The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy

OBJECTIVE: To investigate the effectiveness of the hinged ankle-foot orthosis (AFO) on sit-to-stand (STS) transfers in children with spastic cerebral palsy. DESIGN: Before-after trial. SETTING: University-affiliated hospital. PARTICIPANTS: Nineteen spastic diplegic children (age range, 2-6 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: 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. RESULTS: Total duration of STS transfer was significantly shortened with the hinged AFO (P <.05). The initial knee flexion, the initial angle, and the final angle of ankle dorsiflexion were increased with the AFO, compared with when barefoot (P <.05). However, the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO. The maximal moment and power of hip and knee joints were significantly increased with the AFO (P <.05), whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO. CONCLUSIONS: 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.     

辅助器具在小儿脑性瘫痪康复中的选用探讨

本文针对小儿脑性瘫痪(脑瘫)康复中辅助器具的作用和选用进行探讨,并介绍了60多种供个人使用和训练用的相关辅助器具。在小儿脑瘫的康复过程中需要应用辅助器具来改善脑瘫患儿的功能障碍、帮助建立正常的运动模式、防止畸形进一步加重和提高他们的生活自理能力。为此着重提出了小儿脑瘫肢体残疾辅助器具选用时要考虑的3个因素即按照儿童运动发育规律、按照脑瘫儿功能障碍的身体部位、按照脑瘫儿的日常生活能力来选用。此外,有部分辅助器具将伴随脑瘫儿一生,成为他们回归社会的无障碍通道。     

治疗小儿脑性瘫痪的常用矫形器

本文通过10年来的临床实践,对脑性瘫痪(脑瘫)患儿康复中应用矫形器及其它辅助器具的目的、常用种类、作用、流程、评定、应用注意事项等内容做了简介。临床实践表明矫形器及其它辅助器具的应用在脑瘫患儿康复中起到了应有的作用。     

A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis

Andrysek J, Redekop S, Matsui NC, Kooy J, Hubbard S. A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis.

Objectives

To determine (1) the forces and moments passing through knee-ankle-foot orthoses (KAFOs) during walking and (2) the accuracy with which these loads can be measured using conventional gait analysis techniques.

Design

Comparative case series.

Setting

Rehabilitation facility with human movement laboratory (gait lab).

Participants

Four patients with poliomyelitis wearing KAFOs.

Interventions

KAFOs were instrumented with a load cell, and walking data were concurrently collected using conventional gait analysis.

Main Outcome Measures

Load measurements and gait parameters.

Results

Predominant orthotic loads (knee joint forces and moments) were composed of knee flexion moments and axial compression forces. With conventional gait analysis, peak knee joint moments were substantially underestimated compared with those directly measured using the load cell. Defining the knee axis anatomically versus at the orthotic axis, tracking it dynamically, and compensating for each patient's corrected knee flexion contracture resulted in considerable improvements in the gait lab estimates of knee joint moments.

Conclusions

A practical method that directly measures moments and forces in conventional KAFOs has been applied to show that conventional gait analysis techniques substantially underestimate knee joint moments in the KAFOs of persons with poliomyelitis. Underestimation of orthotic loads could result in underdesigned orthotic components and ultimately higher incidence of component failure in clinical applications.     

Orthoses Alter In Vivo Segmental Foot Kinematics During Walking in Patients With Midfoot Arthritis

Rao S, Baumhauer JF, Tome J, Nawoczenski DA. Orthoses alter in vivo segmental foot kinematics during walking in patients with midfoot arthritis.

Objective

To assess the effect of a 4-week intervention with a full-length carbon graphite (FL) orthosis on pain and function in patients with midfoot arthritis, and to identify alterations in in vivo foot kinematics accompanying FL use in patients with midfoot arthritis. These results have immediate application for enhancing patient care through effective orthotic recommendations.

Design

Experimental laboratory study supplemented by a case series.

Setting

University based clinical research laboratory.

Participants

Patients (n=30) with midfoot arthritis and age-, sex-, and body mass index-matched control subjects (n=20).

Intervention

Four-week intervention with FL orthoses.

