vector machine in terms of both accuracy and training time. The oxyhemoglobin versus deoxyhemoglobin comparison revealed that the two concentrations almost equally contribute to the hand motion estimation. The relationship between the number of NIRS channels and accuracy indicated that a certain number of channels are needed and suggested a need for a method of selecting informative channels. The computation time of 5.84 ms was acceptable for our purpose. Overall, the preliminary prototype showed sufficient feasibility for further development and clinical testing with stroke patients.

  11. The specific role of gravitational accelerations for arterial adaptations.

    Science.gov (United States)

    Weber, Tobias; Ducos, Michel; Mulder, Edwin; Herrera, Frankyn; Brüggemann, Gert-Peter; Bloch, Wilhelm; Rittweger, Jörn

    2013-02-01

    It is mostly agreed that arterial adaptations occur, among others, in response to changes in mechanical stimuli. Models like bed rest, spinal cord injury, or limb suspension have been applied to study vascular adaptations to unloading in humans. However, these models cannot distinguish the role of muscle contractions and the role of gravitational accelerations for arterial adaptation. The HEPHAISTOS orthosis allows normal ambulation, while it significantly reduces force generation in the lower leg muscles. Eleven subjects wore HEPHAISTOS unilaterally for 56 days and were followed up for another 4 wk. Arterial diameters, intima media thickness (IMT), flow-mediated dilation (FMD), and resting blood flow (BF(rest)) were measured using high-frequency ultrasonography. Arterial adaptations were investigated in the superficial femoral artery (SFA), the brachial artery (BA), and the carotid artery (CA). Mean SFA resting diameter was decreased from 6.57 mm (SD = 0.74 mm) at baseline to 5.77 mm (SD = 0.87 mm) at the end of the intervention (P acceleration profiles in the lower leg constituting an important stimulus for the maintenance of FMD and wall-to-lumen ratio.

  12. A combined robotic and cognitive training for locomotor rehabilitation: Evidences of cerebral functional reorganization in two chronic traumatic brain injured patients

    Directory of Open Access Journals (Sweden)

    Katiuscia eSacco

    2011-11-01

    Full Text Available It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found.

  13. An ecologically-controlled exoskeleton can improve balance recovery after slippage

    Science.gov (United States)

    Monaco, V.; Tropea, P.; Aprigliano, F.; Martelli, D.; Parri, A.; Cortese, M.; Molino-Lova, R.; Vitiello, N.; Micera, S.

    2017-05-01

    The evolution to bipedalism forced humans to develop suitable strategies for dynamically controlling their balance, ensuring stability, and preventing falling. The natural aging process and traumatic events such as lower-limb loss can alter the human ability to control stability significantly increasing the risk of fall and reducing the overall autonomy. Accordingly, there is an urgent need, from both end-users and society, for novel solutions that can counteract the lack of balance, thus preventing falls among older and fragile citizens. In this study, we show a novel ecological approach relying on a wearable robotic device (the Active Pelvis Orthosis, APO) aimed at facilitating balance recovery after unexpected slippages. Specifically, if the APO detects signs of balance loss, then it supplies counteracting torques at the hips to assist balance recovery. Experimental tests conducted on eight elderly persons and two transfemoral amputees revealed that stability against falls improved due to the “assisting when needed” behavior of the APO. Interestingly, our approach required a very limited personalization for each subject, and this makes it promising for real-life applications. Our findings demonstrate the potential of closed-loop controlled wearable robots to assist elderly and disabled subjects and to improve their quality of life.

  14. ALGORITHM OF TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN OF YOUNGER AGE GROUP

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    Ирина Юрьевна Клычкова

    2013-03-01

    Full Text Available Congenital clubfoot requires complete correction before the period of verticalization. Conservative methods are priority in treatment. The most effective method is Ponseti method that allows correcting all the deformations even in severe clubfoot. However, if clubfoot is accompanied with abnormal anatomy of foot or significant changes in functional ability of muscles, operative treatment is inevitable. The extent of surgical intervention depends on the severity of detected abnormalities and is determined individually. The use of ultasound, radiographic, and CT investigations, according to indications, contributes to the diagnostics. The indication for surgery is the lack of effect of conservative treatment after 10-12 cast correction in children over the age of 4 months. Diagnostic criteria for deciding in favor of surgery are: availability of fibrous coalition, the deformation of the talar or the sphenoid bone, the anomaly in the point of attachment of the tendon of the tibialis anterior muscle, lack of the repositioning of navicular bone on the talar head. Orthosis supply and rehabilitation treatment depend on the extent of surgical intervention.

  15. Effect of experimental muscle pain on the acquisition and retention of locomotor adaptation: different motor strategies for a similar performance.

    Science.gov (United States)

    Bouffard, Jason; Salomoni, Sauro Emerick; Mercier, Catherine; Tucker, Kylie J; Roy, Jean-Sebastien; van den Hoorn, Wolbert; Hodges, Paul W; Bouyer, Laurent J

    2018-01-24

    As individuals with musculoskeletal disorders often experience motor impairments, contemporary rehabilitation relies heavily on the use of motor learning principles. However, motor impairments are often associated with pain. While there is substantial evidence that muscle pain interferes with motor control, much less is known on its impact on motor learning, especially on locomotor learning. The objective of the present study was to assess the effects of muscle pain on locomotor learning. Two groups (Pain and Control) of healthy participants performed a locomotor adaptation task (robotized ankle-foot orthosis perturbing ankle movements during swing) on two consecutive days. On Day 1 (acquisition), hypertonic saline was injected in the Tibialis Anterior (TA) muscle of the Pain group participants, while Control group participants were pain-free. All participants were pain-free on Day 2 (retention). Changes in movement errors caused by the perturbation were assessed as an indicator of motor performance. Detailed analysis of kinematic and electromyographic data provided information about motor strategies. No between-group differences were observed on motor performance measured during the acquisition and retention phases. However, Pain group participants had a residual movement error later in the swing phase and smaller early TA activation than Control group participants, thereby suggesting a reduction in the use of anticipatory motor strategies to overcome the perturbation. Muscle pain did not interfere with global motor performance during locomotor adaptation. The different motor strategies used in the presence of muscle pain may reflect a diminished ability to anticipate the consequences of a perturbation.

  16. Dynamic long leg casting fixation for treating 12- to 18-month-old infants with developmental dysplasia of the hip.

    Science.gov (United States)

    Cai, Zhencun; Li, Lianyong; Zhang, Lijun; Ji, Shijun; Zhao, Qun

    2017-02-01

    Objective To evaluate the effect of dynamic long leg casting in paediatric patients with developmental dysplasia of hip (DDH) diagnosed at 12-18 months. Methods The adductor tenotomy, closed reduction, and dynamic long leg casting method was adopted to treat paediatric patients with DDH. The hips were divided into four groups according to the Tonnis radiographic dislocation classification. Groups were also classified according to the baseline acetabular index (AI): 30°-35°, 36°-40°, and > 40°. The outcomes of the reductions were evaluated according to McKay's hip function criteria and Severin's radiological criteria. Results A total of 246 patients (339 hips) had complete follow-up data. After 3 months of orthosis fixation, the results were satisfactory in 264 hips (77.88%). Hip function was rated as 'excellent' or 'good' in 43 of 51 (84.31%) Tonnis type 1 hips, 125 of 155 (80.65%) type 2 hips, 70 of 90 (77.78%) type 3 hips, and 34 of 43 (79.07%) type 4 hips. The higher the baseline AI, the lower the rates of 'excellent' and 'good' hip function. Favourable radiological results (Severin types I and II) were found in 266 of 339 (78.47) hips. Conclusions Dynamic long leg casting is an effective method for treating patients with DDH aged 12-18 months at diagnosis.

  17. Resistive flex sensors: a survey

    International Nuclear Information System (INIS)

    Saggio, Giovanni; Riillo, Francesco; Sbernini, Laura; Quitadamo, Lucia Rita

    2016-01-01

    Resistive flex sensors can be used to measure bending or flexing with relatively little effort and a relatively low budget. Their lightness, compactness, robustness, measurement effectiveness and low power consumption make these sensors useful for manifold applications in diverse fields. Here, we provide a comprehensive survey of resistive flex sensors, taking into account their working principles, manufacturing aspects, electrical characteristics and equivalent models, useful front-end conditioning circuitry, and physic-bio-chemical aspects. Particular effort is devoted to reporting on and analyzing several applications of resistive flex sensors, related to the measurement of body position and motion, and to the implementation of artificial devices. In relation to the human body, we consider the utilization of resistive flex sensors for the measurement of physical activity and for the development of interaction/interface devices driven by human gestures. Concerning artificial devices, we deal with applications related to the automotive field, robots, orthosis and prosthesis, musical instruments and measuring tools. The presented literature is collected from different sources, including bibliographic databases, company press releases, patents, master’s theses and PhD theses. (topical review)

  18. Effects of neurofeedback training with an electroencephalogram-based brain-computer interface for hand paralysis in patients with chronic stroke: a preliminary case series study.

    Science.gov (United States)

    Shindo, Keiichiro; Kawashima, Kimiko; Ushiba, Junichi; Ota, Naoki; Ito, Mari; Ota, Tetsuo; Kimura, Akio; Liu, Meigen

    2011-10-01

    To explore the effectiveness of neurorehabilitative training using an electroencephalogram-based brain- computer interface for hand paralysis following stroke. A case series study. Eight outpatients with chronic stroke demonstrating moderate to severe hemiparesis. Based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extending the affected fingers, real-time visual feedback was provided. After successful motor imagery, a mechanical orthosis partially extended the fingers. Brain-computer interface interventions were carried out once or twice a week for a period of 4-7 months, and clinical and neurophysiological examinations pre- and post-intervention were compared. New voluntary electromyographic activity was measured in the affected finger extensors in 4 cases who had little or no muscle activity before the training, and the other participants exhibited improvement in finger function. Significantly greater suppression of the sensory motor rhythm over both hemispheres was observed during motor imagery. Transcranial magnetic stimulation showed increased cortical excitability in the damaged hemisphere. Success rates of brain-computer interface training tended to increase as the session progressed in 4 cases. Brain-computer interface training appears to have yielded some improvement in motor function and brain plasticity. Further controlled research is needed to clarify the role of the brain-computer interface system.

  19. A preliminary study into the effects of pelvic rotations on upper body lateral translation.

    Science.gov (United States)

    Pennycott, Andrew; Wyss, Dario; Vallery, Heike; Riener, Robert

    2013-06-01

    An understanding concerning the roles of the various degrees of freedom of the human body during functions such as walking is crucial to the design of robotic devices for rehabilitation. However, the function of the three rotational degrees of freedom of the pelvis during walking remains uncertain. Theories have been previously presented postulating a role of pelvic obliquity in reducing vertical movements of the body's centre of mass, and therefore in minimising energy expenditure, but these are not fully supported by empirical evidence. In this paper, an alterative role of pelvic obliquity in reducing lateral movements of the upper body is proposed. Through the application of a robotic orthosis platform, a variety of walking conditions are tested with different levels of pelvic rotation and lateral movement of the upper body. The presence of the robotic device significantly reduces the degree of pelvic obliquity. Though the data show no significant relationship between the pelvic angles and lateral movement, a trend for decreasing upper body movement with increasing pelvic obliquity is apparent.

  20. A combined robotic and cognitive training for locomotor rehabilitation: evidences of cerebral functional reorganization in two chronic traumatic brain injured patients.

    Science.gov (United States)

    Sacco, Katiuscia; Cauda, Franco; D'Agata, Federico; Duca, Sergio; Zettin, Marina; Virgilio, Roberta; Nascimbeni, Alberto; Belforte, Guido; Eula, Gabriella; Gastaldi, Laura; Appendino, Silvia; Geminiani, Giuliano

    2011-01-01

    It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found.

  1. Subchondral cysts of the atlantoaxial joint: a risk factor for odontoid fractures in the elderly.

    Science.gov (United States)

    Julien, Terrill P; Schoenfeld, Andrew J; Barlow, Brian; Harris, Mitchel B

    2009-10-01

    Scholars have postulated that cervical degeneration can predispose the upper cervical spine to injury after minor trauma. Subchondral cysts have previously been recognized as potentiators of fracture in the hip and knee but no cases of cervical degenerative cysts contributing to fracture have been reported. This report documents a case series in which patients sustained significant injury to the upper cervical spine in the setting of subchondral cervical cysts. Case series/academic level I trauma center. Between 2004 and 2008, six patients (ages 73-91 years) with cervical pathology were admitted to the trauma service at our Level I trauma center. The most common mechanism of injury was a low velocity fall, which occurred in 5 out of 6 patients. All patients suffered an odontoid fracture. In all cases, there was radiographic evidence of cyst formation, and computed tomographic imaging demonstrated fracture communication with the subchondral cyst. Of the six cases, four were treated definitively with immobilization in a cervical orthosis and two required surgery. One patient was treated with an occipital-cervical fusion, whereas the other underwent Brooks wiring. All patients ultimately went on to heal their fractures. Degenerative changes in the cervical spine have previously been recognized to potentiate injury. This report raises the question of whether degenerative processes at the C1-C2 articulation predispose elderly patients to injury at this level. The presence of cystic degeneration at the atlantoaxial joint should be recognized as a potential risk factor for cervical injury after relatively minor trauma.

  2. Effect of Cathodal Transcranial Direct Current Stimulation on a Child with Involuntary Movement after Hypoxic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Mayumi Nagai

    2018-01-01

    Full Text Available The aim of the study was to investigate the effect of cathodal transcranial direct current stimulation to the supplementary motor area to inhibit involuntary movements of a child. An 8-year-old boy who developed hypoxic encephalopathy after asphyxia at the age of 2 had difficulty in remaining standing without support because of involuntary movements. He was instructed to remain standing with his plastic ankle-foot orthosis for 10 s at three time points by leaning forward with his forearms on a desk. He received cathodal or sham transcranial direct current stimulation to the supplementary motor area at 1 mA for 10 min. Involuntary movements during standing were measured using an accelerometer attached to his forehead. The low-frequency power of involuntary movements during cathodal transcranial direct current stimulation significantly decreased compared with that during sham stimulation. No adverse effects were observed. Involuntary movement reduction by cathodal stimulation to supplementary motor areas suggests that stimulations modulated the corticobasal ganglia motor circuit. Cathodal stimulation to supplementary motor areas may be effective for reducing involuntary movements and may be safely applied to children with movement disorders.

  3. Preliminary results of BRAVO project: brain computer interfaces for Robotic enhanced Action in Visuo-motOr tasks.

    Science.gov (United States)

    Bergamasco, Massimo; Frisoli, Antonio; Fontana, Marco; Loconsole, Claudio; Leonardis, Daniele; Troncossi, Marco; Foumashi, Mohammad Mozaffari; Parenti-Castelli, Vincenzo

    2011-01-01

    This paper presents the preliminary results of the project BRAVO (Brain computer interfaces for Robotic enhanced Action in Visuo-motOr tasks). The objective of this project is to define a new approach to the development of assistive and rehabilitative robots for motor impaired users to perform complex visuomotor tasks that require a sequence of reaches, grasps and manipulations of objects. BRAVO aims at developing new robotic interfaces and HW/SW architectures for rehabilitation and regain/restoration of motor function in patients with upper limb sensorimotor impairment through extensive rehabilitation therapy and active assistance in the execution of Activities of Daily Living. The final system developed within this project will include a robotic arm exoskeleton and a hand orthosis that will be integrated together for providing force assistance. The main novelty that BRAVO introduces is the control of the robotic assistive device through the active prediction of intention/action. The system will actually integrate the information about the movement carried out by the user with a prediction of the performed action through an interpretation of current gaze of the user (measured through eye-tracking), brain activation (measured through BCI) and force sensor measurements. © 2011 IEEE

  4. Design and analysis of coiled fiber reinforced soft pneumatic actuator.

    Science.gov (United States)

    Singh, Gaurav; Xiao, Chenzhang; Hsiao-Wecksler, Elizabeth T; Krishnan, Girish

    2018-04-18

    Fiber reinforced elastomeric enclosures (FREEs) are soft pneumatic actuators that can contract and generate forces upon pressurization. Typical engineering applications utilize FREEs in their straight cylindrical configuration and derive actuation displacement and forces from their ends. However, there are several instances in nature, such as an elephant trunk, snakes and grapevine tendrils, where a spiral configuration of muscle systems is used for gripping, thereby establishing a mechanical connection with uniform force distribution. Inspired by these examples, this paper investigates the constricting behavior of a contracting FREE actuator deployed in a spiral or coiled configuration around a cylindrical object. Force balance is used to model the blocked force of the FREE, which is then related to the constriction force using a string model. The modeling and experimental findings reveal an attenuation in the blocked force, and thus the constriction force caused by the coupling of peripheral contact forces acting in the spiral configuration. The usefulness of the coiled FREE configuration is demonstrated in a soft arm orthosis for crutch users that provides a constriction force around the forearm. This design minimizes injury risk by reducing wrist load and improving wrist posture.

  5. Are External Cervical Orthoses Necessary after Anterior Cervical Discectomy and Fusion: A Review of the Literature.

    Science.gov (United States)

    Camara, Richard; Ajayi, Olaide O; Asgarzadie, Farbod

    2016-07-14

    The use of external cervical orthosis (ECO) after anterior cervical discectomy and fusion (ACDF) varies from physician to physician due to an absence of clear guidelines. Our purpose is to evaluate and present evidence answering the question, "Does ECO after ACDF improve fusion rates?" through a literature review of current evidence for and against ECO after ACDF.  A PubMed database search was conducted using specific ECO and ACDF related keywords. Our search yielded a total of 1,267 abstracts and seven relevant articles. In summary, one study provided low quality of evidence results supporting the conclusion that external bracing is not associated with improved fusion rates after ACDF.  The remaining six studies provide very low quality of evidence results; two studies concluded that external bracing after cervical procedures is not associated with improved fusion rates, one study concluded that external bracing after cervical procedures is associated with improved fusion rates, and the remaining three studies lacked sufficient evidence to draw an association between external bracing after ACDF and improved fusion rates. We recommend against the routine use of ECO after ACDF due to a lack of improved fusion rates associated with external bracing after surgery.

  6. Increased lower limb muscle coactivation reduces gait performance and increases metabolic cost in patients with hereditary spastic paraparesis.

