Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications

Title order Author order Journal order Date order
Category: Orthoses

Title: Ankle-foot orthoses for rehabilitation and reducing metabolic cost of walking: Possibilities and challenges
Author: Bing Chen, Bin Zi, Yishan Zeng, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
Journal: Mechatronics
Citation: Volume 53, August 2018, Pages 241-250
Publication Year and Month: 2018 08

Abstract: People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Biomechanical abnormalities of post-polio patients and the implications for orthotic management.
Author: Perry J, Clark D
Affiliation: Rancho Los Amigos Medical Center, 7601 East Imperial Highway, Bldg. 304, Downey, CA 90242, USA.
Journal: NeuroRehabilitation
Citation: 1997;8(2):119-38
Publication Year and Month: 1997

Abstract: Muscle weakness resulting from the combined effects of acute and late motor neuron pathology is the basic cause of post-polio dysfunction. Through their normal sensation and moter control, post-polio patients minimize their disability by useful substitutions. Orthoses are needed only when these substitutions either are inadequate or result in muscle or joint overuse. The areas most commonly showing late disability are the lower extremities, shoulders and low-back. In the lower extremities, the major muscle groups are the hip extensors and abductors, the knee extensors (quadriceps), ankle plantar flexors and dorsi flexors. Each group has a specific function which relates to one of the basic tasks of walking, weight acceptance, single limb support and swing. To determine orthotic needs, polio gait deviations representing useful substitutions must be differentiated from symptomatic dysfunction. Weight acceptance utilizes the quadriceps, hip extensors and hip abductors to establish a stable limb and provide shock absorbing mechanics. Substitutions to preserve weight bearing stability include sacrifice of normal shock absorbing knee flexion for quadriceps weakness, backward or lateral trunk lean for hip extensor and abductor weakness. Knee pain, excessive hyperextension and flexion contractures are indications for orthotic assistance with a KAFO. Orthotic designs relate to the type of knee joint (off-set, free, locked) and completeness of the AFO component. Low-back pain from hip substitutions or over use of the hip muscles requires a walking aid. Single limb support is the period when the limb and body advance over the supporting foot. The key muscle group is the soleus-gastrocnemius complex. Swing involves lifting and advancing the unloaded limb. While all three joints flex simultaneously, the hip flexors and ankle dorsi flexors are the critical muscles. A drop foot from ankle dorsiflexor weakness is the common disability. Excessive hip flexion is the usual substitution.

Conclusions: An orthosis which assists dorsiflexion without obstructing loading response plantar flexion is the most functional design.

Outcome of Research: More research required

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Category: Assistive Technology, Orthoses

Title: Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review
Author: Yoo Jin Choo and Min Cheol Chang
Affiliation: Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Healthcare 2021, 9(8), 1046; https://doi.org/10.3390/healthcare9081046
Publication Year and Month: 2021 08

Abstract: (1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO.

(2) Methods: narrative review.

(3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed.

(4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.

Keywords: ankle-foot orthosis; orthosis; review

Conclusions: In this study, we described the most commonly used and recently developed AFO. Compared to conventional AFOs, recently developed AFOs have better durability, shorter production time, more sophisticated shape-making ability, easier donning, or improved appearance, depending on their types. However, these superior qualities do not necessarily preclude conventional AFOs. The convergence of high-intensity materials and high technology may be economically burdensome, and patients may not want to prematurely use recently developed AFOs because they have no confidence in the products. A variety of new AFOs have been developed, but the most widely used in clinical practice is plastic AFOs because they are relatively inexpensive, vary in type depending on the additional materials used, and can be worn regardless of shoe type. However, plastic AFOs are slightly less durable than recently developed AFOs.

The selection of an appropriate AFO that considers both the physical and psychological state of the user is important to achieve the most successful rehabilitation and increase convenience in daily living. Because different AFOs have different indications, contraindications, features, and user preferences, the appropriate AFO should be selected depending on the status of the user. Future research should consistently be conducted to continuously update AFO selection guidelines and systematically classify which AFO type is most effective for each disease, increasing user preference. In addition, the effectiveness of AFOs that are still being developed should be obtained through clinical trials.

We consider our review to be useful for clinicians when prescribing the appropriate AFO for the specific needs of patients in the future. In addition, this review provides information to broaden the choices of AFO during AFO prescription by clinicians.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness
Author: Niels F.J.Waterval, Merel-AnneBrehm, Hilde E.Ploegera, Frans Nollet, Jaap Harlaar
Affiliation: Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
Department of Biomechanical Engineering, Delft University of Technology, The Netherlands
Journal: Gait & Posture
Citation: Volume 66, October 2018, Pages 38-44

Publication Year and Month: 2018 10

Abstract: Background
Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost.

Research question
Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost?