Main Outcome Measures

Pain and function were assessed using the Foot Function Index-Revised (FFI-R). In vivo foot kinematics were quantified as peak and total range of calcaneal eversion, forefoot abduction, first metatarsal plantarflexion, and first metatarsophalangeal joint dorsiflexion during walking in 2 conditions: with FL orthoses and with shoes only. A paired t test and repeated-measures analysis of variance were used to assess statistical significance (α=.05) of change in FFI-R score and in vivo foot kinematics, respectively.

Results

Significant improvements in pain and function, discerned as lower FFI-R scores (P<.001), were noted after the 4-week intervention with FL orthoses. During walking, FL orthosis use resulted in decreased first metatarsophalangeal joint dorsiflexion (P=.024) and first metatarsal plantarflexion range of motion (P=.038), compared with the shoe-only condition.

Conclusions

Orthotic intervention emphasizing a “stiffening” strategy of the first metatarsal and first metatarsophalangeal joint may be valuable in patients with midfoot arthritis and early degenerative changes.     

Presentation 5: An investigation of foot alignment and support in ankle foot orthoses

Objective: To investigate the effect that ankle-foot alignment and foot support in ankle-foot orthoses (AFOs) may have on the gait of subjects with hemiplegia after stroke. Design: Test-retest. Setting: Motion analysis research laboratory. Participants: 20 participants with hemiplegia. Intervention: Subjects underwent 3 gait analyses, each 2 weeks apart. The first tested walking with a conventionally aligned AFO; the second tested walking with a heel-height compensated AFO with full-length footplate; and the third tested walking with a heel-height compensated AFO with three-quarter length footplate. Main Outcome Measures: We acquired bilateral kinematic, kinetic, electromyographic, and plantar pressure data, as well as subjective information from the subjects using a questionnaire. Results: Preliminary data from 7 subjects suggests that, compared with a shoes-only condition, all AFO conditions improved ankle position at initial contact and in swing, and, where knee hyperextension was present, reduced the onset and magnitude of the hyperextension. All AFO conditions also changed the internal knee moment from flexor to extensor, decreased the heel strike transient present in the vertical ground reaction force, and improved roll-over shape. Conclusions: Compared with the full length AFOs, the three-quarter length AFO provided the shortest roll-over shape and had the highest peak pressures in the midfoot. We believe that this study will give us a better understanding of the effect of ankle-foot alignment and foot support on hemiplegic gait, and may enable us to recommend more appropriate AFO designs.     

Effects of Bracing in Adult With Scoliosis: A Retrospective Study

Objective

To assess the effectiveness of bracing in adult with scoliosis.

Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis

We describe the design of a new cost-effective, comfortable orthotic designed to treat heel pain associated with plantar fasciitis. The heel pad is fabricated from a 4 degrees Sorbothane medial wedge with a customized insertion of low-density Plastazote. The orthotic is medium-density Plastazote reinforced with cork in the medial longitudinal arch. One pair of orthotics takes less than 1 hour to make. Pilot data were collected retrospectively to evaluate the efficacy of the orthotic for reducing pain. Ten clients at a hand and foot orthotic clinic with a mean age of 71+/-9.1 years and with unilateral or bilateral heel pain associated with plantar fasciitis were provided with customized heel pads and soft, molded orthotics at their initial visit. Pain levels were recorded with verbal and Likert-type scales. After 5 weeks of heel pad and orthotic use, all patients showed a reduction in pain, with the overall reduction being highly significant (P相似文献   

Effects of disease severity on response to lateral wedged shoe insole for medial compartment knee osteoarthritis

OBJECTIVE: To determine the effects of lateral wedged insoles on knee kinetics and kinematics during walking, according to radiographic severity of medial compartment knee osteoarthritis (OA). DESIGN: A prospective case control study of patients with medial compartment OA of the knee. SETTING: Gait analysis laboratory in a university hospital. PARTICIPANTS: Forty-six medial compartment knees with OA of 23 patients with bilateral disease and 38 knees of 19 age-matched healthy subjects as controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We measured the peak external adduction moment at the knee during the stance phase of gait and the first acceleration peak after heel strike at the lateral side of the femoral condyles. Kellgren and Lawrence grading system was used for radiographic assessment of OA severity. RESULTS: The mean value of peak external adduction moment of the knee was higher in OA knees than the control. Application of lateral wedged insoles significantly reduced the peak external adduction moment in Kellgren-Lawrence grades I and II knee OA patients. The first acceleration peak value after heel strike in these patients was relatively high compared with the control. Application of lateral wedged insoles significantly reduced the first acceleration peak in Kellgren-Lawrence grades I and II knee OA patients. CONCLUSIONS: The kinetic and kinematic effects of wearing of lateral wedged insoles were significant in Kellgren-Lawrence grades I and II knee OA. The results support the recommendation of use of lateral wedged insoles for patients with early and mild knee OA.     