    Science.gov (United States)

    Rinaldi, Martina; Ranavolo, Alberto; Conforto, Silvia; Martino, Giovanni; Draicchio, Francesco; Conte, Carmela; Varrecchia, Tiwana; Bini, Fabiano; Casali, Carlo; Pierelli, Francesco; Serrao, Mariano

    2017-10-01

    The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis. Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time-distance, kinematic, kinetic, and energetic parameters were estimated. Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery. Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Prototype of a mechanical assistance device for the wrists' flexion-extension movement

    International Nuclear Information System (INIS)

    Politti, Julio C; Puglisi, Lisandro J; Farfan, Fernando D

    2007-01-01

    Using CMU actuators, a Prototype of Mechanical Assistance Device for the Wrist's Flexion Movement (PMA) was developed and probed in a mechanical model, in order to be implemented in a future as a dynamic powered orthosis or as a rehabilitation assistant instrument. Two Mayor Actuators conformed by three CMU actuators arranged in a series configuration, allows to an artificial hand to be placed in four predefined positions: 0 0 , 20 0 , 40 0 and 60 0 . The synchronism and control of the actuators is achieved with the Programmable Control Module (PCM). It is capable to drive up to six CMU actuators, and possess two different modes of execution: a Manual mode and an Exercise mode. In the Manual Mode, the position of the hand responds directly to the commands of the keyboard of the front panel, and in the Exercise mode, the hand realizes a repetitive and programmed movement. The prototype was tested in 100 positions in the Manual Mode and for 225 works cycles in the Exercise Mode. The relative repetition error was less than 5% for both test. This prototype only consumes 4,15W, which makes it possible to be powered by small rechargeable batteries, allowing its use as a portable device

  8. [Advances in the research of prevention and treatment of postburn contractures of hand].

    Science.gov (United States)

    Wang, K A; Wu, G S; Sun, Y; Xia, Z F

    2017-01-20

    Scar contracture deformity, which can lead to dysfunction of hand and low quality of life, is one of the common complication after hand burns. The prevention measures of scar contracture after hand burns include large skin grafting, prevention of infection, insistence on wearing pressure gloves, use of silicone sheets, wearing orthosis, accepting proper physical therapy, and early functional exercise. The primary treatments of postburn contractures of the hand are surgery, drugs, laser treatment, and rehabilitation therapy. Excision of scars, release of muscle, joints or bones, and soft tissue transplantation are the core of surgery. Laser treatment has a bright future but still needs to be further studied. Additionally, some novel treatments such as molecular targeted therapy, cell therapy, fat injection, and botulinum toxin injection will play important roles in prevention and treatment of postburn contractures in the future. The purpose of this article is to review the literature concerning postburn contractures of the hand, and summarize the present situation of prevention and treatment of such disease comprehensively.

  9. Postoperative stabilization of the posttraumatic thoracic and lumbar spine: a review of concepts and orthotic techniques.

    Science.gov (United States)

    Benzel, E C; Larson, S J

    1989-03-01

    A review of 109 case histories of patients who had undergone a spine fusion and/or posterior instrumentation procedure for thoracic and/or lumbar spine trauma was performed with respect to efficacy of several postoperative external splinting techniques. These data formed the basis for a review of external spinal splinting techniques. The type of orthosis that appears to offer the most efficacious immobilization and maximum patient comfort for fractures in the upper thoracic region in a body shell jacket extending from the submental and suboccipital regions to the lumbar region (modified Minerva jacket). To gain a lower point of fixation in patients with mid-to-low lumbar fractures, it was found that an extended body shell or an extension of a body jacket to one leg (hip spica) was necessary. Thoracic and thoracolumbar injuries may be stabilized with either a Jewett brace or a body jacket. The lack of maintenance of the cylindrical body shell, as well as excessive discomfort, make the Jewett brace and similar orthotic devices a second choice to body shell jackets for fractures in this region. The application of plastic polymer (Thermoplast) to spine splinting techniques offers the patient increased comfort and stability, as well as facilitating easy application and a more snug fit.

  10. Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system. Indications, techniques, and first results of treatment.

    Science.gov (United States)

    Aebi, M; Etter, C; Kehl, T; Thalgott, J

    1987-01-01

    Since 1984, 30 patients with burst fractures of the lower thoracic and lumbar spine were treated with AO internal spinal skeletal fixation system. All patients in this series had a minimum follow-up of 12 months. This new instrumentation is a posterior intrapedicular system developed by Dick in 1982. It allows stable fixation that is limited only to adjacent spinal segments. The internal fixator permits reduction in all three planes. Independently, it is possible to add distraction or compression to the involved segments. It also is able to reduce effectively the "middle column" which is thought to be accomplished by "ligamentotaxis." In this series there were 16 neurologically intact patients and 14 with partial or complete neurologic injury. There were two minor instrumentation loosenings early in the series. Most patients in this series had a near-anatomic reduction of all three columns in the involved segment. It was also possible to re-establish the normal lordosis of the lumbar spine. The device provided sufficient rigid fixation for rapid postoperative mobilization in a light external orthosis.

  11. Scoliosis secondary to lumbar osteoid osteoma: A case report of delayed diagnosis and literature review.

    Science.gov (United States)

    Zhang, Haiping; Niu, Xingbang; Wang, Biao; He, Simin; Hao, Dingjun

    2016-11-01

    Lumbar osteoid osteoma has a low incidence, which could easily lead to scoliosis. Scoliosis secondary to lumbar osteoid osteoma could be easily misdiagnosed when patients do not complain of obvious symptoms. We reported a case of a 9-year-old boy with back deformity that was firstly diagnosed with scoliosis at the local hospital. After prescribed with orthosis, the patient experienced aggravating pain that could not be relieved with painkillers. After he admitted to our hospital for further medical advice, he was prescribed to complete radiological examinations. Considering his radiological examination results and his medical history, correct diagnosis of lumbar osteoid osteoma was made. Surgical intervention of posterior lesion resection was conducted after diagnosis. Intra-operative frozen pathology indicated features of osteoid osteoma. As the lesion involved inferior articular process of L5, which could cause lumbar instability after lesion resection, internal fixation was conducted at L4-S1 segment, and posterolateral bone fusion was also conducted at L5-S1 segment. Three months after operation, the patient showed marked improvement of scoliosis deformity and great relief of lumbar pain. Although spine osteoid osteoma is clinically rare, it shall not be overlooked when young patients present with scoliosis first. Radiological results including computed tomography and magnetic resonance imaging shall be taken carefully as reference when making diagnosis. Surgical intervention of lesion resection could well improve scoliosis and relieve lumbar pain.

  12. [Characteristics of neuromuscular scoliosis].

    Science.gov (United States)

    Putzier, M; Groß, C; Zahn, R K; Pumberger, M; Strube, P

    2016-06-01

    Usually, neuromuscular scolioses become clinically symptomatic relatively early and are rapidly progressive even after the end of growth. Without sufficient treatment they lead to a severe reduction of quality of life, to a loss of the ability of walking, standing or sitting as well as to an impairment of the cardiopulmonary system resulting in an increased mortality. Therefore, an intensive interdisciplinary treatment by physio- and ergotherapists, internists, pediatricians, orthotists, and orthopedists is indispensable. In contrast to idiopathic scoliosis the treatment of patients with neuromuscular scoliosis with orthosis is controversially discussed, whereas physiotherapy is established and essential to prevent contractures and to maintain the residual sensorimotor function.Frequently, the surgical treatment of the scoliosis is indicated. It should be noted that only long-segment posterior correction and fusion of the whole deformity leads to a significant improvement of the quality of life as well as to a prevention of a progression of the scoliosis and the development of junctional problems. The surgical intervention is usually performed before the end of growth. A prolonged delay of surgical intervention does not result in an increased height but only in a deformity progression and is therefore not justifiable. In early onset neuromuscular scolioses guided-growth implants are used to guarantee the adequat development. Because of the high complication rates, further optimization of these implant systems with regard to efficiency and safety have to be addressed in future research.

  13. [The influence of locomotor treatment using robotic body-weight-supported treadmill training on rehabilitation outcome of patients suffering from neurological disorders].

    Science.gov (United States)

    Schwartz, Isabella; Meiner, Zeev

    2013-03-01

    Regaining one's ability to walk is of great importance for neurological patients and is a major goal of all rehabilitation programs. Treating neurological patients in the acute phase after the event is technically difficult because of their motor weakness and balance disturbances. Based on studies in spinalized animals, a novel locomotor training that incorporates high repetitions of task-oriented practice by the use of body weight-supported treadmill training (BWSTT) was developed to overcome these obstacles. The use of BWSTT enables early initiation of gait training, integration of weightbearing activities, stepping and balance by the use of a task-specific approach, and a symmetrical gait pattern. However, despite the theoretical potential of BWSTT to become an invaluable therapeutic tool, its effect on walking outcomes was disappointing when compared with conventional training of the same duration. To facilitate the deLivery of BWSTT, a motorized robotic driven gait orthosis (RBWSTT) was recently developed. It has many advantages over the conventional method, including less effort for the physiotherapists, longer session duration, more physiological and reproducible gait patterns, and the possibility of measuring a patient's performances. Several studies have been conducted using RBWSTT in patients after stroke, spinal cord injury, multiple sclerosis and other neurological diseases. Although some of the results were encouraging, there is still uncertainty regarding proper patient selection, timing and protocol for RBWTT treatment following neurological diseases. More large randomized controlled studies are needed in order to answer these questions.

  14. Painful lateral knee condyle bone marrow edema after treatment with lateral wedged insole.

    Science.gov (United States)

    Chaler, Joaquim; Torra, Mercè; Dolz, Josep Lluís; Müller, Bertram; Garreta, Roser

    2010-05-01

    A 50-yr-old man arrived at our department for a rehabilitation prescription after a right knee medial collateral ligament sprain. Magnetic resonance imaging showed medial collateral ligament partial rupture and medial femoral condyle increased signal intensity indicating bone edema. After treatment, the patient still complained of weight-bearing knee medial compartment pain. A lateral wedged insole was prescribed to decrease medial compartment compression forces. Initial response to insole use was good, but soon after, the patient complained of severe worsening knee pain. On examination, the lateral joint line and condyle palpation were tender. Insole use discontinuation was recommended, and another magnetic resonance imaging scan was performed. It showed an high T2-weighted signal intensity, representing bone marrow edema comprising a volume of 5 x 5 x 4.5 cm of lateral femoral condyle. Discontinuation of orthosis use relieved the pain, and the edema disappeared. To our knowledge, lateral femoral condyle painful bone marrow edema after lateral wedged insole use has not been previously described. The findings of this case report indicate that lateral wedged insole prescription should be carefully evaluated.

  15. [More than 10 years of follow up of the stop screw technique].

    Science.gov (United States)

    Calvo Calvo, S; Marti Ciruelos, R; Rasero Ponferrada, M; González de Orbe, G; Viña Fernández, R

    2016-01-01

    Infantile flexible flatfoot does not require treatment in most cases. Symptomatic flexible flat feet are treated orthopaedically and surgery is only indicated when orthosis fails. Cases who underwent surgical treatment with the stop screw technique at the 12 de Octubre Hospital between 1995 and 2002 are reported. Patient progress is also analysed. Six angles are measured on the x-ray prior to surgery and those same x-ray angles are measured again before material extraction. They are then compared to see if the correction achieved is statistically significant. A more reduced sample is currently being assessed with the same radiological measurements and two clinical assessment scales: Lickert, and Smith and Millar. The latest x-rays are analysed by two radiologists to determine if there is subtalar arthrosis. In the short term, statistically significant differences are observed in all angles. The comparison between the post-surgery angles and the current angles does not show differences, except for the Giannestras angle, which has statistically significantly worsened. Clinical results and patient satisfaction is good. Incipient subtalar arthrosis is present in 68.5% of current patient x-rays. Stop screw method is a cheap, simple and effective technique to correct symptomatic flexible flatfoot that has not improved with conservative treatment. This technique provides short-term foot correction which can be maintained over time. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  16. Resistive flex sensors: a survey

    Science.gov (United States)

    Saggio, Giovanni; Riillo, Francesco; Sbernini, Laura; Quitadamo, Lucia Rita

    2016-01-01

    Resistive flex sensors can be used to measure bending or flexing with relatively little effort and a relatively low budget. Their lightness, compactness, robustness, measurement effectiveness and low power consumption make these sensors useful for manifold applications in diverse fields. Here, we provide a comprehensive survey of resistive flex sensors, taking into account their working principles, manufacturing aspects, electrical characteristics and equivalent models, useful front-end conditioning circuitry, and physic-bio-chemical aspects. Particular effort is devoted to reporting on and analyzing several applications of resistive flex sensors, related to the measurement of body position and motion, and to the implementation of artificial devices. In relation to the human body, we consider the utilization of resistive flex sensors for the measurement of physical activity and for the development of interaction/interface devices driven by human gestures. Concerning artificial devices, we deal with applications related to the automotive field, robots, orthosis and prosthesis, musical instruments and measuring tools. The presented literature is collected from different sources, including bibliographic databases, company press releases, patents, master’s theses and PhD theses.

  17. Rib stress fracture in a male adaptive rower from the arms and shoulders sport class: case report.

    Science.gov (United States)

    Smoljanovic, Tomislav; Bojanic, Ivan; Pollock, Courtney L; Radonic, Radovan

    2011-10-15

    Adaptive rowing is rowing or sculling for rowers with a physical disability. It debuted at the Paralympic Games in 2008. In order to ensure an equitable playing field, rowers with similar levels of physical function and disability are classified into different sport classes for competition. Rowers with an inability to use a sliding seat and impaired trunk function resulting in an inability to perform trunk forward and backward lean via hip flexion/extension are assigned to the Arms and Shoulders (AS) class. AS rowers have to use a chest strap set immediately below the chest in order to localize any trunk movement in AS class. Conditions created by adaptations of rowing equipment and technique within the AS class create unique stresses on the upper thoracic region. The following case report demonstrates how etiology and management of a rib stress fracture in an AS rower differs in comparison to able-body rowers. Of significant importance were the limitations imposed on the rower's ability to maintain rowing-specific fitness, due to the nature of the rib stress fracture and requirement to decrease force transmission through the ribs for several weeks. The rower's gradual return to full training was further impacted by obligatory use of the chest strap, which directly applied pressure over the injured area. Protective orthosis for the chest was designed and applied in order to dissipate pressure of the chest strap over the thorax during rowing (most importantly at the catch position) both on the ergometer and in the boat.

  18. Static response of maximally pronated and nonmaximally pronated feet to frontal plane wedging of foot orthoses.

    Science.gov (United States)

    Pascual Huerta, Javier; Ropa Moreno, Juan Manuel; Kirby, Kevin A

    2009-01-01

    Research on foot orthoses has shown that their effect on the kinematics of the rearfoot is variable, with no consistent patterns of changes being demonstrated. It has also been hypothesized that the mechanical effect of foot orthoses could be subject specific. The purpose of our study was to determine if maximally pronated feet have a different response to frontal plane wedging of foot orthoses than do nonmaximally pronated feet during static stance. One hundred six feet of 53 healthy asymptomatic subjects were divided into two groups (maximally pronated and nonmaximally pronated) on the basis of their subtalar joint rotational position during relaxed bipedal stance. Functional foot orthoses were constructed for each subject and the relaxed calcaneal stance position was measured while standing on five separate frontal plane orthosis wedging conditions, 10 degrees valgus, 5 degrees valgus, no wedging, 5 degrees varus, and 10 degrees varus, to assess changes in calcaneal position. Relative to the no-wedging condition, there were statistically significant differences (P foot orthoses is variable between individuals. Maximally pronated subjects do not exhibit the same response to frontal plane wedging of foot orthoses as do nonmaximally pronated with 10 degrees wedging. Intrinsic biomechanical factors such as subtalar joint position may influence the response to foot orthoses.

  19. Brain-computer interfaces in neurological rehabilitation.

    Science.gov (United States)

    Daly, Janis J; Wolpaw, Jonathan R

    2008-11-01

    Recent advances in analysis of brain signals, training patients to control these signals, and improved computing capabilities have enabled people with severe motor disabilities to use their brain signals for communication and control of objects in their environment, thereby bypassing their impaired neuromuscular system. Non-invasive, electroencephalogram (EEG)-based brain-computer interface (BCI) technologies can be used to control a computer cursor or a limb orthosis, for word processing and accessing the internet, and for other functions such as environmental control or entertainment. By re-establishing some independence, BCI technologies can substantially improve the lives of people with devastating neurological disorders such as advanced amyotrophic lateral sclerosis. BCI technology might also restore more effective motor control to people after stroke or other traumatic brain disorders by helping to guide activity-dependent brain plasticity by use of EEG brain signals to indicate to the patient the current state of brain activity and to enable the user to subsequently lower abnormal activity. Alternatively, by use of brain signals to supplement impaired muscle control, BCIs might increase the efficacy of a rehabilitation protocol and thus improve muscle control for the patient.

  20. Standardized voluntary force measurement in a lower extremity rehabilitation robot.

    Science.gov (United States)

    Bolliger, Marc; Banz, Raphael; Dietz, Volker; Lünenburger, Lars

    2008-10-28

    Isometric force measurements in the lower extremity are widely used in rehabilitation of subjects with neurological movement disorders (NMD) because walking ability has been shown to be related to muscle strength. Therefore muscle strength measurements can be used to monitor and control the effects of training programs. A new method to assess isometric muscle force was implemented in the driven gait orthosis (DGO) Lokomat. To evaluate the capabilities of this new measurement method, inter- and intra-rater reliability were assessed. Reliability was assessed in subjects with and without NMD. Subjects were tested twice on the same day by two different therapists to test inter-rater reliability and on two separate days by the same therapist to test intra-rater reliability. Results showed fair to good reliability for the new measurement method to assess isometric muscle force of lower extremities. In subjects without NMD, intraclass correlation coefficients (ICC) for inter-rater reliability ranged from 0.72 to 0.97 and intra-rater reliability from 0.71 to 0.90. In subjects with NMD, ICC ranged from 0.66 to 0.97 for inter-rater and from 0.50 to 0.96 for intra-rater reliability. Inter- and intra- rater reliability of an assessment method for measuring maximal voluntary isometric muscle force of lower extremities was demonstrated. We suggest that this method is a valuable tool for documentation and controlling of the rehabilitation process in patients using a DGO.

  1. Use of a Portable Assistive Glove to Facilitate Rehabilitation in Stroke Survivors With Severe Hand Impairment.

    Science.gov (United States)

    Fischer, Heidi C; Triandafilou, Kristen M; Thielbar, Kelly O; Ochoa, José M; Lazzaro, Emily D C; Pacholski, Kathleen A; Kamper, Derek G

    2016-03-01

    Treatment options for stroke survivors with severe hand impairment are limited. Active task practice can be restricted by difficulty in voluntarily activating finger muscles and interference from involuntary muscle excitation. We developed a portable, actuated glove-orthosis, which could be employed to address both issues. We hypothesized that combining passive cyclical stretching (reducing motoneuronal hyperexcitability) imposed by the device with active-assisted, task-oriented training (rehabilitating muscle activation) would improve upper extremity motor control and task performance post-stroke. Thirteen participants who experienced a stroke 2-6 months prior to enrollment completed 15 treatment sessions over five weeks. Each session involved cyclically stretching the long finger flexors (30 min) followed by active-assisted task-oriented movement practice (60 min). Outcome measures were completed at six intervals: three before and three after treatment initiation. Overall improvement in post-training scores was observed across all outcome measures, including the Graded Wolf Motor Function Test, Action Research Arm Test, and grip and pinch strength (p ≤ 0.02), except finger extension force. No significant change in spasticity was observed. Improvement in upper extremity capabilities is achievable for stroke survivors even with severe hand impairment through a novel intervention combining passive cyclical stretching and active-assisted task practice, a paradigm which could be readily incorporated into the clinic.