Methods
Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost.

Results
Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122).

Conclusions: Significance
Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration.

Outcome of Research: More research required

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Category: Assistive Technology, Orthoses

Title: Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis
Author: Arazpour M (1), Ahmadi F (2), Bahramizadeh M (2), Samadian M (3), Mousavi ME (2), Bani MA (4), Hutchins SW (5)
Affiliation: (1) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; (2) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (3) Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; (4) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (5) Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
Journal: Prosthetics and Orthotics International
Citation: Prosthet Orthot Int. 2015 Aug 12. pii: 0309364615596063
Publication Year and Month: 2015 08

Abstract: BACKGROUND: 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.

OBJECTIVES: 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.

STUDY DESIGN: Quasi experimental study.

METHODS: 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.

RESULTS: 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.

Conclusions: 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.

CLINICAL RELEVANCE: 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.

Outcome of Research: Effective

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Category: Orthoses

Title: Findings in Post-Poliomyelitis Syndrome
Author: Perry, J.P., Fontaine, J.D., Mulroy, S., Downey, P.T.
Affiliation: Pathokinesiology Service, Rancho Los Amigos Medical Center, Downey
Journal:
Citation: The Journal of Bone and Joint Surgery Vol. 77-A, No. 8, August 1995, 1148-1153
Publication Year and Month: 1995 08

Abstract: The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing.

Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris. the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded.

The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution.

These obervations support the theory that postpoliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment -- based on the early identification of overuse of muscles and ligamentous strain -- should aim at modification of lifestyle and include use of a brace.

Conclusions:

Outcome of Research:

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Category: Orthoses

Title: Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode
Author: Sarah Schroder, Eva Probsting, Thomas Schmalz, Andreas Kannenberg, Hartmut Stinus
Affiliation: Ottobock SE & Co. KGaA, Duderstadt, Germany
Journal: Physical Medicine and Rehabilitation Research (PM&R)
Citation: DOI: 10.15761/PMRR.1000168
Publication Year and Month: 2018

Abstract: People with a paresis or paralysis of the knee extensors depend on knee-ankle-foot orthoses (KAFOs) to restore walking ability. Unlike locked KAFOs whose orthotic
knee joints are only unlocked for sitting down, stance control orthoses (SCOs) may utilize various mechanisms to lock the orthotic knee joint during the stance phase
and unlock it for a free swing phase. Thus far, all studies comparing SCOs to locked KAFOs have only used laboratory-based measures, but no clinical performance
measures commonly used in rehabilitation medicine. Therefore, the aim of this study was to investigate functional walking capacity using the 6-minute walk test
(6MWT), combined with objective 3D gait measurements, in established SCO users when using the orthosis in the unlocked and locked mode, respectively. In
addition, satisfaction with the SCO was surveyed using the QUEST questionnaire. A total of eight subjects participated in this study. The results show that in the
locked condition, subjects walked a significantly shorter distance (284.4±53.0 m vs. 316.9±59.6 m, p=.04) in the 6MWT than in the unlocked condition. Gait was
more physiological in the unlocked mode with a mean knee flexion angle during swing of 57°±15° vs. full extension in the locked mode. QUEST scores showed a
high overall satisfaction with the E-MAG Active SCO.

Conclusions: Compared to the unlocked condition, the locked mode imposed a clinically meaningful restriction to the functional walking capacity on the subjects. Therefore, fitting
of an SCO may be considered beneficial in individuals dependent on a KAFO to improve their functional walking capacity.

Outcome of Research: More research required

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Category: Orthoses

Title: Gait Analysis Techniques
Author: JoAnne K. Gronley and Jacquelin Perry

Affiliation: Physical Therapist, Pathokinesiology Service, Rancho Los Amigos Hospital; Director, Pathokinesiology Service, Rancho Los Amigos Hospital, and Professor of Orthopaedic Surgery, University of Southern California
Journal:
Citation: The Journal of American Physical Therapy Assn. Vol. 63, No. 12, December 1984 1831-1838
Publication Year and Month: 1984 12

Abstract: In the gait laboratory at Rancho Los Amigos Hospital, the emphasis is on patient testing to identify functional problems and determine the effectiveness of treatment programs. Footswitch stride analysis, dynamic EMG, energy-cost measurements, force plate, and instrumented motion analysis are the techniques most often used. Stride data define the temporal and distance factors of gait. We use this information to classify the patient's ability to walk and measure response to treatment programs. Inappropriate muscle action in the patient disabled by an upper motor neuron lesion is identified with dynamic EMG. Intramuscular wire electrodes are used to differentiate the action of adjacent muscles. We use the information to localize the source of abnormal function so that selection of treatment procedures is more precise. Force and motion data aid in determining the functional requirement and the muscular response necessary to meet the demand. Determining the optimum mode of locomotion and developing criteria for program planning have become more realistic with the aid of energy-cost measurements. Microprocessors and personal computer systems have made compact and reliable single-concept instrumentation available for basic gait analysis in the standard clinical environment at a modest cost. The more elaborate composite systems, however, still require custom instrumentation and engineering support.