A novel thoracic weight-bearing long-leg orthosis that permits ambulation after massive pelvic tumor resection

Osteosarcomas require aggressive medical and surgical treatments that frequently result in impaired musculoskeletal function. Amputation was formerly a treatment of choice for patients with sarcomas in an extremity. Although there has been controversy over the relative benefits of amputation and limb sparing, it is undeniable that limb sparing is becoming more common and that it frequently leaves a person with a limb whose function is limited. This is particularly true in the lower extremities, where pelvic and proximal femoral resections may lead to severe weight-bearing and mobility limitations. We report a novel thoracic weight-bearing long-leg orthosis that permitted a person who otherwise would not have been able to bear weight on a lower extremity after resection of a large iliac osteosarcoma to walk with a 4-point gait and forearm crutches.     

Construction methods and materials for external prostheses — present and future

Summary

In the first part of this paper the methods of constructing lower limb prostheses and their major components are discussed. Attention is paid to the foot, shank, knee joint, swing control, thigh, and hip joint. The second part is devoted to the use of thermoplastics in prosthetics and orthotics. Thermoplastics are polymers of varying chain length which can be moulded when heated. The properties of the various materials are discussed and their potential use described.

Résumé

La première partie de ce travail décrit les diverses méthodes de fabrication de prothèses des membres inférieurs et les éléments essentiels qui en font partie. On étudie successivement les problèmes au niveau du pied, de la cheville, du genou, de la cuisse et de la hanche ainsi que le contrôle du mouvement pendulaire. La deuxième partie de l'étude est consacrée à l'utilité des matériaux thermoplastiques dans la fabrication des prothèses et orthèses. Les substances thermo-plastiques sont des polymères à chaiˇnes variables qui se prětent facilement au moulage apres` avoir été chauffées. On décrit les propriétés de cette gamme de matériaux et les multiples possibilités de leur utilisation.

Zusammenfassung

Im ersten Teil dieser Arbeit werden die Konstruktionsmethoden der Prothesen der unteren Extremitäten und ihre Hauptbestandteile diskutiert. Besondere Aufmerksamkeit wird dem Fuss, dem Unterschenkel, dem Kniegelenk, der Schwungkontrolle, dem Oberschenkel und der Hüfte gewidmet. Der zweite Teil ist dem Gebrauch thermoplastischen Materials in der Prothetik und Orthetik gewidmet. Thermoplastische Stoffe sind Polymere verschieden langer Ketten, die im warmen Zustand geformt werden können. Die Eigenschaften verschiedener Materialien werden diskutiert und ihr potentieller Nutzen beschrieben.

Resumen

En la primera parte de este trabajo se comentan los métodos de construir prótesis para las extremidades inferiores. Se presta atención al pie, canilla, articulacion de la rodilla, regulatión de las oscilaciones, muslo y articulación de la cadera. La segunda parte se dedica al empleo de termoplásticos en las prótesis y ortosis. Los termoplásticos son polímeros cuyas cadenas varían de longitud y que pueden moldearse cuando se calientan. Se comentan las propiedades de diversos materiales y se describe su uso potencial.     

Effects of Cerebral Palsy on Neuropsychological Function

Cerebral Palsy (CP) is a muscle and movement disorder that affects children and is the result of early brain injury. The causes and nature of the brain damage may vary considerably, which renders children with cerebral palsy a heterogeneous group. Only recently has research begun to utilize technology to determine the nature of the brain injury and the relation to clinical observations. This paper reviews neuropsychological findings on children with a diagnosis of CP with regard to the spastic, dyskinetic, and ataxic types. Specifically, areas of sensorimotor functioning, language and verbal skills, visual-spatial and perceptual skills, learning and memory, and executive functioning are reviewed. Implications for learning as well as a neurobiological cause of executive function deficits are discussed.     