  2. New horizons for orthotic and prosthetic technology: artificial muscle for ambulation

    Science.gov (United States)

    Herr, Hugh M.; Kornbluh, Roy D.

    2004-07-01

    The rehabilitation community is at the threshold of a new age in which orthotic and prosthetic devices will no longer be separate, lifeless mechanisms, but intimate extensions of the human body-structurally, neurologically, and dynamically. In this paper we discuss scientific and technological advances that promise to accelerate the merging of body and machine, including the development of actuator technologies that behave like muscle and control methodologies that exploit principles of biological movement. We present a state-of-the-art device for leg rehabilitation: a powered ankle-foot orthosis for stroke, cerebral palsy, or multiple sclerosis patients. The device employs a forcecontrollable actuator and a biomimetic control scheme that automatically modulates ankle impedance and motive torque to satisfy patient-specific gait requirements. Although the device has some clinical benefits, problems still remain. The force-controllable actuator comprises an electric motor and a mechanical transmission, resulting in a heavy, bulky, and noisy mechanism. As a resolution of this difficulty, we argue that electroactive polymer-based artificial muscle technologies may offer considerable advantages to the physically challenged, allowing for joint impedance and motive force controllability, noise-free operation, and anthropomorphic device morphologies.

  3. Effect of Modified Suit Therapy in Spastic Diplegic Cerebral Palsy - A Single Blinded Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Jagatheesan Alagesan,

    2011-01-01

    Full Text Available Background & Objective: Development of gross motor function in children with cerebral palsy has been a primary goal of physical therapists for decades. Suit therapy has been proposed as an adjunct to conventional physiotherapy to treat the impairments associated with cerebral palsy. Providing an orthosis along with the conventional therapy improves the motor performance of the child. Hence, this study aimed to determine the effect of modified suit therapy in gross motor function of spastic diplegic children. Method: A simple random sample of 30 spastic diplegic subjects in age group of 4-12 years fulfilling inclusion criteria from Mobility India, Bangalore was included. The outcome was evaluated using Gross Motor Function Measure-88 scale before and after the intervention. Suit therapy along with the conventional therapy is given for 2hrs daily for duration of 3 weeks. Results & Conclusion: Wilcoxon signed rank test and Mann-Whitney U test were used to find the significance of improvement before and after the intervention. There was statistically significant difference between the experimental and control groups (P=0.030. It is concluded that modified suit therapy along with conventional physiotherapy is effective in improving the gross motor function of children with spastic diplegic cerebral palsy.

  4. Assistive technology in occupational therapy practice with a child with degenerative disease of the central nervous system

    Directory of Open Access Journals (Sweden)

    Tácia Caroline de Lima Rodrigues

    2015-07-01

    Full Text Available This paper aims to report the effects of the interventions, using the resource of assistive technology, carried out with a child with degenerative disease of the central nervous system at his home. This is a study case, which was conducted in seven meetings, addressing the child and his caregivers during a process of evaluation, preparation of assistive devices, family orientation, and evaluation of the family environment repercussion. The results showed that the child presents significant motor, cognitive, and psychosocial impairments, resulting in difficulties in performing activities of daily living, communication, and play. Adjustments were proposed to facilitate the child’s involvement and alleviate family difficulties on equipment and environments, such as wheelchair, bedroom, bathroom, orthosis, toys and communication. Finally, it was possible to note that the assistive technology resources were used according to the child’s needs and his own reality, and that the domiciliary visits contributed positively to the family’s life because they facilitated the child’s care, despite the limitations faced.

  5. Avascular Necrosis of the Metacarpal Head: A Review of 4 Cases.

    Science.gov (United States)

    Aldekhayel, Salah; Ghanad, Erfan; Mudgal, Chaitanya S

    2018-04-03

    To report on 4 cases of avascular necrosis of the metacarpal head. We retrospectively reviewed 4 patients who received a diagnosis of avascular necrosis of the metacarpal head and were treated from 2000 to 2016. All patients were males with involvement of the dominant hand. Three patients had a history of trauma and/or fractures in another finger and one had a history of fracture in the same finger. The diagnosis was confirmed on regular x-rays and magnetic resonance imaging. Nonsurgical management was offered to all patients (rest, placement of an orthosis, and nonsteroidal anti-inflammatory drugs) for 3 to 6 months. Two patients responded well to nonsurgical management and improved in their symptoms. One patient refused surgical intervention and continued to have persistent pain. The other patient was treated with curettage and bone graft and had total resolution of pain symptoms with full active range of motion. A high index of suspicion is required to diagnose and treat avascular necrosis of the metacarpal head correctly. Treatment options are numerous and require further studies to investigate their effectiveness in the treatment of this rare disease. Therapeutic V. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Open wound management of esophagocutaneous fistula in unstable cervical spine after corpectomy and multilevel laminectomy: A case report and review of the literature.

    Science.gov (United States)

    Elgafy, Hossein; Khan, Mustafa; Azurdia, Jacob; Peters, Nicholas

    2017-08-18

    A 67-year-old female patient developed an esophagocutaneous fistula 4 mo after C4 and C5 partial corpectomy. Plain radiograph and computed tomography (CT) scan of cervical spine showed inferior screws pullout with plate migration that caused the esophageal perforation. Management included removal of anterior hardware, revision C4-5 corpectomy, iliac crest strut autograft and halo orthosis immobilization. The fistula was treated using antibiotics and a 10-french gauge rubber tube for daily irrigation and Penrose drain. At 3 mo, the esophagocutaneous fistula healed and the patient resumed oral feeding. Six months follow-up CT scan showed sound fusion with graft incorporation. At two-year follow-up, patient denied any neck pain or dysphagia. This case report presents a successful outcome of a conservative open wound management without attempted repair. The importance of this case report is to highlight this treatment method that may be considered in such a rare complication particularly if surgical repair failed.

  7. Rhythmic arm swing enhances patterned locomotor-like muscle activity in passively moved lower extremities

    Science.gov (United States)

    Ogawa, Tetsuya; Sato, Takahiko; Ogata, Toru; Yamamoto, Shin-Ichiro; Nakazawa, Kimitaka; Kawashima, Noritaka

    2015-01-01

    The use of driven gait orthosis (DGO) has drawn attention in gait rehabilitation for patients after central nervous system (CNS) lesions. By imposing a passive locomotor-like kinematic pattern, the neural mechanisms responsible for locomotion can be activated as in a normal gait. To further enhance this activity, discussions on possible intervention are necessary. Given the possible functional linkages between the upper and lower limbs, we investigated in healthy subjects the degree of modification in the lower limb muscles during DGO-induced passive gait by the addition of swing movement in the upper extremity. The results clearly showed that muscle activity in the ankle dorsiflexor TA muscle was significantly enhanced when the passive locomotor-like movement was accompanied by arm swing movement. The modifications in the TA activity were not a general increase through the stride cycles, but were observed under particular phases as in normal gaits. Voluntary effort to swing the arms may have certain effects on the modification of the muscle activity. The results provide clinical implications regarding the usefulness of voluntary arm swing movement as a possible intervention in passive gait training using DGO, since ordinary gait training using DGO does not induce spontaneous arm swing movement despite its known influence on the lower limb movement. PMID:25742956

  8. Prototype of a mechanical assistance device for the wrists' flexion-extension movement

    Energy Technology Data Exchange (ETDEWEB)

    Politti, Julio C; Puglisi, Lisandro J; Farfan, Fernando D [Departamento de BioingenierIa - FaCEyT - UNT (Argentina)

    2007-11-15

    Using CMU actuators, a Prototype of Mechanical Assistance Device for the Wrist's Flexion Movement (PMA) was developed and probed in a mechanical model, in order to be implemented in a future as a dynamic powered orthosis or as a rehabilitation assistant instrument. Two Mayor Actuators conformed by three CMU actuators arranged in a series configuration, allows to an artificial hand to be placed in four predefined positions: 0{sup 0}, 20{sup 0}, 40{sup 0} and 60{sup 0}. The synchronism and control of the actuators is achieved with the Programmable Control Module (PCM). It is capable to drive up to six CMU actuators, and possess two different modes of execution: a Manual mode and an Exercise mode. In the Manual Mode, the position of the hand responds directly to the commands of the keyboard of the front panel, and in the Exercise mode, the hand realizes a repetitive and programmed movement. The prototype was tested in 100 positions in the Manual Mode and for 225 works cycles in the Exercise Mode. The relative repetition error was less than 5% for both test. This prototype only consumes 4,15W, which makes it possible to be powered by small rechargeable batteries, allowing its use as a portable device.

  9. The effect of frame rate on the ability of experienced gait analysts to identify characteristics of gait from closed circuit television footage.

    Science.gov (United States)

    Birch, Ivan; Vernon, Wesley; Burrow, Gordon; Walker, Jeremy

    2014-03-01

    Forensic gait analysis is increasingly being used as part of criminal investigations. A major issue is the quality of the closed circuit television (CCTV) footage used, particularly the frame rate which can vary from 25 frames per second to one frame every 4s. To date, no study has investigated the effect of frame rate on forensic gait analysis. A single subject was fitted with an ankle foot orthosis and recorded walking at 25 frames per second. 3D motion data were also collected, providing an absolute assessment of the gait characteristics. The CCTV footage was then edited to produce a set of eight additional pieces of footage, at various frame rates. Practitioners with knowledge of forensic gait analysis were recruited and instructed to record their observations regarding the characteristics of the subject's gait from the footage. They were sequentially sent web links to the nine pieces of footage, lowest frame rate first, and a simple observation recording form, over a period of 8 months. A sample-based Pearson product-moment correlation analysis of the results demonstrated a significant positive relationship between frame rate and scores (r=0.868, p=0.002). The results of this study show that frame rate affects the ability of experienced practitioners to identify characteristics of gait captured on CCTV footage. Every effort should therefore be made to ensure that CCTV footage likely to be used in criminal proceedings is captured at as high a frame rate as possible. © 2013.

  10. Hallux valgus—a case for a physiotherapist or only for a surgeon? Literature review

    Science.gov (United States)

    Mortka, Kamila; Lisiński, Przemysław

    2015-01-01

    [Purpose] Hallux valgus is one of the most common deformations of the human foot, and it causes great difficulties for the patients. The aim of this paper was to review available medical literature in search of evidence which would justify implementation of physiotherapy, based on its effectiveness for patients with hallux valgus. [Subjects and Methods] The following databases were searched for applicable papers: PubMed, Google Scholar, Clinical Key and UpToDate. Full-text articles from the last 15 years were subjected to a review, which ultimately selected seven papers about hallux valgus therapy published over the past 12 years. These studies were grouped according to their design and level of evidence and classified depending on whether they concerned physiotherapy as postoperative therapy or as the only treatment. [Results] The studies included in the present analysis used the following interventions for patients with hallux valgus: exercise, manual therapy, gait training, taping and orthosis. All the studies showed beneficial effects and the most frequently observed results were reductions in pain and improvements in function. [Conclusion] The evidence found in the reviewed materials clearly indicates that patients with hallux valgus should not only be subject to surgical procedures but also undergo physiotherapeutic treatment. PMID:26644698

  11. Analysis of foot structural damage in rheumatoid arthritis: clinical evaluation by validated measures and serological correlations

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    E. Bartoloni Bocci

    2011-06-01

    Full Text Available Objective: To examine foot involvement in rheumatoid arthritis (RA and to characterize structural alterations in patients with anti-cyclic citrullinated peptide (CCP antibody-positive and -negative disease. Methods: Seventy-eight patients with RA with foot pain were consecutively enrolled. The Manchester Hallux Valgus (MHV rating scale was used to evaluate the hallux valgus deformity degree. The Foot Posture Index (FPI6, a novel, foot-specific outcome measure, was adopted in order to quantify variation in the position of the foot. The findings were correlated with disease duration and presence or absence of anti-CCP antibodies. Results: About 84.6% patients had different degrees of hallux valgus and 65.4% subjects had a pronated foot. These two foot alterations were prevalently found in patients with long-standing disease and circulating anti-CCP antibodies. On the contrary, RA patients without anti-CCP and early disease essentially displayed a supinated foot without relevant hallux valgus deformity. Conclusion: Our findings allowed to identify different anatomic foot alterations in RA patients according to disease duration and negative prognostic factors such as anti-CCP antibodies. Our findings support the role of an accurate analysis of foot structural damage and may suggest the usefulness of a correct plantar orthosis prescription also in early phases of the disease.

  12. Orthoses as enablers of occupation: client-centred splinting for better outcomes.

    Science.gov (United States)

    McKee, Pat; Rivard, Annette

    2004-12-01

    Orthotic intervention (splinting) may have become an end unto itself in the minds of therapists and clients rather than the means to enable optimal occupational performance. Some policy makers and payers seem to hold the belief that orthoses/splints are mere technical aids and as such do not require professional skill and expertise. NARRATIVES: Three client stories demonstrate how iterative collaboration and follow-up help achieve client-identified objectives. Client input is an important component of the process and an orthosis must fit into the person's lifestyle, especially if required for long-term use. Six essential considerations when providing orthoses to meet occupational goals are emphasized: client-centredness, comfort, cosmesis, convenience, less is more and follow-up. Use of the Canadian Occupational Performance Model for intervention planning and as an outcome measure is demonstrated. Orthoses that are thoughtfully designed with client input and carefully constructed can make a difference in a person's life by relieving pain, providing protection and joint stabilization and enabling valued occupations.

  13. Vertigo, can it be redefined?

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    Bhabani Kumar Choudhury

    2016-04-01

    Full Text Available Background & Objectives- Vertigo, a clinical symptom complex is not infrequent in our patients. Its diagnosis too is controversial. Majority of these cases run from hospital to clinics, some times to Otolaryngologists to get rid of this bizarre experience. Sometimes they get benefit but otherwise they experience a destitute life. Our aim was to treat them by Physical Therapy in the light of Cervical Spondylosis that is commonly associated with vertigo. Material & Methods- This is a prospective case study done in PMR department (OPD of a teaching institute over a period of 6 months time period. 20 OPD patients of both sexes (14 ladies and 6 gents with definite Cervical Spondylosis along with complain of vertigo or dizziness, pain at cervical spine were accounted for the study. Only extreme aged persons or patients with other major co-morbidity were excluded. These 20 patients were treated with conventional Physical Therapy for CS. Medications were prescribed as and when required. Results- After Physical Therapy, that included lifestyle modification, isometric cervical exercise, intermittent cervical traction, application of Therapeutic Ultrasound (UST to cervical region and proper posture care of cervical spine along with use of cervical orthosis (where needed, majority of the patients become symptom free. Conclusion- Physical Therapy may be considered as an alternative method of treatment of Vertigo patients, who are otherwise not responding satisfactorily to pharmaceutical agents.

  14. Effects of ankle-foot orthoses for children with hemiplegia on weight-bearing and functional ability.

    Science.gov (United States)

    O'Reilly, Tara; Hunt, Adrienne; Thomas, Bronwyn; Harris, Lynne; Burns, Joshua

    2009-01-01

    To compare the effects of a leaf spring ankle-foot orthosis (LAFO) and a hinged AFO with plantar flexion stop with that of shoe only on weight-bearing and function in children with hemiplegia. The study used an experimental single-subject alternating treatment design with replication. Outcomes measured were weight-bearing symmetry, weight-bearing on the hemiplegic rear foot compared with that of the forefoot, functional ability, and child and parent preference. Both AFOs increased relative contact area of the hemiplegic foot. The LAFO increased relative force through the hemiplegic foot. There was increased pressure through the rear foot, time spent on the rear foot, and force through the forefoot. Rear foot contact area increased in the LAFO. Neither AFO affected function. Patient preference for AFO condition was inconsistent. Both AFOs increased weight-bearing through the hemiplegic foot and rear foot, indicative of potential benefit to growth. Neither the LAFO nor the hinged AFO with plantar flexion stop improved function of the children.

  15. The effects of ankle-foot orthoses on the ankle and knee in persons with myelomeningocele: an evaluation using three-dimensional gait analysis.

    Science.gov (United States)

    Thomson, J D; Ounpuu, S; Davis, R B; DeLuca, P A

    1999-01-01

    The purpose of this study was to determine the effects of the ankle-foot orthosis (AFO) on gait patterns in patients with low-level myelomeningocele and to identify any abnormal gait patterns that may lead to future knee instability and pain. A total of 28 children (26 L4-level sides, 18 L5-level sides, and 10 S1-2-level sides) underwent a three-dimensional gait analysis when ambulating barefoot and with AFOs. Results show significant improvements in sagittal plane function with reductions in excessive ankle dorsiflexion, increases in peak plantar flexor moment, and reductions in crouch and knee extensor moment in the L4 and L5 groups. The only improvement in the S1-2 group was a reduction in excessive dorsiflexion, but there was a reduction in power generation at the ankle. The S1-2 group had normal transverse plane knee motion in stance during barefoot walking that increased significantly (p AFO. Both the L5 and L4 groups showed greater-than-normal transverse plane knee motion in stance during barefoot walking that also increased significantly (p AFO. The results suggest that excessive knee transverse plane rotation may contribute to knee instability more than coronal plane abnormalities. The AFO in S1-2-level patients may be more detrimental for the knee than barefoot walking.

  16. The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy.

    Science.gov (United States)

    Park, Eun Sook; Park, Chang Il; Chang, Hyun Jung; Choi, Jong Eun; Lee, Don Shin

    2004-12-01

    To investigate the effectiveness of the hinged ankle-foot orthosis (AFO) on sit-to-stand (STS) transfers in children with spastic cerebral palsy. Before-after trial. University-affiliated hospital. Nineteen spastic diplegic children (age range, 2-6 y). Not applicable. The transitional movement of STS was tested in random order with children while wearing the barefoot and hinged AFOs. The temporal, kinematic, and kinetic data during the task were collected by using a motion analyzer (with 6 infrared cameras). Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test. Total duration of STS transfer was significantly shortened with the hinged AFO (P AFO, compared with when barefoot (P AFO. The maximal moment and power of hip and knee joints were significantly increased with the AFO (P AFO. Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO, some improvements of temporal, kinematic, and kinetic parameters were identified during the task. These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia.