Conclusions: This review of the RLAH gait laboratory has emphasized our clinical focus on patient care. Research projects have followed two directions. Technical developments have related to developing the footswitch, energy cost, and dynamic EMG systems. Functional research has assessed normal performance to provide baselines for interpreting pathological activities.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Author: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A.
Affiliation: Nil identified
Journal:
Citation: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait & Posture. 2017 58:146-153. doi: 10.1016/j.gaitpost.2017.07.107.
Publication Year and Month: 2017 07

Abstract: 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 clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.

Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20 and 32% of the variance in individual gait parameters.

Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.

Conclusions:

Outcome of Research: Effective

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Comments (if any): There are many differences in gait patterns and it can be difficult to detect the forces and weight distribution from observation. 3D gait analysis appears to be more effective in combination with physical examination of muscle weakness in prescription of effective orthoses.

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Category: Orthoses

Title: Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome
Author: Kiriakos Daniilidis, Eike Jakubowitz, Daiwei Yao
Affiliation:
Journal: Part of the Biosystems &amp; Biorobotics book series (BIOSYSROB, volume 19) pp 399-414
Citation: Daniilidis K., Jakubowitz E., Yao D. (2018) Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome. In: Sandrini G., Homberg V., Saltuari L., Smania N., Pedrocchi A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_27
Publication Year and Month: 2018 01

Abstract: The adult paralytic foot or drop foot is a secondary related foot deformity, which usually arises due to neurogenic damage (Kunst et al. in Stroke 42:2126–2130, 2011; Truelsen et al. in European Journal of Neurology 13:581–598, 2006). The lack of neural innervation of the muscles, which play a major role in ankle dorsiflexion—M. tibialis anterior, Mm. peronei, M. extensor digitorum longus, and M. extensor halluces longus—can cause a secondary malposition of the foot. As a dorsiflexion of the ankle cannot be actively provoked, this leads to a domination of the flexors and as a secondary outcome to a shortening of these muscles and their tendons. Similarly, it may also lead to a malposition in supination (www.mayoclinic.org/diseases-conditions/foot-drop/basics/definition/con-20032918).

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Knee exoskeletons for gait rehabilitation and human performance augmentation: A state-of-the-art
Author: Bing Chen, Bin Zi, Zhengyu Wang, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal: Mechanism and Machine Theory
Citation: Volume 134, April 2019, Pages 499-511

Publication Year and Month: 2019

Abstract: The number of patients with knee impairments caused by a stroke, spinal cord injury, post-polio, injury, osteoarthritis, or other related diseases is increasing worldwide. Robotic devices such as knee exoskeletons have been studied and adopted in gait rehabilitation, as they can provide effective gait training for the patients and release the physical therapists from the intensive labor required by the traditional physical therapy. In addition, knee exoskeletons can augment human performance in normal walking, loaded walking, and even running by enhancing the strength of the wearers’ knee joints. A systematic review of knee exoskeletons is presented in this paper. The biomechanics of the human knee joint is firstly presented. Then, the design concepts of knee exoskeletons, including the actuators and sensors, are provided, followed by the introduction of the corresponding control strategies. Finally, the limitations of the available devices and the research and development directions in the field of knee exoskeletons are discussed, thus providing useful information to the researchers developing knee exoskeletons that are suitable for practical applications.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Manufacture of Passive Dynamic Ankle–Foot Orthoses Using Selective Laser Sintering
Author: Mario C. Faustini ; Richard R. Neptune ; Richard H. Crawford ; Steven J. Stanhope
Affiliation: Department of Mechanical Engineering, the University of Texas at Austin.
Journal: IEEE Transactions on Biomedical Engineering
Citation: Volume: 55 , Issue: 2 , Feb. 2008
Publication Year and Month: 2008 02