Efficacy and Safety of a Hip Flexion Assist Orthosis in Ambulatory Multiple Sclerosis Patients

Sutliff MH, Naft JM, Stough DK, Lee JC, Arrigain SS, Bethoux FA. Efficacy and safety of a hip flexion assist orthosis in ambulatory multiple sclerosis patients.

Objective

To evaluate the efficacy and safety of a hip flexion assist orthosis (HFAO) in ambulatory patients with multiple sclerosis (MS).

Design

Fourteen week pre- and postintervention uncontrolled trial.

Setting

Outpatient rehabilitation clinic within an MS center.

Participants

Ambulatory MS patients (N=21) with unilateral (or unilateral predominant) hip flexor weakness.

Intervention

Subjects were fitted with the HFAO on the weaker side, trained to use the device, and given a wear schedule. Subjects completed 2 baseline evaluations and follow-up testing at 8 and 12 weeks.

Main Outcome Measures

Lower-extremity manual muscle testing, pain, and gait performance (Timed 25-Foot Walk, Timed Up & Go, 6-minute walk test, Mellen Center Gait Test). Subject satisfaction was evaluated by using a 9-item custom questionnaire.

Results

There was a statistically significant improvement of strength in the affected lower extremity at 8 and 12 weeks (effect size [ES]=0.63; ES=1.32, respectively), of pain at 12 weeks only (ES=−0.64), and of all gait tests at 8 and 12 weeks (ES range, 0.38–1.33). The overall mean satisfaction score at 12 weeks was 39 (maximum score, 45). No serious adverse events were recorded during the study. The most frequent side effect of the HFAO was low back pain (19%). No side effects led to discontinuation of the HFAO use during the study.

Conclusions

The HFAO was safe and well tolerated. HFAO use was associated with significant improvement of gait performance as well as improvement of strength in the lower extremity fitted with the HFAO. Subjective reports suggest that there was an increase in daily life activity level.     

Effect of a gravity-compensating orthosis on reaching after stroke: evaluation of the Therapy Assistant WREX

Iwamuro BT, Cruz EG, Connelly LL, Fischer HC, Kamper DG. Effect of a gravity-compensating orthosis on reaching after stroke: evaluation of the Therapy Assistant WREX.

Objective

To evaluate the effectiveness of an upper-extremity orthosis to improve the reaching workspace of stroke survivors.

Design

Within-subjects repeated-measures design evaluating reaching with and without the Therapy Assistant Wilmington Robotic Exoskeleton (WREX).

Setting

Laboratory.

Participants

Stroke survivors (N=10) with chronic upper-extremity hemiparesis.

Interventions

Not applicable.

Main Outcome Measures

Arm movement kinematics (Optotrak Certus motion detection system), muscle activity for biceps, triceps, anterior deltoid, and brachioradialis muscles (bipolar surface electromyography).

Results

Significant improvements of reaching distance occurred for all subjects across all targets (P<.001) when using the Therapy Assistant WREX. While the self-selected peak speed of hand movement during the reach decreased significantly with the Therapy Assistant WREX (P<.001), use of the Therapy Assistant WREX led to improved quality of movement as signified by a decrease in jerk (P<.001) and a shift in the timing of the peak speed to an earlier point in the movement (P<.001). Electromyographic muscle activity analysis showed that use of the Therapy Assistant WREX led to a reduction in biceps activity across all targets during the reach (P<.05), in conjunction with a marginally significant reduction in activity of the anterior deltoid (P<.055). No changes were observed in triceps (P=.47) or brachioradialis activity (P=.28).

Conclusions

By reducing requirements for shoulder activation, the Therapy Assistant WREX improved reaching performance among stroke survivors compared with free reaching, thereby potentially facilitating practice of functional tasks.     

Genu recurvatum in hemophilia: a case report

Hemorrhages in the musculoskeletal system of patients with hemophilia give rise to a number of disabilities requiring rehabilitative measures. The knee is the most commonly affected joint. Recurrent hemorrhages in the knee joint can cause arthropathy and flexion deformity. The current literature does not reveal development of genu recurvatum from repeated hemorrhages. This report presents a patient with hemophilia who developed a genu recurvatum deformity. We have discussed the clinical presentation, probable cause, and the management of the patient, and have included a brief review of the epidemiology of this deformity along with management options.