  17. A systematic review to determine best practice reporting guidelines for AFO interventions in studies involving children with cerebral palsy.

    Science.gov (United States)

    Ridgewell, Emily; Dobson, Fiona; Bach, Timothy; Baker, Richard

    2010-06-01

    Studies which have examined the effects of ankle-foot orthoses (AFOs) on children with cerebral palsy (CP) often report insufficient detail about the participants, devices and testing protocols. The aim of this systematic review was to evaluate the level and quality of detail reported about these factors in order to generate best practice guidelines for reporting of future studies. A systematic search of the literature was conducted to identify studies which examined any outcome measure relating to AFO use in children with CP. A customized checklist was developed for data extraction and quality assessment. There was substantial variability in the level and quality of detail reported across the 41-paper yield. Many papers reported insufficient detail to allow synthesis of outcomes across studies. The findings of this review have been used to generate guidelines for best practice of reporting for AFO intervention studies. It is important to ensure homogeneity of gait pattern in a subject sample or to subdivide a sample to investigate the possibility that heterogeneity affected results. It is also important to describe the orthosis in sufficient detail that the device can be accurately replicated because differences in designs have been shown to affect outcomes. These guidelines will help researchers provide more systematic and detailed reports and thereby permit future reviewers to more accurately assess both the reporting and quality of orthotic interventions, and will facilitate synthesis of literature to enhance the evidence base.

  18. Negative pressure wound therapy in the management of mine blast injuries of lower limbs: Lessons learnt at a tertiary care center.

    Science.gov (United States)

    Maurya, Sanjay; Srinath, N; Bhandari, P S

    2017-10-01

    Mine blast injuries of foot are devastating injuries that result in composite tissue loss or amputations. Negative pressure wound therapy has helped in the management of such combat-related wounds. The aim of this study was to report experiences gained in managing such injuries at a tertiary care center. 17 combatants who sustained mine blast injuries were included in this study. Severity of foot injury was assessed as per Foot and Ankle Severity Score. After wound debridement, negative pressure wound therapy was started and foot defect was appropriately reconstructed. Following wound healing, the foot was assessed for Foot and Ankle Severity Score in terms of impairment. The patients were then suitably rehabilitated by shoe modifications, orthosis, or custom-made prosthesis. Mean age of soldiers who sustained mine blast injuries was 30.2 years. The mean Foot and Ankle Severity Score was 3.76. Temporary wound closure was achieved using negative pressure wound therapy and it prevented local and systemic infection. The defect could be reconstructed appropriately using split skin graft, regional fasciocutaneous flap, or microvascular free flap. Mean time to definitive reconstructive procedure was 16.5 days. Mean Foot and Ankle Severity Score in terms of impairment was 4.11. All soldiers could be rehabilitated and were returned to their respective units and were able to perform sedentary duties assigned to them. The negative pressure wound therapy was helpful in preventing proximal amputations due to mine blast injury and was helpful in satisfactory reconstruction of foot defects.

  19. Multiphysics modeling of magnetorheological dampers

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    D Case

    2016-09-01

    Full Text Available The dynamics of a small scale magnetorheological damper were modeled and analyzed using multiphysics commercial finite element software to couple the electromagnetic field distribution with the non-Newtonian fluid flow. The magnetic flux lines and field intensity generated within the damper and cyclic fluid flow in the damper under harmonic motion were simulated with the AC/DC and CFD physics modules of COMSOL Multiphysics, respectively. Coupling of the physics is achieved through a modified Bingham plastic definition, relating the fluid's dynamic viscosity to the intensity of the induced magnetic field. Good agreement is confirmed between simulation results and experimentally observed resistance forces in the damper. This study was conducted to determine the feasibility of utilizing magnetorheological dampers in a medical orthosis for pathological tremor attenuation. The implemented models are thus dimensioned on a relatively small scale. The method used, however, is not specific to the damper's size or geometry and can be extended to larger-scale devices with little or no complication.

  20. A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part one: considerations for success.

    Science.gov (United States)

    Ikeda, Andrea J; Grabowski, Alena M; Lindsley, Alida; Sadeghi-Demneh, Ebrahim; Reisinger, Kim D

    2014-08-01

    Literature Review We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services. Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision. We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer. We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented. Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two. © The International Society for Prosthetics and Orthotics 2013.

  1. Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet.

    Science.gov (United States)

    Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Yoon, Sung-Won; Yun, Hyun-Ju; Jeong, Tae-Ho

    2015-12-01

    To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses. Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (pfoot orthoses. In addition, significant (pfoot orthoses. Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot.

  2. Extensor deficiency: first cause of childhood flexible flat foot.

    Science.gov (United States)

    Vittore, Donato; Patella, Vittorio; Petrera, Massimo; Caizzi, Gianni; Ranieri, Maurizio; Putignano, Piero; Spinarelli, Antonio

    2009-01-01

    Childhood flexible flat foot is the most common paramorphism of the lower limb. The cause is not a bony malformation of the foot but a functional deficiency of the anatomic structures supporting the plantar arch. These structures, working as active tie rods (the tibialis anterior and posterior muscles) or passive factors of support (flexor hallucis longus and flexor digitorum longus muscles) act together to maintain the plantar arch. Their deficiency is responsible for childhood flexible flat foot, characterized by a flattening of the plantar arch and calcaneus pronation (heel valgus) and manifested in the characteristic "duck walking" in children. Hypothesizing poor extensor activity of the tibialis anterior, extensor digitorum longus, and extensor hallucis longus muscles during the heel contact phase of the gait cycle, we began a preliminary study to evaluate, through superficial electromyography (sEMG), the activation of muscle groups involved in the pathogenesis of childhood flexible flat foot, in particular the tibialis anterior and extensor hallucis longus muscles, to plan a rehabilitative program addressing the strengthening of insufficient muscles. The therapeutic program should also include the use of a medial elastic push orthosis. Data obtained by sEMG highlight a reduced activation of muscles related to the grade of flat foot, emphasizing the concept that a reduced activation of extensor muscles may be involved in determining flexible flat foot.

  3. Synoviorthesis with colloidal 32P chromic phosphate for hemophilic arthropathy: clinical follow-up

    International Nuclear Information System (INIS)

    Rivard, G.E.; Girard, M.; Lamarre, C.; Jutras, M.; Danais, S.; Guay, J.P.; Belanger, R.D.

    1985-01-01

    Thirty-one synoviortheses were performed in 22 joints of 14 hemophilic patients (aged 12 to 28 years) with chronic synovitis and for whom conventional treatments were considered ineffective. Except for patients with inhibitors, conventional treatments included three to six months of adequate prophylactic therapy with the missing coagulation factors, intensive physiotherapy and, when indicated, antiinflammatory agents and orthosis. Colloidal 32 P chromic phosphate was injected intraarticularly in doses of 1.0 mCi for knees and of 0.5 mCi for the other joints. Time of follow-up ranged from two to five years. Frequency and importance of bleeding decreased in all patients. Effect on range of motion was best in knees. In elbows, flexion-extension was improved in four cases, unchanged in five and decreased in one; pronation-supination was decreased in four cases. The results of 13 synoviortheses in four hemophilic patients with high titer factor VIII inhibitors were comparable to those in hemophiliacs with no inhibitors. However, in three of the four patients synoviorthesis had to be repeated after two to four years for recurrence of synovitis. Extraarticular escape of radioactivity was monitored 62 times for 17 synoviortheses in 12 patients; extraarticular counts never exceeded 4% of the intraarticular counts. Chromosome aberrations were found not to be increased after treatment in the seven patients in whom adequate analysis could be done

  4. Synoviorthesis with colloidal /sup 32/P chromic phosphate for hemophilic arthropathy: clinical follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Rivard, G.E.; Girard, M.; Lamarre, C.; Jutras, M.; Danais, S.; Guay, J.P.; Belanger, R.D.

    1985-11-01

    Thirty-one synoviortheses were performed in 22 joints of 14 hemophilic patients (aged 12 to 28 years) with chronic synovitis and for whom conventional treatments were considered ineffective. Except for patients with inhibitors, conventional treatments included three to six months of adequate prophylactic therapy with the missing coagulation factors, intensive physiotherapy and, when indicated, antiinflammatory agents and orthosis. Colloidal /sup 32/P chromic phosphate was injected intraarticularly in doses of 1.0 mCi for knees and of 0.5 mCi for the other joints. Time of follow-up ranged from two to five years. Frequency and importance of bleeding decreased in all patients. Effect on range of motion was best in knees. In elbows, flexion-extension was improved in four cases, unchanged in five and decreased in one; pronation-supination was decreased in four cases. The results of 13 synoviortheses in four hemophilic patients with high titer factor VIII inhibitors were comparable to those in hemophiliacs with no inhibitors. However, in three of the four patients synoviorthesis had to be repeated after two to four years for recurrence of synovitis. Extraarticular escape of radioactivity was monitored 62 times for 17 synoviortheses in 12 patients; extraarticular counts never exceeded 4% of the intraarticular counts. Chromosome aberrations were found not to be increased after treatment in the seven patients in whom adequate analysis could be done.

  5. Consumer satisfaction with the services of prosthetics and orthotics facilities.

    Science.gov (United States)

    Bosmans, Joline; Geertzen, Jan; Dijkstra, Pieter U

    2009-03-01

    Consumer satisfaction with the services provided in a prosthetics and orthotics (P&O) facility has seldom been studied. The aim of this study was to analyze consumer satisfaction regarding the services provided by 15 P&O facilities in The Netherlands. Consumers (n = 1,364) of these P&O facilities who were fitted with a prosthesis, orthopaedic shoes, an orthosis, or another device, were asked to rate the overall services provided and whether they were satisfied with the device provided and its delivery time. Additionally, they filled in a modified SERVQUAL questionnaire (see Appendix). Consumers gave the service provided by P&O facilities a mean overall rating of 8.1. The highest ratings were given by consumers fitted with a prosthesis (mean overall rating of services: 8.4). In total, 78% of the consumers were satisfied with the device provided and 93% with the delivery time. The results of our study showed that, on the SERVQUAL, 50% of the statements fulfilled the criteria for a satisfactory quality of the services. The overall consumer rating of the service provided by P&O facilities is high and depends on the device provided. The outcomes on the SERVQUAL were moderate. In future, it is important to study consumer satisfaction more extensively in order to improve the quality of P&O services in daily practice. Additionally, specific questionnaires need to be developed to measure all aspects of prosthetic and orthotic care, with the aim to improve the services.

  6. Congenital subaxial cervical subluxation presenting as a bilateral Erb's palsy: surgical management, rehabilitation, and outcome.

    Science.gov (United States)

    Sankaran, Ravi; Shah, Rohan; Menon, Sajesh; Pillai, Ashok

    2016-05-01

    Subaxial spine injuries during infancy are uncommon. We present the case of an infant referred to our brachial plexus clinic with proximal weakness of both arms noted immediately following a complicated breech delivery. Nerve conduction studies were consistent with bilateral proximal upper plexus injury; however, radiological evaluation revealed a C4-C5 subluxation and MRI features of bilateral C5 root avulsions. He was immobilized in a cervical-body orthosis and underwent open reduction and posterior C4-C5-C6 fixation at 10 weeks age using luque rods, sublaminar wires, and rib graft. The spine was immobilized in a custom molded cervicothoracic brace for a total of 3 months, and a home exercise program prescribed. Follow-up radiographic evaluation showed good posterior bony fusion by 2 months but persistent bilateral proximal upper limb weakness with reduced compound motor action potential (CMAP) amplitudes of the axillary and musculocutaneous nerves. Bilateral supraclavicular exploration and C5 root neurotization using the ipsilateral C7 nerve roots were performed at 7 months of age. Voluntary biceps activity followed by voluntary external rotation with gravity eliminated was noted within the next 2-3 months. He progressed to develop near normal motor control of bilateral upper limbs within 1 year. We wish to report this rare entity and our favorable outcome using a strategy of early spinal stabilization and neurotization repair to restore function following proximal nerve root injury.

  7. The prevention of ankle sprains in sports. A systematic review of the literature.

    Science.gov (United States)

    Thacker, S B; Stroup, D F; Branche, C M; Gilchrist, J; Goodman, R A; Weitman, E A

    1999-01-01

    To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. Ten citations of studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention. Methods tested included wrapping the ankle with tape or cloth, orthoses, high-top shoes, or some combination of these methods. Most studies indicate that appropriately applied braces, tape, or orthoses do not adversely affect performance. Based on our review, we recommend that athletes with a sprained ankle complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Both coaches and players must assume responsibility for prevention of injuries in sports. Methodologic limitations of published studies suggested several areas for future research.

  8. Effects of prefabricated ankle orthoses on postural stability in basketball players with chronic ankle instability.

    Science.gov (United States)

    Faraji, Elahe; Daneshmandi, Hassan; Atri, Ahmad Ebrahimi; Onvani, Vahid; Namjoo, Faride Rezaee

    2012-12-01

    Ankle sprain is one of the most common injuries among athletes and instability and injury to this joint is responsible for long time loss of physical and recreational activity. Also, it can impose high costs to sport teams. Prevention of this injury is an important concern of practice and rehabilitation. One way of reducing the possibility of ankle joint injury is using an ankle orthosis. The present study aimed at inspecting the effects of two ankle orthoses on dynamic and semi-dynamic postural stability in athletes with chronic ankle instability (CAI). Twenty basketball players with CAI and fifteen non-injured athletes volunteered to participate in this study. Biodex Balance System was used to assess the participants' postural stability in bilateral position at level 8 and level 2. Repeated measures analysis of variance (ANOVA) was performed in order to examine the effects of ankle orthoses. Statistical significance level was determined at Pankle supports on dynamic and semi-dynamic postural stability in the two groups and results indicated there wasn't significant difference between groups. According to our results the orthoses improved both dynamic and semi-dynamic postural stability. Therefore, orthoses can prevent injury and its reoccurrence.

  9. Shoe adaptation after amputation of the II - V phalangeal bones of the foot.

    Science.gov (United States)

    Rommers, G M; Diepstraten, H J M; Bakker, E; Lindeman, E

    2006-12-01

    In The Netherlands, about 50% of all amputations of the lower limb are toes and forefoot amputations. Traumata of toes and mid-foot are rare. Preservation of the foot is the primary goal for treatment. Crush injuries of the foot may be associated with prolonged morbidity. This case study presents an insole solution for the solitary first phalangeal bone after amputation of the phalangeal bones II - V. The normal adaptation for forefoot amputations is stiffening of the sole of the shoe and a rocker bar to improve the toe off phase with load reduction of the forefoot. Because the patient had to do excessive stair climbing during work another solution was chosen. As a foot orthosis, a metal soleplate was made in order to have free movement during loading and toe-off during walking. The soleplate gives safety and provides self-adjusting properties after toe off. This enables the shoe technician to make a shoe without a rocker bar or an extra stiff insole. The 0.5 mm custom-made spring-steel plate is also used as a protective in industrial safety shoes. To improve shoe adaptation more research and case reports have to be published in order to inform doctors and shoe technicians about everyday solutions to partial foot amputations.

  10. The influence of the external ankle support on the dynamic balance in volleyball athletes

    Directory of Open Access Journals (Sweden)

    Manuela Azevedo Correia de Lima

    2015-09-01

    Full Text Available AbstractThe purpose of this study was to assess the effect of ankle external supports on proprioception and dynamic balance in volleyball players. Seventeen female volleyball players (18.94±2.49 years; 65.45±9.49 kg; 1.71±0.05 m; BMI=22.0±2.67 kg/m² took part in this study. The dynamic balance was assessed through the Star Excursion Balance Test (SEBT. Comparisons between stabilization (no stabilizer/NS, orthosis/ORT and functional bandaging/FB modes and the SEBT grid lines and inter-limb were carried out. The SEBT assessment showed a significant difference between the groups NS x ORT and NS x FB (p < .01, and between the lines (p< .01. Significant line/limb interaction in DL and NDL (p< .01 was detected. The external supports tested herein showed similar effects on balance, restricting lower limb's reach in the SEBT execution in some of tested directions.

  11. Proximal fibula resection in the treatment of bone tumours.

    Science.gov (United States)

    Dieckmann, Ralf; Gebert, Carsten; Streitbürger, Arne; Henrichs, Marcel-Philipp; Dirksen, Uta; Rödl, Robert; Gosheger, Georg; Hardes, Jendrik

    2011-11-01

    We present a large study of patients with proximal fibula resection. Moreover we describe a new classification system for tumour resection of the proximal fibula independent of the tumour differentiation. In 57 patients the functional and clinical outcomes were evaluated. The follow-up ranged between six months and 22.2 years (median 7.2 years). The indication for surgery was benign tumours in ten cases and malignant tumours in 47 cases. In 13 of 45 patients, where a resection of the lateral ligament complex was done, knee instability occurred. In 32 patients a resection of the peroneal nerve with resulting peroneal palsy was necessary. Patients with peroneal resection had significantly worse functional outcome than patients without peroneal resection. An ankle foot orthosis was tolerated well by these patients. Three of four patients with pathological tibia fracture had local radiation therapy. There was no higher risk of tibia fracture in patients with partial tibial resection. Resection of tumours in the proximal fibula can cause knee instability, peroneal palsy and in cases of local radiation therapy, a higher risk of delayed wound healing and fracture. Despite the risks of proximal fibula resection, good functional results can be achieved.

  12. Effect of exoskeletal joint constraint and passive resistance on metabolic energy expenditure: Implications for walking in paraplegia.

    Directory of Open Access Journals (Sweden)

    Sarah R Chang

    Full Text Available An important consideration in the design of a practical system to restore walking in individuals with spinal cord injury is to minimize metabolic energy demand on the user. In this study, the effects of exoskeletal constraints on metabolic energy expenditure were evaluated in able-bodied volunteers to gain insight into the demands of walking with a hybrid neuroprosthesis after paralysis. The exoskeleton had a hydraulic mechanism to reciprocally couple hip flexion and extension, unlocked hydraulic stance controlled knee mechanisms, and ankles fixed at neutral by ankle-foot orthoses. These mechanisms added passive resistance to the hip (15 Nm and knee (6 Nm joints while the exoskeleton constrained joint motion to the sagittal plane. The average oxygen consumption when walking with the exoskeleton was 22.5 ± 3.4 ml O2/min/kg as compared to 11.7 ± 2.0 ml O2/min/kg when walking without the exoskeleton at a comparable speed. The heart rate and physiological cost index with the exoskeleton were at least 30% and 4.3 times higher, respectively, than walking without it. The maximum average speed achieved with the exoskeleton was 1.2 ± 0.2 m/s, at a cadence of 104 ± 11 steps/min, and step length of 70 ± 7 cm. Average peak hip joint angles (25 ± 7° were within normal range, while average peak knee joint angles (40 ± 8° were less than normal. Both hip and knee angular velocities were reduced with the exoskeleton as compared to normal. While the walking speed achieved with the exoskeleton could be sufficient for community ambulation, metabolic energy expenditure was significantly increased and unsustainable for such activities. This suggests that passive resistance, constraining leg motion to the sagittal plane, reciprocally coupling the hip joints, and weight of exoskeleton place considerable limitations on the utility of the device and need to be minimized in future designs of practical hybrid neuroprostheses for walking after paraplegia.

  13. Perfil funcional de locomoção em um grupo de pacientes com lesão medular atendidos em um centro de reabilitação Perfil funcional de locomoción en un grupo de pacientes con lesión medular atendidos en un centro de rehabilitación Functional ambulation profile in a group of spinal cord injured patients attended at a rehabilitation center

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    Ana Cristina Franzoi

    2009-12-01

    .5, AIS-LEMS: 13.4. There were differences between traumatic and non-traumatic groups concerning age, sex, AIS, AIS-LEMS, MFAC and WISCI-II. Significant correlations: AIS positively correlated to MFAC, WISCI-II and AIS-LEMS. Level of lesion negatively correlated to MAS. AIS-LEMS positively correlated to AIS, MFAC, WISCI-II and negatively correlated to support and orthosis during ambulation. Time of lesion and presence of disabling pain were not correlated to the studied variables. CONCLUSIONS: traumatic SCI group was composed by younger patients with higher prevalence of complete lesion. Age was correlated to the use of orthosis and walking devices. Functional performance of gait was correlated with AIS and AIS-LEMS, and a AIS-LEMS of at least 32 points was needed to achieve community gait.

  14. Brain-state dependent robotic reaching movement with a multi-joint arm exoskeleton: combining brain-machine interfacing and robotic rehabilitation

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    Daniel eBrauchle

    2015-10-01

    Full Text Available While robot-assisted arm and hand training after stroke allows for intensive task-oriented practice, it has provided only limited additional benefit over dose-matched physiotherapy up to now. These rehabilitation devices are possibly too supportive during the exercises. Neurophysiological signals might be one way of avoiding slacking and providing robotic support only when the brain is particularly responsive to peripheral input.We tested the feasibility of three-dimensional robotic assistance for reach-to-grasp movements with a multi-joint exoskeleton during motor imagery-related desynchronization of sensorimotor oscillations in the β-band only. We also registered task-related network changes of cortical functional connectivity by electroencephalography via the imaginary part of the coherence function.Healthy subjects and stroke survivors showed similar patterns – but different aptitudes – of controlling the robotic movement. All participants in this pilot study with nine healthy subjects and two stroke patients achieved their maximum performance during the early stages of the task. Robotic control was significantly higher and less variable when proprioceptive feedback was provided in addition to visual feedback, i.e. when the orthosis was actually attached to the subject’s arm during the task. A distributed cortical network of task-related coherent activity in the θ-band showed significant differences between healthy subjects and stroke patients as well as between early and late periods of the task.Brain-robot interfaces may successfully link three-dimensional robotic training to the participants’ efforts and allow for task-oriented practice of activities of daily living with a physiologically controlled multi-joint exoskeleton. Changes of cortical physiology during the task might also help to make subject-specific adjustments of task difficulty and guide adjunct interventions to facilitate motor learning for functional restoration.

  15. Human movement training with a cable driven ARm EXoskeleton (CAREX).

    Science.gov (United States)

    Mao, Ying; Jin, Xin; Gera Dutta, Geetanjali; Scholz, John P; Agrawal, Sunil K

    2015-01-01

    In recent years, the authors have proposed lightweight exoskeleton designs for upper arm rehabilitation using multi-stage cable-driven parallel mechanism. Previously, the authors have demonstrated via experiments that it is possible to apply "assist-as-needed" forces in all directions at the end-effector with such an exoskeleton acting on an anthropomorphic machine arm. A human-exoskeleton interface was also presented to show the feasibility of CAREX on human subjects. The goals of this paper are to 1) further address issues when CAREX is mounted on human subjects, e.g., generation of continuous cable tension trajectories 2) demonstrate the feasibility and effectiveness of CAREX on movement training of healthy human subjects and a stroke patient. In this research, CAREX is rigidly attached to an arm orthosis worn by human subjects. The cable routing points are optimized to achieve a relatively large "tensioned" static workspace. A new cable tension planner based on quadratic programming is used to generate continuous cable tension trajectory for smooth motion. Experiments were carried out on eight healthy subjects. The experimental results show that CAREX can help the subjects move closer to a prescribed circular path using the force fields generated by the exoskeleton. The subjects also adapt to the path shortly after training. CAREX was also evaluated on a stroke patient to test the feasibility of its use on patients with neural impairment. The results show that the patient was able to move closer to a prescribed straight line path with the "assist-as-needed" force field.

  16. Effect of hip braces on brake response time: Repeated measures designed study.

    Science.gov (United States)

    Dammerer, Dietmar; Waidmann, Cornelia; Huber, Dennis G; Krismer, Martin; Haid, Christian; Liebensteiner, Michael C

    2017-08-01

    The question whether or not a patient with a hip brace should drive a car is of obvious importance because the advice given to patients to resume driving is often anecdotal as few scientific data are available on this specific subject. To assess driving ability (brake response time) with commonly used hip braces. Repeated measures design. Brake response time was assessed under six conditions: (1) without a brace (control), (2) with a typical postoperative hip brace with adjustable range of motion and the settings: unrestricted, (3) flexion limited to 70°, (4) extension blocked at 20° hip flexion, (5) both flexion and extension limited (20°/70°) and (6) an elastic hip bandage. Brake response time was assessed using a custom-made driving simulator as used in previous studies. The participants were a convenience sample of able-bodied participants. A total of 70 participants (35 women and 35 men) participated in our study. Mean age was 31.1 (standard deviation: 10.6; range: 21.7-66.4) years. A significant within-subject effect for brake response time was found ( p = 0.009), but subsequent post hoc analyses revealed no significant differences between control and the other settings. Based on our findings, it does not seem mandatory to recommend driving abstinence for patients wearing a hip orthosis. We suggest that our results be interpreted with caution, because (1) an underlying pathological hip condition needs to be considered, (2) the ability to drive a car safely is multifactorial and brake response time is only one component thereof and (3) brake response time measurements were performed only with healthy participants. Clinical relevance Hip braces are used in the context of joint-preserving and prosthetic surgery of the hip. Therefore, clinicians are confronted with the question whether to allow driving a car with the respective hip brace or not. Our data suggest that hip braces do not impair brake response time.

  17. A Modern Historical Perspective of Schroth Scoliosis Rehabilitation and Corrective Bracing Techniques for Idiopathic Scoliosis

    Science.gov (United States)

    Moramarco, Kathryn; Borysov, Maksym

    2017-01-01

    The treatment of scoliosis has a long history dating back to Hippocrates and his luxation table. In recent history, conservative rehabilitation treatment methods have come and gone. Some have had more longevity than others and currently there are only a handful of these “schools” for rehabilitation in existence. What is important to note in this twenty-first century world is that any approach to bracing or scoliosis rehabilitation must strive for a correction effect and be as user-friendly as possible. Patients look to achieve some measure of success, whether it be halted Cobb angle, improved breathing function, decreased rotation, or postural improvement via trunk symmetry. Katharina Schroth created her method in 1921 as a result of self-analysis of her own imperfect scoliotic torso and the effect on it as she altered her breathing patterns. It was from these observations and self-experimentation that she devised her rotational angular breathing method. Subsequently, the Schroth method evolved under the leadership of her daughter, Christa Lehnert-Schroth P.T., and grandson, Dr. Hans-Rudolf Weiss. Collaboration with Dr. Jacques Chêneau led to a new Schroth method compatible scoliosis bracing approach. The most recent advancement of Chêneau bracing is the Gensingen Brace® (GBW). Gensingen braces have an asymmetric design and rely on Schroth principles of correction in a smaller, lighter, more wearer-friendly brace. Each brace is designed to be a complementary supportive orthosis. It may be used independently, or in conjunction with Schroth exercise protocols. PMID:29399223

  18. Congenital vertical talus: Treatment by reverse ponseti technique

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    Bhaskar Atul

    2008-01-01

    Full Text Available Background: The surgery for idiopathic congenital vertical talus (CVT can lead to stiffness, wound complications and under or over correction. There are sporadic literature on costing with mixed results. We describe our early experience of reverse ponseti technique. Materials and methods: Four cases (four feet of idiopathic congenital vertical talus (CVT which presented one month after birth were treated by serial manipulation and casting, tendoachilles tenotomy and percutaneous pinning of talonavicular joint. An average of 5.2 (range - four to six plaster cast applications were required to correct the forefoot deformity. Once the talus and navicular were aligned based on the radiographic talus-first metatarsal axis, percutaneous fixation of the talo-navicular joint with a Kirschner wire, and percutaneous tendoachilles tenotomy under anesthesia was performed following which a cast was applied with the foot in slight dorsiflexion. Results: The mean follow-up period for the four cases was 8.5 months (6-12 months. At the end of the treatment all feet were supple and plantigrade but still using ankle foot orthosis (AFO. The mean talocalcaneal angle was 70 degrees before treatment and this reduced to 31 degrees after casting. The mean talar axis first metatasal base angle (TAMBA angle was 60° before casting and this improved to 10.5°. Conclusion: Although our follow-up period is small, we would recommend early casting for idiopathic CVT along the same lines as the Ponseti technique for clubfoot except that the forces applied are in reverse direction. This early casting method can prevent extensive surgery in the future, however, a close vigil is required to detect any early relapse.

  19. A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke: A proof of concept study.

    Science.gov (United States)

    Kawakami, Michiyuki; Fujiwara, Toshiyuki; Ushiba, Junichi; Nishimoto, Atsuko; Abe, Kaoru; Honaga, Kaoru; Nishimura, Atsuko; Mizuno, Katsuhiro; Kodama, Mitsuhiko; Masakado, Yoshihisa; Liu, Meigen

    2016-09-21

    Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent. The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis. Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score. After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy. Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after

  20. Conservative treatment of neural arch fractures of the axis: computed tomography scan and X-ray study on consolidation time.

    Science.gov (United States)

    Ramieri, Alessandro; Domenicucci, Maurizio; Landi, Alessandro; Rastelli, Emanuela; Raco, Antonino

    2011-02-01

    Computed tomography (CT) scan and X-ray study on consolidation time of C2 neural arch fractures treated conservatively were examined. A prospective study was undertaken: 28 conservatively treated fractures of the neural arch of the axis (11 hanged-man type I, 5 type II, and 12 miscellaneous fractures) were monitored during the period of orthosis by means of CT scan and plain X-rays performed on admission, and then at intervals between 2 and 120 days afterward. In patients treated with a halo vest (20 cases), a CT scan of the skull was performed to make sure that the pins were correctly positioned and to evaluate the osteolytic processes at the pin-bone interface. Two patients died as a result of other severe brain or thoracoabdominal injuries, and the remaining 26 fractures healed in an average time of 109 days (range 90-120). The process of bone consolidation was documented in detail by CT, which showed how the newly formed osteofibrous tissue (iso-hypodense) progressively filled the interfragmentary space. In 2 cases of cranial pin loosening, CT demonstrated an osteolytic rim at the interface, which prompted early removal of the halo system. At clinical follow-up (mean 32 months; range 24-84), functional status was evaluated: all of the patients were neurologically intact with the exception of one, who presented with persistent paresthesias. The most frequent disturbance was cervical pain (12 cases, 46%). CT with two- and three-dimensional reconstructed images has been shown to be the most reliable method for clarifying the evolution of bone consolidation and to show any osteolytic processes at the pin-bone interface during halo vest immobilization. Follow-up results of our series suggest that surgical treatment would not have improved the quality of life in these patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. [S2-Guideline: Pediatric Flat Foot].

    Science.gov (United States)

    Hell, Anna K; Döderlein, Leo; Eberhardt, Oliver; Hösl, Matthias; von Kalle, Thekla; Mecher, Frauke; Simon, Angela; Stinus, Hartmut; Wilken, Bernd; Wirth, Thomas

    2018-04-09

    In pediatric flat foot a differentiation has to be made between the flexible and the rigid form. The diagnosis is based on the history, clinical examination as well as pedobarography, gait analysis and imaging techniques. It is important to rule out neuropediatric conditions such as muscular dystrophies, Ehlers-Danlos- or Marfan syndrome. In children six years of age and younger a flexible flat foot is nearly always physiological (97% of all 19 months old children). Up to the age of ten years the medial column of the foot is developing. Only a minority of children (4% in ten year olds) has a persistent or progressive deformity. Beyond to age of ten there is a danger of deformity decompensation as well as an increased rigidity. Only a minority of children develops some pain (< 2%). A clear risk factor for persistent pediatric flat foot is obesity (62% of six year old children with flat foot are obese). Pathogenetic factors include muscular, bony or soft tissue conditions. However, there specific rule is still unclear. Prevention consists in a thorough parent information about the normal development as well as encouragement of regular sportive activities. Soft and large enough shoes should be carried as a protection. Barfoot walking has to be encouraged on uneven grounds. If physiotherapy is needed different methods can be applied. Orthosis treatment should include a proprioceptive approach. Surgical interventions in children are rare. If surgical treatment is planned a detailed algorhythm should be used before utilizing one of the many different surgical methods. Georg Thieme Verlag KG Stuttgart · New York.

  2. Abduction bracing for residual acetabular dysplasia in infantile DDH.

    Science.gov (United States)

    Gans, Itai; Flynn, John M; Sankar, Wudbhav N

    2013-01-01

    Abduction bracing is often used to treat residual acetabular dysplasia in infants whose acetabular indices (AI) exceed 30 degrees after 6 months of age. However, little data exist to support this practice. The purpose of this study was to determine the efficacy of part-time abduction bracing in treating residual acetabular dysplasia by comparing a cohort of braced infants with a cohort of unbraced infants. We performed a retrospective review of a consecutive series of patients with developmental dysplasia of the hip (DDH) treated at our institution over 4 years. Children with stable, treated DDH but residual acetabular dysplasia at 6 months of age were identified; those with available anteroposterior pelvic radiographs at 6 months and 1 year of age were included. Patients who required open surgical reduction and those with syndromic or neuromuscular diagnoses were excluded. On the basis of practice variations at our institution, some orthopaedists start bracing when the 6-month radiograph demonstrates an AI≥30 degrees, whereas others do not; we compared these 2 cohorts. Braced patients were instructed to wear an abduction orthosis during nights and naps until follow-up at 1 year of age. The AI at 6 months and 1 year of age for both cohorts were then measured by a single observer and the differences compared. Seventy-six hips in 52 patients were identified with residual dysplasia on the 6-month radiograph. Thirty-nine hips (27 patients) were unbraced, 31 hips (21 patients) were braced, and 6 hips (4 patients) were excluded for cross-over. Over a 6-month period, the braced cohort had significantly better improvement in the AI of 5.3 degrees (95% confidence interval, 4.3 to 6.3 degrees) compared to the unbraced cohort which had an improvement in the AI of only 1.1 degrees (95% confidence interval 0.6 to 1.6 degrees) (PDDH. Level III-retrospective comparative study.

  3. Complete Remodeling After Conservative Treatment of a Severely Angulated Odontoid Fracture in a Patient With Osteogenesis Imperfecta: A Case Report.

    Science.gov (United States)

    Colo, Dino; Schlösser, Tom P C; Oostenbroek, Hubert J; Castelein, René M

    2015-09-15

    Case report. This is the first case report describing successful healing and remodeling of a traumatic odontoid fracture that was dislocated and severely angulated in a patient with osteogenesis imperfecta who was treated conservatively. Osteogenesis imperfecta (OI) is a rare genetic disorder resulting in a low bone mass and bone fragility, predisposing these patients to fractures that often occur at a young age. Although any bone in the body may be involved, odontoid fractures are uncommon in this population. Because of a very high fusion rate, conservative management is accepted as a safe and efficient treatment of fractures of the odontoid in children. Several authors, however, recommend surgical treatment of patients who have failure of conservative treatment and have severe angulation or displacement of the odontoid. A 5-year-old female, diagnosed with OI type I, presented with neck pain without any neurological deficits after falling out of a rocking chair backward, with her head landing first on the ground. Computed tomography confirmed a type III odontoid fracture without dislocation and she was initially treated with a rigid cervical orthosis. At 1 and 2 months of follow-up, progressive severe angulation of the odontoid was observed but conservative treatment was maintained as the space available for the spinal cord was sufficient and also considering the patient's history of OI. Eight months postinjury, she had no clinical symptoms and there was osseous healing of the fracture with remodeling of the odontoid to normal morphology. Even in patients with OI, severely angulated odontoid fractures might have the capacity for osseous healing and complete remodeling under conservative treatment. 5.

  4. Validation of the Arabic version of the client satisfaction with device module of the orthotics and prosthetics users survey.

    Science.gov (United States)

    Bakhsh, Hadeel; Franchignoni, Franco; Bravini, Elisabetta; Ferriero, Giorgio; Giordano, Andrea; Foti, Calogero

    2014-01-01

    Assessing patient satisfaction with orthosis (PSwO) is a key point for clinical practice to increase a patient's adherence to therapeutic programs and reduce orthotic-related costs. The Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey (OPUS) is one of the most widely-used questionnaires for assessing PSwO, but its validated version in the Arabic language is lacking. The objective of this study is to generate and psychometrically validate an Arabic version of the CSD (CSD-Ar). This is a cross-sectional study, conducted during February to June 2013 at 2 inpatient and outpatient rehabilitation departments in Riyadh, Saudi Arabia. Translation of CSD-Ar was carried out according to the guideline recommendations of Linacre. A convenience sample of 100 orthotic-user patients with various conditions (59% men, mean age 36 years) completed the CSD-Ar. Data were analyzed using exploratory factor analysis followed by Rasch analysis. Factor analysis confirmed the unidimensionality of the CSD-Ar. Rasch criteria for the functioning of rating scale categories were fulfilled. All items showed an adequate fit to the Rasch model. The person separation reliability was .75 and Cronbach alpha .83. There was a borderline local dependency between items 1 ("My device fits well") and 3 ("My device is comfortable throughout the day"). The internal construct validity of the CSD-Ar in Arab patients with various types of orthotics has been confirmed. This study provides a useful starting point for the use of this outcome measure in Arabic-speaking countries.

  5. Validation of the Italian version of the Client Satisfaction with Device module of the Orthotics and Prosthetics Users' Survey.

    Science.gov (United States)

    Bravini, Elisabetta; Franchignoni, Franco; Ferriero, Giorgio; Giordano, Andrea; Bakhsh, Hadeel; Sartorio, Francesco; Vercelli, Stefano

    2014-10-01

    Information on patient satisfaction with orthosis (PSwO) is crucial for verifying and enhancing orthotic quality, for clinical decision making, and for improving patient's quality of life. To perform the translation and cross-cultural adaptation into Italian of the recently revised version of the Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey, and then analyze its psychometric properties using factor and Rasch analyses. We translated and cross-culturally adapted the revised CSD into Italian (CDS-It) and assessed it in a convenience sample of orthotic-user patients with orthopedic, neurological and rheumatic conditions (N = 178; 56% men; median age, 62 years). Exploratory factor analysis and Rasch analysis (rating scale model) were used to investigate, respectively, dimensionality and metric properties of the scale. Factor analysis confirmed the substantial unidimensionality of the CSD-It. The rating scale fulfilled the category functioning criteria. All items fitted the Rasch model except #2 ("The weight of my device is manageable") that overfitted the model, and #4 ("It is easy to put on my device") that was underfitting in six stroke patients (i.e. not systematically). The targeting of item difficulty to person ability was out of range. The person separation reliability was 0.70 and Cronbach's alpha 0.73. The residual correlation between items #7 and #8 showed a borderline local dependency. This study confirms the validity of the CSD-It, and provides a useful starting point for further refinement of this outcome measure. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Treatment of the Spasticity in Children with Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Ajša Meholjić-Fetahović

    2008-11-01

    Full Text Available Botulinum toxin is a natural purified protein and one of the strongest biological poisons - neurotoxin. It is produced by the bacterium Clostridium botulinum. Its medical usage started in USA in 1981 and in Europe in 1992. There are seven different immune types of the toxin: A, B, C1, D, E, F and G. Toxin types A and B are used to decrease muscular spasticity. Botulinum toxin prevents the formation of acetylcholine from cholinergic nerve tissues in muscles, which in the end irreversibly destroys neuromuscular synapses. It is called temporary local chemodenervation. It does not affect the synthesis of acetylcholine.As it affects neuromuscular bond it also affects one of the symptoms of cerebral palsy - spasticity Decreasing the spasticity of children with cerebral palsy leads to the improvement of conscious movements, muscles are less toned, passive mobility is improved, orthosis tolerance is also improved, and the child is enabled to perform easier and better motor functions such as crawling, standing and walking. Since the action of Botulinum toxin is limited to 2-6 months, new neural collaterals are formed and neuromuscular conductivity is reestablished which in the end once again develops a muscular spasm. This leads to a conclusion that botulinum toxin should again be applied into spastic muscles.It is very important for good effect of Botulinum toxin to set the goals of the therapy in advance. The goals include improvement of a function, prevention of contractions and deformities, ease of care and decrease of pain for children with cerebral palsy. After application of botulinum toxin, it is necessary to perform adequate and intensive physical treatment with regular monitoring of effects.This work shows a case of a boy with spastic form of cerebral palsy. After being habilitated using Vojta therapy and Bobath concept and the conduct of certain physical procedures, botulinum toxin is administered into his lower limbs’ muscles and

  7. Human-Robot Interaction: Does Robotic Guidance Force Affect Gait-Related Brain Dynamics during Robot-Assisted Treadmill Walking?

    Science.gov (United States)

    Knaepen, Kristel; Mierau, Andreas; Swinnen, Eva; Fernandez Tellez, Helio; Michielsen, Marc; Kerckhofs, Eric; Lefeber, Dirk; Meeusen, Romain

    2015-01-01

    In order to determine optimal training parameters for robot-assisted treadmill walking, it is essential to understand how a robotic device interacts with its wearer, and thus, how parameter settings of the device affect locomotor control. The aim of this study was to assess the effect of different levels of guidance force during robot-assisted treadmill walking on cortical activity. Eighteen healthy subjects walked at 2 km.h-1 on a treadmill with and without assistance of the Lokomat robotic gait orthosis. Event-related spectral perturbations and changes in power spectral density were investigated during unassisted treadmill walking as well as during robot-assisted treadmill walking at 30%, 60% and 100% guidance force (with 0% body weight support). Clustering of independent components revealed three clusters of activity in the sensorimotor cortex during treadmill walking and robot-assisted treadmill walking in healthy subjects. These clusters demonstrated gait-related spectral modulations in the mu, beta and low gamma bands over the sensorimotor cortex related to specific phases of the gait cycle. Moreover, mu and beta rhythms were suppressed in the right primary sensory cortex during treadmill walking compared to robot-assisted treadmill walking with 100% guidance force, indicating significantly larger involvement of the sensorimotor area during treadmill walking compared to robot-assisted treadmill walking. Only marginal differences in the spectral power of the mu, beta and low gamma bands could be identified between robot-assisted treadmill walking with different levels of guidance force. From these results it can be concluded that a high level of guidance force (i.e., 100% guidance force) and thus a less active participation during locomotion should be avoided during robot-assisted treadmill walking. This will optimize the involvement of the sensorimotor cortex which is known to be crucial for motor learning.

  8. Effect of body weight support variation on muscle activities during robot assisted gait: a dynamic simulation study.

    Science.gov (United States)

    Hussain, Shahid; Jamwal, Prashant K; Ghayesh, Mergen H

    2017-05-01

    While body weight support (BWS) intonation is vital during conventional gait training of neurologically challenged subjects, it is important to evaluate its effect during robot assisted gait training. In the present research we have studied the effect of BWS intonation on muscle activities during robotic gait training using dynamic simulations. Two dimensional (2-D) musculoskeletal model of human gait was developed conjointly with another 2-D model of a robotic orthosis capable of actuating hip, knee and ankle joints simultaneously. The musculoskeletal model consists of eight major muscle groups namely; soleus (SOL), gastrocnemius (GAS), tibialis anterior (TA), hamstrings (HAM), vasti (VAS), gluteus maximus (GLU), uniarticular hip flexors (iliopsoas, IP), and Rectus Femoris (RF). BWS was provided at levels of 0, 20, 40 and 60% during the simulations. In order to obtain a feasible set of muscle activities during subsequent gait cycles, an inverse dynamics algorithm along with a quadratic minimization algorithm was implemented. The dynamic parameters of the robot assisted human gait such as joint angle trajectories, ground contact force (GCF), human limb joint torques and robot induced torques at different levels of BWS were derived. The patterns of muscle activities at variable BWS were derived and analysed. For most part of the gait cycle (GC) the muscle activation patterns are quite similar for all levels of BWS as is apparent from the mean of muscle activities for the complete GC. Effect of BWS variation during robot assisted gait on muscle activities was studied by developing dynamic simulation. It is expected that the proposed dynamic simulation approach will provide important inferences and information about the muscle function variations consequent upon a change in BWS during robot assisted gait. This information shall be quite important while investigating the influence of BWS intonation on neuromuscular parameters of interest during robotic gait training.

  9. PLAY HANDS PROTECTIVE GLOVES: TECHNICAL NOTE ON DESIGN AND CONCEPT.

    Science.gov (United States)

    Houston-Hicks, Michele; Lura, Derek J; Highsmith, M Jason

    2016-09-01

    Cerebral Palsy (CP) is the leading cause of childhood motor disability, with a global incidence of 1.6 to 2.5/1,000 live births. Approximately 23% of children with CP are dependent upon assistive technologies. Some children with developmental disabilities have self-injurious behaviors such as finger biting but also have therapeutic needs. The purpose of this technical note is to describe design considerations for a protective glove and finger covering that maintains finger dexterity for children who exhibit finger and hand chewing (dermatophagia) and require therapeutic range of motion and may benefit from sensory stimulation resulting from constant contact between glove and skin. Protecting Little and Adolescent Youth (PLAY) Hands are protective gloves for children with developmental disorders such as CP who injure themselves by biting their hands due to pain or sensory issues. PLAY Hands will be cosmetically appealing gloves that provide therapeutic warmth, tactile sensory feedback, range of motion for donning/ doffing, and protection to maximize function and quality of life for families of children with developmental disorders. The technology is either a per-finger protective orthosis or an entire glove solution designed from durable 3D-printed biodegradable/bioabsorbable materials such as thermoplastics. PLAY Hands represent a series of protective hand wear interventions in the areas of self-mutilating behavior, kinematics, and sensation. They will be made available in a range of protective iterations from single- or multi-digit finger orthoses to a basic glove design to a more structurally robust and protective iteration. To improve the quality of life for patients and caregivers, they are conceptualized to be cosmetically appealing, protective, and therapeutic.

  10. Reducing robotic guidance during robot-assisted gait training improves gait function: a case report on a stroke survivor.

    Science.gov (United States)

    Krishnan, Chandramouli; Kotsapouikis, Despina; Dhaher, Yasin Y; Rymer, William Z

    2013-06-01

    To test the feasibility of patient-cooperative robotic gait training for improving locomotor function of a chronic stroke survivor with severe lower-extremity motor impairments. Single-subject crossover design. Performed in a controlled laboratory setting. A 62-year-old man with right temporal lobe ischemic stroke was recruited for this study. The baseline lower-extremity Fugl-Meyer score of the subject was 10 on a scale of 34, which represented severe impairment in the paretic leg. However, the subject had a good ambulation level (community walker with the aid of a stick cane and ankle-foot orthosis) and showed no signs of sensory or cognitive impairments. The subject underwent 12 sessions (3 times per week for 4wk) of conventional robotic training with the Lokomat, where the robot provided full assistance to leg movements while walking, followed by 12 sessions (3 times per week for 4wk) of patient-cooperative robotic control training, where the robot provided minimal guidance to leg movements during walking. Clinical outcomes were evaluated before the start of the intervention, immediately after 4 weeks of conventional robotic training, and immediately after 4 weeks of cooperative control robotic training. These included: (1) self-selected and fast walking speed, (2) 6-minute walk test, (3) Timed Up & Go test, and (4) lower-extremity Fugl-Meyer score. Results showed that clinical outcomes changed minimally after full guidance robotic training, but improved considerably after 4 weeks of reduced guidance robotic training. The findings from this case study suggest that cooperative control robotic training is superior to conventional robotic training and is a feasible option to restoring locomotor function in ambulatory stroke survivors with severe motor impairments. A larger trial is needed to verify the efficacy of this advanced robotic control strategy in facilitating gait recovery after stroke. Copyright © 2013 American Congress of Rehabilitation Medicine

  11. Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial.

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    Baumbach, Sebastian Felix; Fasser, Mariette; Polzer, Hans; Sieb, Michael; Regauer, Markus; Mutschler, Wolf; Schieker, Matthias; Blauth, Michael

    2013-01-14

    Ankle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV) is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains. 60 patients, aged 18-40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D. This is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various neuromuscular parameters, WBV is a promising treatment method for

  12. Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial

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    Baumbach Sebastian Felix

    2013-01-01

    Full Text Available Abstract Background Ankle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains. Methods/Design 60 patients, aged 18–40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D. Discussion This is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various

  13. Modifications in ankle dorsiflexor activation by applying a torque perturbation during walking in persons post-stroke: a case series.

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    Blanchette, Andreanne K; Noël, Martin; Richards, Carol L; Nadeau, Sylvie; Bouyer, Laurent J

    2014-06-09

    Results obtained in a previous study (Gait Posture 34:358-363, 2011) have shown that, in non-disabled participants, a specific increase in ankle dorsiflexor (Tibialis anterior [TA]) activation can be induced by walking with a torque perturbation that plantarflexes the ankle during the swing phase. After perturbation removal, the increased TA activation persisted temporarily and was associated with a more dorsiflexed ankle during swing. The objective of the present case-series study was to verify if these results can be reproduced in persons post-stroke. Six participants who sustained a stroke walked on a treadmill before, during and after exposure to a torque perturbation applied at the ankle by a robotized ankle-foot orthosis. Spatiotemporal gait parameters, ankle and knee kinematics, and the electromyographic activity of TA and Soleus were recorded. Mean amplitude of the TA burst located around toe off and peak ankle dorsiflexion angle during swing were compared across the 3 walking periods for each participant. At the end of the walking period with the perturbation, TA mean amplitude was significantly increased in 4 of the 6 participants. Among these 4 participants, modifications in TA activation persisted after perturbation removal in 3 of them, and led to a statistically significant increase in peak dorsiflexion during swing. This approach may be helpful to evaluate the residual adaptive capacity in the ankle dorsiflexors after a stroke and guide decision-making for the selection of optimal rehabilitation interventions. Future work will investigate the clinical impact of a multiple-session gait training based on this approach in persons presenting a reduced ankle dorsiflexion during the swing phase of walking.

  14. [Discitis in children less than 3 years old: a case series and literature review].

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    Miranda, I; Salom, M; Burguet, S

    2014-01-01

    Review of the cases of discitis treated in our unit in children under 3 years old. A retrospective medical record review was made of 10 cases with a diagnosis of discitis at discharge, in children hospitalized from January 1998 to December 2010. The most affected level was L5-S1 (4 cases), followed by L4-L5 (3 cases). The history at presentation was non-specific and caused a delay in the diagnosis of 3.7 weeks, and a wrong initial diagnosis in 7 patients. Most frequent symptoms were the refusal to sit (70%) and an alteration in gait or refusal to walk (50%), with pain at spinal palpation (80%), and stiffness (70%). All patients had unspecific laboratory test anomalies, and radiographs were normal in 6 patients. Magnetic resonance imaging (MRI) was performed on 9 patients and was diagnostic in all of them. All patients were treated and remain asymptomatic after a mean follow-up of 24.2 months, but radiographic abnormalities persist in 80% of them. The diagnosis of discitis is difficult in patients under 3 years due to the absence of specific clinical and laboratory findings. Magnetic resonance is the tool of choice to make the diagnosis. Treatment consists of a combination of antibiotics and orthosis. Radiological abnormalities persist in the majority of cases. In patients under 3 years with the suspected diagnosis of discitis, MRI should be considered in the diagnosis of discitis. Symptoms resolve with antibiotics and immobilization. Because of the persistency of the radiographical abnormalities, a long-term period of follow-up is advised to detect long-term sequelae. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Early mobilization in complete spinal cord injury under conservative treatment in a developing country

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    Sankhadeb Acharya

    2015-01-01

    Full Text Available Background: Spinal cord injury (SCI management requires extended acute care and life-long chronic care. Aims: The present study was conducted to mobilize complete SCI patients early during conservative treatment and follow them up at the same time weekly for 6 weeks. Materials and Methods: This study was conducted in a time span of 2 years in a tertiary care hospital of Eastern India. All SCI patients admitted in the hospital for the treatment were assessed clinicoradiologically for the level of lesion. Those complete SCI patients who did not recover within 3 weeks of conservative treatment were mobilized with orthosis and efforts were done to recover the activities of daily living (ADL. The effects of early mobilization were monitored and noted at weekly interval with serial radiographs for increasing vertebral collapse and displacement and neurologically up to 6 weeks in the hospital and monthly for a time span of 1 year. Results: Results clearly indicated that guarded mobilization with braces on does not further aggravate the deformity. Bed sores occurred in 8% of cervical cord injury (CCI and 7% of D-L injury. Respiratory infections occurred in 8% of CCI and 5% of D-L injury. Urinary tract infection affected 12% of CCI and 10% of D-L injury, and the incidences were lower when compared to previous studies, and this may be attributed to early mobilization. Conclusions: Complete SCI patients may be discharged from the hospital within 6 weeks of sustaining an injury with added training for ADL to reduce the social burden in developing countries.

  16. Upper cervical injuries: Clinical results using a new treatment algorithm

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    Andrei F Joaquim

    2015-01-01

    Full Text Available Introduction: Upper cervical injuries (UCI have a wide range of radiological and clinical presentation due to the unique complex bony, ligamentous and vascular anatomy. We recently proposed a rational approach in an attempt to unify prior classification system and guide treatment. In this paper, we evaluate the clinical results of our algorithm for UCI treatment. Materials and Methods: A prospective cohort series of patients with UCI was performed. The primary outcome was the AIS. Surgical treatment was proposed based on our protocol: Ligamentous injuries (abnormal misalignment, facet perched or locked, increase atlanto-dens interval were treated surgically. Bone fractures without ligamentous injuries were treated with a rigid cervical orthosis, with exception of fractures in the dens base with risk factors for non-union. Results: Twenty-three patients treated initially conservatively had some follow-up (mean of 171 days, range from 60 to 436 days. All of them were neurologically intact. None of the patients developed a new neurological deficit. Fifteen patients were initially surgically treated (mean of 140 days of follow-up, ranging from 60 to 270 days. In the surgical group, preoperatively, 11 (73.3% patients were AIS E, 2 (13.3% AIS C and 2 (13.3% AIS D. At the final follow-up, the American Spine Injury Association (ASIA score was: 13 (86.6% AIS E and 2 (13.3% AIS D. None of the patients had neurological worsening during the follow-up. Conclusions: This prospective cohort suggested that our UCI treatment algorithm can be safely used. Further prospective studies with longer follow-up are necessary to further establish its clinical validity and safety.

  17. Improvement of lower extremity electrodiagnostic findings following a trial of spinal manipulation and motion-based therapy

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    Morningstar Mark W

    2006-09-01

    Full Text Available Abstract Background Lumbar disc herniation is a problem frequently encountered in manual medicine. While manual therapy has shown reasonable success in symptomatic management of these cases, little information is known how manual therapy may affect the structure and function of the lumbar disc itself. In cases where lumbar disc herniation is accompanied by radicular symptoms, electrodiagnostic testing has been used to provide objective clinical information on nerve function. This report examines the treatment rendered for a patient with lower extremity neurological deficit, as diagnosed on electrodiagnostic testing. Patient was treated using spinal manipulation and exercises performed on a Pettibon Wobble Chair™, using electrodiagnostic testing as the primary outcome assessment. Case Presentation An elderly male patient presented to a private spine clinic with right-sided foot drop. He had been prescribed an ankle-foot orthosis for this condition. All sensory, motor, and reflex findings in the right leg and foot were absent. This was validated on prior electromyography and nerve conduction velocity testing, performed by a board certified neurologist. Patient was treated using spinal manipulation twice-weekly and wobble chair exercises three times daily for 90 days total. Following this treatment, the patient was referred for follow-up electrodiagnostic studies. Significant improvements were made in these studies as well as self-rated daily function. Conclusion Motion-based therapies, as part of a comprehensive rehabilitation program, may contribute to the restoration of daily function and the reversal of neurological insult as detected by electrodiagnostic testing. Electrodiagnostic testing may be a useful clinical tool to evaluate the progress of chiropractic patients with lumbar disc herniation and radicular pain syndromes.

  18. Using robot-applied resistance to augment body-weight-supported treadmill training in an individual with incomplete spinal cord injury.

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    Lam, Tania; Pauhl, Katherine; Krassioukov, Andrei; Eng, Janice J

    2011-01-01

    The efficacy of task-specific gait training for people with spinal cord injury (SCI) is premised on evidence that the provision of gait-related afferent feedback is key for the recovery of stepping movements. Recent findings have shown that sensory feedback from flexor muscle afferents can facilitate flexor muscle activity during the swing phase of walking. This case report was undertaken to determine the feasibility of using robot-applied forces to resist leg movements during body-weight-supported treadmill training (BWSTT) and to measure its effect on gait and other health-related outcomes. The patient described in this case report was a 43-year-old man with a T11 incomplete chronic SCI. He underwent 36 sessions of BWSTT using a robotic gait orthosis to provide forces that resist hip and knee flexion. Tolerance to the training program was monitored using the Borg CR10 scale and heart rate and blood pressure changes during each training session. Outcome measures (ie, 10-Meter Walk Test, Six-Minute Walk Test, modified Emory Functional Ambulation Profile [mEFAP], Activities-specific Balance Confidence Scale, and Canadian Occupational Performance Measure) were completed and kinematic parameters of gait, lower-extremity muscle strength (force-generating capacity), lower-limb girth, and tolerance to orthostatic stress were measured before and after the training program. The patient could tolerate the training. Overground walking speed, endurance, and performance on all subtasks of the mEFAP improved and were accompanied by increased lower-limb joint flexion and toe clearance during gait. The patient's ambulatory self-confidence and self-perceived performance in walking also improved. These findings suggest that this new approach to BWSTT is a feasible and potentially effective therapy for improving skilled overground walking performance.

  19. Posterior glenohumeral thermal capsulorraphy, capsular imbrication and labral repair with complication of adhesive capsulitis: a modified rehabilitation approach.

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    Podraza, Jeffrey T; White, Scott C

    2012-02-01

    Isolated atraumatic posterior glenohumeral instability is rare. Use of thermal capsulorraphy for glenohumeral instability is considered controversial. This case study describes a modified rehabilitation protocol for a patient who underwent a multistep arthroscopic procedure for isolated posterior glenohumeral instability with a postoperative complication of adhesive capsulitis. A 30-y-old man with a 15-y history of bilateral posterior glenohumeral instability related to generalized hypermobility underwent right-shoulder arthroscopy consisting of a combined posterior labral repair, capsular imbrication, and thermal capsulorraphy. A gunslinger orthosis was prescribed for 6 wk of immobilization. Adhesive capsulitis was diagnosed at the 5-wk postoperative visit and immobilization was discontinued. A modified treatment protocol was devised to address both the surgical procedures performed and the adhesive capsulitis. Residual symptoms resolved with release of an adhesion while stretching 10 months postoperatively. Scores of 5 shoulder-assessment tools improved from poor to excellent/good with subjective report of a very good outcome. The complication of adhesive capsulitis required an individualized treatment protocol. In contrast to the standard protocol, our modified approach allowed more time to be spent in each phase of the program, was aggressive with restoring range of motion (ROM) without excessively stressing the posterior capsule, and allowed the patient to progress to activities that were tolerated regardless of protocol phase. Shoulder stiffness or frank adhesive capsulitis after stabilization, as in this case, requires a more aggressive modification to prevent permanent ROM limitations. Conversely, patients with early rapid gains in ROM must be protected from overstretching the repaired tissue with a program that allows functional motion to be incorporated over a longer time frame. This study indicates the use of thermal capsulorraphy as a viable surgical

  20. Effect of a 2-week trial of functional electrical stimulation on gait function and quality of life in people with multiple sclerosis.

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    Downing, Abbey; Van Ryn, David; Fecko, Anne; Aiken, Christopher; McGowan, Sean; Sawers, Sarah; McInerny, Thomas; Moore, Katie; Passariello, Louis; Rogers, Helen

    2014-01-01

    Footdrop is a common gait deviation in people with multiple sclerosis (MS) leading to impaired gait and balance as well as decreased functional mobility. Functional electrical stimulation (FES) provides an alternative to the current standard of care for footdrop, an ankle-foot orthosis (AFO). FES stimulates the peroneal nerve and activates the dorsiflexor muscles, producing an active toe clearance and a more normal gait. This study was undertaken to determine the effects of a 2-week FES Home Assessment Program on gait speed, perceived walking ability, and quality of life (QOL) among people with MS-related footdrop. Participants completed the Timed 25-Foot Walk test (T25FW) and two self-report measures: 12-item Multiple Sclerosis Walking Scale (MSWS-12) and 29-item Multiple Sclerosis Impact Scale (MSIS-29). Measures were taken without FES before and with FES after 2 weeks of full-time FES wear. A total of 19 participants (10 female, 9 male) completed the study; mean age and duration of disease were 51.77 ± 10.16 and 9.01 ± 7.90 years, respectively. Use of FES for 2 weeks resulted in a significant decrease in time to complete the T25FW (P < .0001), the MSWS-12 standardized score (P < .0001), and the MSIS-29 total (P < .0001), Physical subscale (P < .0001), and Psychological subscale (P = .0006) scores. These results suggest that use of FES can significantly improve gait speed, decrease the impact of MS on walking ability, and improve QOL in people with MS-related footdrop even over a short period of time.

  1. The use of custom-made shoes in patients with foot deformities in foot clinic, Siriraj Hospital.

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    Paecharoen, Siranya; Chadchavalpanichaya, Navaporn

    2013-11-01

    To study the frequency, result, and concomitant factors of the use of custom-made shoes in Foot Clinic, Siriraj Hospital. Studying from patient records and interviewing the patients who had foot deformities without numbness and received custom-made shoes from the Foot Clinic, Siriraj Hospital between January 2009 and December 2011 about the latest custom-made shoes after the first three months of use. Sixty-seven participants were reviewed and included eight males (11.9%) and 59 females (88.1%) with an average age of 57.1 years. The majority had congenital foot deformity (19.4%). Most of them received sandal-type shoes (34.3%) and total contact orthosis (52.2%). The use of custom-made shoes that the participants had to use for more than 3 days/week and for more than or equal to 50% of daily walking and standing duration was 47.8%. Using these shoes reduced foot pain and increased walking stability (p-value = 0.007 and 0.023). Factors associated with the use of custom-made shoes were no previous callus (odds ratio = 25.30, 95% CI 2.20-290.56), decreasing callus after using the shoes (odds ratio = 23.54, 95% CI 1.65-335.23), decreasing foot pain after using the shoes (odds ratio = 5.01, 95% CI 1.20-20.95), and overall satisfaction (odd ratio = 21.47, 95% CI 3.81-121.04). The use of custom-made shoes from the Foot Clinic, Siriraj Hospital was 47.8%. Using the shoes could reduce foot pain and increase walking stability. Factors associated with the use of custom-made shoes were no previous callus, decreasing callus, decreasing foot pain, and overall satisfaction.

  2. Botulinum toxin with and without casting in ambulant children with spastic diplegia: a clinical and functional assessment.

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    Bottos, M; Benedetti, M G; Salucci, P; Gasparroni, V; Giannini, S

    2003-11-01

    This study compared clinical and functional outcomes after treatment with botulinum toxin A (BTX-A) and BTX-A with casting in children with dynamic equinus foot. Ten children (seven males, three females; mean age 6 years 4 months, SD 2 years 7 months; range 4 to 11 years) with mild spastic diplegia and independent walking were divided into two groups: group 1, BTX-A and group 2, BTX-A plus casting. BTX-A was injected in the triceps surae bilaterally at multiple sites while the children were sedated with mask anaesthesia. Dysport toxin was used, 15 to 20 IU/kg in each muscle. Immediately after injection an ankle-foot orthosis was applied to children in group 1 and a cast to children in group 2. Clinical assessment using the Ashworth scale, Gross Motor Function Measure (GMFM), range of movement measurement, and gait analysis was performed before treatment and 1, 4, and 12 months after treatment. Spasticity decreased significantly at 1-month examination in both groups (p = 0.002), at 4-month examinations (Wilcoxon test p = 0.003), and 12 month (p = 0.052) examinations in group 2. GMFM highlighted a significant improvement in group 2 at the 4-month examination (p = 0.052 for standing,p = 0.007 for walking). Gait analysis showed a significant increase in the walking speed in group 2 (p = 0.04). No change was detected in ankle kinematics and kinetics or in muscular activity during the gait cycle. We confirmed that BTX-A reduces spasticity and improves functional performance in standing and walking; association with casting provides more marked and enduring results.

  3. Requirements for and impact of a serious game for neuro-pediatric robot-assisted gait training.

    Science.gov (United States)

    Labruyère, Rob; Gerber, Corinna N; Birrer-Brütsch, Karin; Meyer-Heim, Andreas; van Hedel, Hubertus J A

    2013-11-01

    We investigated whether children with neurological gait disorders who walked in a driven gait orthosis could adjust their participation level according to the demands of a newly developed rehabilitation game. We further investigated if cognitive capacity and motor impairment influenced game performance. Nineteen children with neurological gait disorders (mean age: 13.4 y, 42% girls) participated. To quantify game participation, electromyographic muscle activity (M. rectus femoris) and heart rate were compared in a demanding part and a less demanding part of the game. Cognitive capacity was assessed with the Test of Nonverbal Intelligence (TONI-4). Furthermore, the Functional Independence Measure for Children (WeeFIM), Manual Muscle Tests and a therapist-derived score of how well the child was able to train were assessed. Results showed that muscle activity and heart rate were higher during the demanding part of the game (30.7 ± 22.6 μV; 129.4 ± 15.7 bpm) compared to the less demanding part (16.0 ± 13.4 μV; 124.1 ± 15.9 bpm; pGame performance correlated moderately with the TONI-4 (r=0.50, p=0.04) and the cognition subscale of the WeeFIM (ρ=0.59, p=0.01). The therapist-derived score correlated significantly with game performance (p=0.75, pgame (p=-0.72, pgame and those not. We conclude that children with neurological gait disorders are able to modify their activity to the demands of the VR-scenario. However, cognitive function and motor impairment determine to which extent. These results are important for clinical decision-making. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Changes in input-output relations in the corticospinal pathway to the lower limb muscles during robot-assisted passive stepping.

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    Kamibayashi, Kiyotaka; Nakajima, Tsuyoshi; Takahashi, Makoto; Nakazawa, Kimitaka

    2011-01-01

    We investigated input (stimulus)-output (response) relations of the corticospinal pathway in the lower limb muscles during passive stepping using a robotic driven gait orthosis. Nine healthy adult subjects passively stepped with 40% body weight unloading (ground stepping) and 100% body weight unloading in the air (air stepping). During passive stepping, the motor evoked potentials (MEPs) of the lower limb muscles elicited by transcranial magnetic stimulation (TMS) were recorded at late-stance, early-, and late-swing phases of 2 stepping conditions. The input-output relation at each phase of the stepping conditions was obtained by increasing stimulus intensity in 5% increments from 40% to 70% of maximal stimulator output. The slopes of input-output relations were steeper at the early-swing phase in the rectus femoris muscle and at the late-stance and late-swing phases in the biceps femoris muscle in both stepping conditions. There were no significant differences in the MEP responses of the rectus femoris and biceps femoris muscles at each phase between the 2 conditions. Low muscle activity was seen at the late-stance phase of ground stepping in the soleus muscle and the MEP amplitude at this phase became larger. The slopes in the tibialis anterior muscle were steep at the early- and late-swing phases of ground stepping. There was a significant difference in the MEPs of the tibialis anterior muscle between the late-swing phases in ground and air stepping. The present study indicates that corticospinal excitability to the lower limb muscles is modulated by sensory inputs elicited by passive stepping.

  5. Correction of the axial and appendicular deformities in a patient with Silver-Russel syndrome

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    Ali Al Kaissi

    2015-01-01

    Full Text Available Background: Scoliosis and limb length discrepancy are the major orthopaedic abnormalities in patients with Silver-Russel syndrome (SRS. In this paper, we describe a series of orthopaedic interventions in an attempt to overcome the progressive pathologic mechanism in a 7-year-old girl who manifested the full phenotypic features of SRS. Materials and Methods: Unilateral hip dislocation, progressive scoliosis and limb length discrepancy have been dealt with through Pemberton osteotomy, spinal fusion and Taylor-Spatial-Frame respectively. Results: In order to correct the axial and the appendicular deformities a sum of seven operations were performed (between the age of 7 years and 13 years. Pemberton osteotomy was performed to treat dislocation of her right hip because of developmental dysplasia of the hip. Spinal fusion (spondylodesis of segments Th3-L5 was done to correct her scoliosis. And, to overcome the limb length discrepancy of 15-cm we used Taylor-Spatial-Frame with percutaneous distal corticotomy of the femur, and the proximal tibia, as well as the foot, were performed. We were able to minimize the limb length discrepancy to 5 cm. The girl became able to walk with the aid of a below knee orthosis and through lifting the left limb with 5-cm height shoe. Conclusion: Limb lengthening surgery in patients with multiple malformation complex as in SRS is associated with high recurrence risk because of; muscular hypotonia, overtubulation of the long bones, and the poor bone regenerative quality. Our interventions were principally directed towards improving the cosmetic outlook, functions and the biomechanics.

  6. Active robotic training improves locomotor function in a stroke survivor

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    Krishnan Chandramouli

    2012-08-01

    Full Text Available Abstract Background Clinical outcomes after robotic training are often not superior to conventional therapy. One key factor responsible for this is the use of control strategies that provide substantial guidance. This strategy not only leads to a reduction in volitional physical effort, but also interferes with motor relearning. Methods We tested the feasibility of a novel training approach (active robotic training using a powered gait orthosis (Lokomat in mitigating post-stroke gait impairments of a 52-year-old male stroke survivor. This gait training paradigm combined patient-cooperative robot-aided walking with a target-tracking task. The training lasted for 4-weeks (12 visits, 3 × per week. The subject’s neuromotor performance and recovery were evaluated using biomechanical, neuromuscular and clinical measures recorded at various time-points (pre-training, post-training, and 6-weeks after training. Results Active robotic training resulted in considerable increase in target-tracking accuracy and reduction in the kinematic variability of ankle trajectory during robot-aided treadmill walking. These improvements also transferred to overground walking as characterized by larger propulsive forces and more symmetric ground reaction forces (GRFs. Training also resulted in improvements in muscle coordination, which resembled patterns observed in healthy controls. These changes were accompanied by a reduction in motor cortical excitability (MCE of the vastus medialis, medial hamstrings, and gluteus medius muscles during treadmill walking. Importantly, active robotic training resulted in substantial improvements in several standard clinical and functional parameters. These improvements persisted during the follow-up evaluation at 6 weeks. Conclusions The results indicate that active robotic training appears to be a promising way of facilitating gait and physical function in moderately impaired stroke survivors.

  7. Bilateral L5 Radiculopathy Due to Osteoporotic L1 Vertebral Fracture: A Case Report

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    Tezer, Mehmet; Ozturk, Cagatay; Erturer, Erden; Aydogan, Mehmet; Hamzaoglu, Azmi

    2006-01-01

    Background: The true incidence of osteoporotic vertebral fractures is not well defined because many osteoporotic vertebral fractures are asymptomatic. Although the true incidence of neurological compromise as a result of osteoporotic vertebral fractures is not known, it is thought to be low. In this case report, we present a case of L1 osteoporotic vertebral fracture causing bilateral L5 nerve root compression and manifestation of bilateral foot-drop. Methods: Pedicle screws were inserted in the vertebrae, 2 above and 2 below the L1 vertebra. A temporary rod was placed on the left. An L1 right hemilaminectomy via a posterior approach and a corpectomy were performed. The spinal cord was decompressed. Anterior fusion was carried out by placing titanium mesh cage into the vertebrectomy site as a strut graft via posterior approach, and posterolateral fusion with spongious allografts were added to the procedure. Results: Two years later the patient was completely symptom free and receiving medical treatment for osteoporosis, which was diagnosed as primary type. Conclusion: If a fracture is detected on the posterior wall of the vertebral body in computerized tomography (CT) examination with plain radiographs, a magnetic resonance imaging (MRI) examination should be conducted in the presence of symptoms and physical findings suggestive of neurological compression. Follow-up neurological examinations should be carried out, and it should be kept in mind that most of the neurological symptoms may develop late and manifest as radiculopathy. The majority of the osteoporotic vertebral fractures can be managed conservatively with bed rest and orthosis, but cases with accompanying neurological deficit should be managed surgically using decompression and stabilization by fusion and instrumentation. PMID:17044395

  8. The impact of continuous use of lumbosacral orthoses on trunk motor performance: a systematic review with meta-analysis.

    Science.gov (United States)

    Takasaki, Hiroshi; Miki, Takahiro

    2017-06-01

    Lumbosacral orthosis (LSO) is prescribed by general practitioners for the management of low back pain. It may be speculated that continuous use of an LSO for a prolonged period reduces mechanical loading to the trunk muscle in daily living and results in impairments of the trunk muscle. This study aims to investigate whether trunk motor performances are impaired by the continuous use of an LSO. This is a systematic review with meta-analysis. A systematic search was undertaken using PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, and Cochrane Library from inception to November 2016. Inclusion criteria were (1) the use of an LSO for ≥2 days, (2) the use of a soft LSO designed for musculoskeletal conditions, (3) absence of cointervention except education, and (4) measures of trunk motor performance. The following were excluded: (1) studies with insufficient data and (2) studies with poor methodological quality (Evaluation (GRADE) system was used to determine the quality of evidence. Data of eight studies were analyzed. The most common measures for motor performances were the maximum strength of the trunk flexors and extensors and the endurance and fatigability of the trunk extensors. In all measures, 95% confidence intervals of the pooled standardized mean difference between the control or preintervention group and the intervention or postintervention group included zero. Further, quality of evidence ranged from low to very low in the GRADE system in all findings of the meta-analyses. The meta-analyses demonstrated no negative effect by the continuous use of an LSO for 1-6 months. However, the quality of evidence ranged from low to very low, and more high-quality trials are required to draw a definitive conclusion on the impact of the continuous use of an LSO on trunk motor performances. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Coupling brain-machine interfaces with cortical stimulation for brain-state dependent stimulation: enhancing motor cortex excitability for neurorehabilitation

    Directory of Open Access Journals (Sweden)

    Alireza eGharabaghi

    2014-03-01

    Full Text Available Motor recovery after stroke is an unsolved challenge despite intensive rehabilitation training programs. Brain stimulation techniques have been explored in addition to traditional rehabilitation training to increase the excitability of the stimulated motor cortex. This modulation of cortical excitability augments the response to afferent input during motor exercises, thereby enhancing skilled motor learning by long-term potentiation-like plasticity. Recent approaches examined brain stimulation applied concurrently with voluntary movements to induce more specific use-dependent neural plasticity during motor training for neurorehabilitation. Unfortunately, such approaches are not applicable for the many severely affected stroke patients lacking residual hand function. These patients require novel activity-dependent stimulation paradigms based on intrinsic brain activity. Here, we report on such brain state-dependent stimulation (BSDS combined with haptic feedback provided by a robotic hand orthosis. Transcranial magnetic stimulation of the motor cortex and haptic feedback to the hand were controlled by sensorimotor desynchronization during motor-imagery and applied within a brain-machine interface environment in one healthy subject and one patient with severe hand paresis in the chronic phase after stroke. BSDS significantly increased the excitability of the stimulated motor cortex in both healthy and post-stroke conditions, an effect not observed in non-BSDS protocols. This feasibility study suggests that closing the loop between intrinsic brain state, cortical stimulation and haptic feedback provides a novel neurorehabilitation strategy for stroke patients lacking residual hand function, a proposal that warrants further investigation in a larger cohort of stroke patients.

  10. TREATMENT OF THE SPASTICITY IN CHILDREN WITH CEREBRAL PALSY

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    Meholjić-Fetahović, Ajša

    2007-01-01

    Botulinum toxin is a natural purified protein and one of the strongest biological poisons - neurotoxin. It is produced by the bacterium Clostridium botulinum. Its medical usage started in USA in 1981 and in Europe in 1992. There are seven different immune types of the toxin: A, B, C1, D, E, F and G. Toxin types A and B are used to decrease muscular spasticity. Botulinum toxin prevents the formation of acetylcholine from cholinergic nerve tissues in muscles, which in the end irreversibly destroys neuromuscular synapses. It is called temporary local chemodenervation. It does not affect the synthesis of acetylcholine. As it affects neuromuscular bond it also affects one of the symptoms of cerebral palsy - spasticity Decreasing the spasticity of children with cerebral palsy leads to the improvement of conscious movements, muscles are less toned, passive mobility is improved, orthosis tolerance is also improved, and the child is enabled to perform easier and better motor functions such as crawling, standing and walking. Since the action of Botulinum toxin is limited to 2-6 months, new neural collaterals are formed and neuromuscular conductivity is reestablished which in the end once again develops a muscular spasm. This leads to a conclusion that botulinum toxin should again be applied into spastic muscles. It is very important for good effect of Botulinum toxin to set the goals of the therapy in advance. The goals include improvement of a function, prevention of contractions and deformities, ease of care and decrease of pain for children with cerebral palsy. After application of botulinum toxin, it is necessary to perform adequate and intensive physical treatment with regular monitoring of effects. This work shows a case of a boy with spastic form of cerebral palsy. After being habilitated using Vojta therapy and Bobath concept and the conduct of certain physical procedures, botulinum toxin is administered into his lower limbs’ muscles and kinezitherapy intensified

  11. Botulin toxin A in the treatment of dynamic equinovarus foot in cerebral palsied children.

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    Kalinowski, Zbigniew; Bonikowski, Marcin

    2002-04-30

    Background. Contracture of the triceps in the calf occurs in most CP children especially those with diplegia and spastic hemiplegia. The purpose of our research was to evaluate the effective of TB-A in the treatment of these contractures and the associated disturbances of the dynamic position of the foot in CP children. Material and methods. Thirty five CP children (19 with diplegia and 16 with hemiplegia) received botulinum toxin A (TBX-A-Dysport) for the dynamic contracture of the triceps surae muscle and secondary equinovarus foot deformity. These children ranged in age from 2-11 years (mean 4.6). Previous conservative treatment had failed to alleviate these conditions. Goniometric measurements of the passive range of motion and the evaluation of dynamie equinovarus foot were performed prior to injection of BTX-A to 54 gastrocnemius muscles, and again at 2, 6, and 12 weeks post injection. Results. The results showed high effectiveness for TBX-A, e.g. marked reduction in equinovarity in 47 and 49 ankle joints (68%- 78%) at 2 and 6 weeks respectively, and in 19 joints (35%) at 12 weeks post-treatment, and moderate reduction in 12 (22%), 8 (15%) and 14 (26%) joints respectively. These improvements were statistically significant. In some children the positive effect was present up to 16 and 20 weeks post injection. No change was found on follow-up in 5 ankle joints (9%) at 2 weeks and in 7 (13%) at 6 and 12 weeks. Reversion to baseline scores was observed in 14 ankle joints (26%). The TB-A therapy was cllosely integrated with physiotherapy and the use of AFO orthosis when necessary. Conclusions. Botulin toxin therapy is effective in the treatment contractures of the triceps of the calf and equinovarus foot in children with cerebral palsy.

  12. Recurrence after correction of acquired ankle equinus deformity in children using Ilizarov technique.

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    Emara, Khaled M; Allam, Mohamed Farouk; Elsayed, Mohamed Nabil M A; Ghafar, Khaled Abd E L

    2008-12-01

    To describe our Ilizarov technique for the treatment of acquired equinus deformity in children and to determine if compliance with continuous use of an ankle foot orthosis (after removal of the fixator and until skeletal maturity) can influence the severity of recurrence. A cohort of 26 children with post-traumatic or post-burn contractures producing an equinus deformity was followed up for a minimum of 2 years after skeletal maturity. Cases with a bony deformity and/or nerve injury were excluded from this study. All patients were managed by a percutaneous tendo-Achilles lengthening followed by application of an Ilizarov external fixator. Post-operative treatment was in the form of gradual correction at a rate of 0.5 mm per day. Correction started from the second postoperative day until an over-correction of 15 degrees dorsiflexion was achieved. Ankle range of movement was encouraged 4 weeks prior to removal of the external fixator. On removal of the fixator, a posterior splint was applied until substituted by an ankle foot orthoses (AFO). The AFO was used continuously during the first 2-3 months and at nighttime thereafter until skeletal maturity. Fifteen children were compliant with the use of the AFO until skeletal maturity and 11 non-compliant. We compared the recurrence and the size of deformity between the two groups. The rate of recurrence, degree of equinus at recurrence and number of episodes of external fixation surgery showed statistical significant differences (P AFO until skeletal maturity can decrease the risk and degree of recurrence.

  13. Tolerability and effectiveness of a neuroprosthesis for the treatment of footdrop in pediatric patients with hemiparetic cerebral palsy.

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    Meilahn, Jill R

    2013-06-01

    To assess the tolerability and efficacy of a commercially available footdrop neuroprosthesis for treatment of footdrop in children with hemiparetic cerebral palsy. A prospective, observational pilot study. Marshfield Clinic, Department of Physical Medicine. Ten children, ages 7-12 years, with hemiparetic cerebral palsy, who use an ankle foot orthosis (AFO) for correction of footdrop. Children replaced their AFO with a transcutaneous peroneal (fibular) nerve stimulation neuroprosthesis for 3 months. The ability to tolerate fitting and programming of the device, device-recorded wear time, a daily-use diary, satisfaction survey, and secondary measures, including passive range of motion and gait laboratory measurement of gait velocity and ankle kinematics. All 10 participants (100%) tolerated fitting and programming of the neuroprosthesis and wore the device for 6 weeks. Seven of 10 (70%) wore the device for the entire 3-month study period; 6 of 10 (60%) continued to use the device after study completion. Wear time varied from 2 to 11 hours per day. Tolerability and satisfaction were high; although 6 participants complained of "size" and "bulkiness" of the device, and 2 reported skin irritation. Gait velocity increased in 5 subjects (50%). Seven participants (70%) preferred the neuroprosthesis to their AFO. Analysis of the preliminary evidence suggests that electrical stimulation by a footdrop neuroprosthesis is tolerated well by children and is effective for the treatment of footdrop in children with hemiparetic cerebral palsy. Commercially available neuroprostheses may offer a promising alternative treatment option for children with footdrop. Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  14. Long-Term Effects of Orthoses Use on the Changes of Foot and Ankle Joint Motions of Children With Spastic Cerebral Palsy.

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    Liu, Xue-Cheng; Embrey, David; Tassone, Channing; Zvara, Kim; Brandsma, Brenna; Lyon, Roger; Goodfriend, Karin; Tarima, Sergey; Thometz, John

    2017-09-01

    Orthoses commonly are prescribed to children with cerebral palsy (CP) to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long-term kinematic effects are lacking clinical evidence. To determine changes in 3-dimensional ankle and foot segment motion in pediatric patients with CP between initial and follow-up visits (18-month average time differences) in both barefoot gait and gait with their AFO. We also investigated intravisit changes between barefoot and AFO gait. A prospective cohort study. Children's Hospital of Wisconsin, Department of Orthopaedic Surgery, Medical College of Wisconsin. A total of 23 children with CP, mean age 10.5 years (6.2-18.1 years) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic. Holes were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6-foot segment model was used. Kinematic and kinetic data was recorded for each patient's initial and follow-up visit (18-month follow-up average, 15-20 months range). For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (P = .008). Furthermore, the SAFO group (barefoot gait) had an increased eversion at the midfoot for most of the gait cycle (P AFO groups. The use of AFOs long term either maintained or improved foot deformities or dysfunction. Level II. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  15. Clinical examination is highly sensitive for detecting clinically significant spinal injuries after gunshot wounds.

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    Inaba, Kenji; Barmparas, Galinos; Ibrahim, David; Branco, Bernardino C; Gruen, Peter; Reddy, Sravanthi; Talving, Peep; Demetriades, Demetrios

    2011-09-01

    The optimal method for spinal evaluation after penetrating trauma is currently unknown. The goal of this study was to determine the sensitivity and specificity of a standardized clinical examination for the detection of spinal injuries after penetrating trauma. After Institutional Review Board approval, all evaluable penetrating trauma patients aged 15 years or more admitted to the Los Angeles County + University of Southern California Medical Center were prospectively evaluated for spinal pain, tenderness to palpation, deformity, and neurologic deficit. During the 6-month study period, 282 patients were admitted after sustaining a penetrating injury; 143 (50.7%) as a result of gunshot wound (GSW) and 139 (49.3%) as a result of stab wound (SW). None of the patients sustaining a SW had a spinal injury. Of the 112 evaluable GSW patients, 9 sustained an injury: 6 with a true-positive and 3 with a false-negative clinical examination. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2% and 95.2%, respectively. For clinically significant injuries requiring surgical intervention, cervical or thoracolumbar spine orthosis, or cord transections, however, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%. Clinically significant spinal injury, although rare after SWs, is not uncommon after GSWs. A structured clinical examination of the spine in evaluable patients who have sustained a GSW is highly reliable for identifying those with clinically significant injuries.

  16. Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study (.).

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    Cruciger, Oliver; Schildhauer, Thomas A; Meindl, Renate C; Tegenthoff, Martin; Schwenkreis, Peter; Citak, Mustafa; Aach, Mirko

    2016-08-01

    Chronic neuropathic pain (CNP) is a common condition associated with spinal cord injury (SCI) and has been reported to be severe, disabling and often treatment-resistant and therefore remains a clinical challenge for the attending physicians. The treatment usually includes pharmacological and/or nonpharmacological approaches. Body weight supported treadmill training (BWSTT) and locomotion training with driven gait orthosis (DGO) have evolved over the last decades and are now considered to be an established part in the rehabilitation of SCI patients. Conventional locomotion training goes along with improvements of the patients' walking abilities in particular speed and gait pattern. The neurologic controlled hybrid assistive limb (HAL®, Cyberdyne Inc., Ibraki, Japan) exoskeleton, however, is a new tailored approach to support motor functions synchronously to the patient's voluntary drive. This report presents two cases of severe chronic and therapy resistant neuropathic pain due to chronic SCI and demonstrates the beneficial effects of neurologic controlled exoskeletal intervention on pain severity and health-related quality of life (HRQoL). Both of these patients were engaged in a 12 weeks period of daily HAL®-supported locomotion training. In addition to improvements in motor functions and walking abilities, both show significant reduction in pain severity and improvements in all HRQoL domains. Although various causal factors likely contribute to abatement of CNP, the reported results occurred due to a new approach in the rehabilitation of chronic spinal cord injury patients. These findings suggest not only the feasibility of this new approach but in conclusion, demonstrate the effectiveness of neurologic controlled locomotion training in the long-term management of refractory neuropathic pain. Implications for Rehabilitation CNP remains a challenge in the rehabilitation of chronic SCI patients. Locomotion training with the HAL exoskeleton seems to improve CNP

  17. Athletic Population with Spondylolysis: Review of Outcomes following Surgical Repair or Conservative Management

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    Panteliadis, Pavlos; Nagra, Navraj S.; Edwards, Kimberley L.; Behrbalk, Eyal; Boszczyk, Bronek

    2016-01-01

    Study Design  Narrative review. Objective  The study aims to critically review the outcomes associated with the surgical repair or conservative management of spondylolysis in athletes. Methods  The English literature listed in MEDLINE/PubMed was reviewed to identify related articles using the term “spondylolysis AND athlete.” The criteria for studies to be included were management of spondylolysis in athletes, English text, and no year, follow-up, or study design restrictions. The references of the retrieved articles were also evaluated. The primary outcome was time to return to sport. This search yielded 180 citations, and 25 publications were included in the review. Results  Treatment methods were dichotomized as operative and nonoperative. In the nonoperative group, 390 athletes were included. A combination of bracing with physical therapy and restriction of activities was used. Conservative measures allowed athletes to return to sport in 3.7 months (weighted mean). One hundred seventy-four patients were treated surgically. The most common technique was Buck's, using a compression screw (91/174). All authors reported satisfactory outcomes. Time to return to play was 7.9 months (weighted mean). There were insufficient studies with suitably homogenous subgroups to conduct a meta-analysis. Conclusion  There is no gold standard approach for the management of spondylolysis in the athletic population. The existing literature suggests initial therapy should be a course of conservative management with thoracolumbosacral orthosis brace, physiotherapy, and activity modification. If conservative management fails, surgical intervention should be considered. Two-sided clinical studies are needed to determine an optimal pathway for the management of athletes with spondylolysis. PMID:27556003

  18. Conservative treatment for pediatric lumbar spondylolysis to achieve bone healing using a hard brace: what type and how long?: Clinical article.

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    Sairyo, Koichi; Sakai, Toshinori; Yasui, Natsuo; Dezawa, Akira

    2012-06-01

    Various kinds of trunk braces have been used to achieve bone healing in cases of pediatric lumbar spondylolysis. However, the optimal brace for achieving bone healing is unclear. The purpose of the present study was to determine in what types of spondylolysis bone healing can be achieved and how long it takes. In this prospective study, 63 pars interarticularis defects (spondylolysis) among 37 patients who were younger than 18 years (mean 13.5 ± 2.7 years) were treated using a hard brace. The youngest patient was 8 years old. Based on the results of CT scanning, the lyses were classified into 3 categories: early, progressive, and terminal defects. Progressive defects were further divided into 2 types according to STIR MRI findings: those with high signal intensity at the adjacent pedicle and those with low signal intensity (that is, a normal appearance). A hard brace, such as a molded plastic thoracolumbosacral orthosis, was used to immobilize the trunk. Approximately every 3 months, CT scanning was performed to evaluate bone healing until approximately 6 months. The union rates were 94%, 64%, 27%, and 0% for the early, progressive with high signal intensity, progressive with low signal intensity, and terminal defects, respectively. It was noted that no terminal defect was healed using conservative treatment. The mean time to healing among the defects that showed bone healing was 3.2, 5.4, and 5.7 months for the early, progressive with high signal intensity, and progressive with low signal intensity groups, respectively. Patients with early-stage defects are the best candidates for conservative treatment with a hard brace because more than 90% of such cases can be healed in 3 months.

  19. Randomized Controlled Trial of Surface Peroneal Nerve Stimulation for Motor Relearning in Lower Limb Hemiparesis

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    Taylor, Paul N.; Gunzler, Douglas D.; Buurke, Jaap H.; IJzerman, Maarten J.; Chae, John

    2013-01-01

    Objective To compare the motor relearning effect of a surface peroneal nerve stimulator (PNS) versus usual care on lower limb motor impairment, activity limitation, and quality of life among chronic stroke survivors. Design Single-blinded randomized controlled trial Setting Teaching hospital of academic medical center Participants 110 chronic stroke survivors (> 12-wks post-stroke) with unilateral hemiparesis and dorsiflexion strength of ≤ 4/5 on the Medical Research Council scale Interventions Subjects were stratified by motor impairment level and then randomized to ambulation training with either a surface PNS device or usual care (ankle foot orthosis or no device) intervention. Subjects were treated for 12-wks and followed for 6-months post-treatment. Main Outcome Measures Lower limb portion of the Fugl-Meyer (FM) Assessment (motor impairment), the Modified Emory Functional Ambulation Profile (mEFAP) performed without a device (functional ambulation), and the Stroke Specific Quality of Life (SSQOL) scale. Results There was no significant treatment group main effect or treatment group by time interaction effect on FM, mEFAP, or SSQOL raw scores (p>0.05). The time effect was significant for the three raw scores (p<0.05). However, when comparing average change scores from baseline (T1) to end of treatment, (T2, 12-wks), and at 12-wks (T3) and 24-wks (T4) after end of treatment, significant differences were noted only for the mEFAP and SSQOL scores. The change in the average scores for both mEFAP and SSQOL occurred between T1 and T2, followed by relative stability thereafter. Conclusions There was no evidence of a motor relearning effect on lower limb motor impairment in either the PNS or usual care groups. However, both PNS and usual care groups demonstrated significant improvements in functional mobility and quality of life during the treatment period, which were maintained at 6-months follow-up. PMID:23399456

  20. Perception of stress level, trunk appearance, body function and mental health in females with adolescent idiopathic scoliosis treated conservatively: a longitudinal analysis.

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    Misterska, Ewa; Glowacki, Maciej; Latuszewska, Joanna; Adamczyk, Katarzyna

    2013-09-01

    In the presented study, we aimed to assess changes over time in the perception of trunk deformity, body function, stress level and mental health in females with adolescent idiopathic scoliosis (AIS) who were treated conservatively with a Cheneau brace, taking the Trunk Appearance Perception Scale (TAPS), Scoliosis Research Society-22 (SRS-22) and Bad Sobberheim Stress Questionnaires (BSSQ) criteria of evaluation into consideration. The study design was comprised of three questionnaire assessments, with the second and the third evaluation taking place 6 and 12 months after the beginning of the study, respectively. Thirty-six females treated conservatively were asked to fill in the TAPS, SRS-22 and BSSQ forms. In regards to TAPS, the results differed between the 1st and the 2nd assessment in Figure 2 only (p = 0.013). T