Abstract: Ankle-foot orthosis (AFO) designs vary in size, shape, and functional characteristics depending on the desired clinical application. Passive Dynamic (PD) Response ankle-foot orthoses (PD-AFOs) constitute a design that seeks to improve walking ability for persons with various neuromuscular disorders by passively (like a spring) providing variable levels of support during the stance phase of gait. Current PD-AFO manufacturing technology is either labor intensive or not well suited for the detailed refinement of PD-AFO bending stiffness characteristics. The primary objective of this study was to explore the feasibility of using a rapid freeform prototyping technique, selective laser sintering (SLS), as a PD-AFO manufacturing process. Feasibility was determined by replicating the shape and functional characteristics of a carbon fiber AFO (CF-AFO). The study showed that a SLS-based framework is ideally suited for this application. A second objective was to determine the optimal SLS material for PD-AFOs to store and release elastic energy; considering minimizing energy dissipation through internal friction is a desired material characteristic. This study compared the mechanical damping of the CF-AFO to PD-AFOs manufactured by SLS using three different materials. Mechanical damping evaluation ranked the materials as Rilsantrade D80 (best), followed by DuraFormtrade PA and DuraFormtrade GF. In addition, Rilsantrade D80 was the only SLS material able to withstand large deformations.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Mechanoadaptation: articular cartilage through thick and thin
Author: Tonia L. Vincent, Angus K. T. Wann
Affiliation:
Journal: The Journal of Physiology
Citation: https://doi.org/10.1113/JP275451
Publication Year and Month: 2018 06

Abstract: The articular cartilage is exquisitely sensitive to mechanical load. Its structure is largely defined by the mechanical environment and destruction in osteoarthritis is the pathophysiological consequence of abnormal mechanics. It is often overlooked that disuse of joints causes profound loss of volume in the articular cartilage, a clinical observation first described in polio patients and stroke victims. Through the 1980s, the results of studies exploiting experimental joint immobilisation supported this. Importantly, this substantial body of work was also the first to describe metabolic changes that resulted in decreased synthesis of matrix molecules, especially sulfated proteoglycans. The molecular mechanisms that underlie disuse atrophy are poorly understood despite the identification of multiple mechanosensing mechanisms in cartilage. Moreover, there has been a tendency to equate cartilage loss with osteoarthritic degeneration. Here, we review the historic literature and clarify the structural, metabolic and clinical features that clearly distinguish cartilage loss due to disuse atrophy and those due to osteoarthritis. We speculate on the molecular sensing pathways in cartilage that may be responsible for cartilage mechanoadaptation.

Conclusions: Mechanoadaptation in cartilage is rapid and reversible, and potentially of a similar scale to that seen in muscle and bone. Comprehensive studies of cartilage atrophy in vivo have been carried out although largely during the ‘pre‐molecular’ era and prior to the discovery of direct chondrocyte mechanosensing mechanisms. Advances in newly available glycobiology and proteomic techniques, in combination with genetic modification in rodents, will add considerable value to future studies. Cartilage atrophy is readily distinguished from osteoarthritis at the clinical, tissue and molecular level but cannot be discerned on a plain radiograph except by noting the absence of bone remodelling. As joint space narrowing is typically used to diagnose OA, it is important to consider atrophy as a differential diagnosis. Harnessing the molecules that drive mechanoadaption in articular cartilage may provide novel strategies to prevent or treat OA.

Outcome of Research: More research required

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Category: Diagnosis and Management, Orthoses, Surgery

Title: Polio revisited: reviving knowledge and skills to meet the challenge of resurgence
Author: Benjamin Joseph (1) and Hugh Watts (2)
Affiliation: (1) Aster Medcity, Kochi, Kerala India, 18 HIG HUDCO Colony, Manipal, Karnataka 576104 India

(2) Shriners Hospital for Children, Los Angeles, CA USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Children's Orthopaedics

9 (5): 325–338, doi: 10.1007/s11832-015-0678-4
Publication Year and Month: 2015 09

Abstract: Purpose
To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.

Methods
Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.

Results
The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.

Conclusions
As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.

Keywords: Poliomyelitis, Resurgence, Surgical decision-making, Bracing, Paralytic deformity

Conclusions: Polio has not been eradicated and there is a risk of resurgence of the disease. Paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques of managing the effects of paralysis following polio is needed.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Predictors of changes in gait performance over four years in persons with late effects of polio.
Author: Flansbjer, Lexell, Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden.

Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.

Department of Health Science, Luleå University of Technology, Luleå, Sweden.
Journal: NeuroRehabilitation
Citation: 2017;41(2):403-411.
Publication Year and Month: 2017

Abstract: BACKGROUND:
Reduced gait performance is common in persons with late effects of polio.

OBJECTIVE:
To identify predictors of change in gait performance over four years in persons with late effects of polio.

METHODS:
Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

RESULTS:
There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

Conclusions: CONCLUSION:
The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.

Outcome of Research: More research required

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Category: Orthoses

Title: Quality of life of prosthetic and orthotic users in South India: a cross-sectional study
Author: Lina Magnusson, Ritu GhoshKatrine Randbøll JensenKatharina GöbelJenny WågbergSofia WallénAlma SvenssonRebecka StavenheimGerd Ahlström
Affiliation: 1.Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
2.Mobility India Rehabilitation Research and Training Centre Bangalore India
Journal: Health and Quality of Life Outcomes
Citation: December 2019, 17:50
Publication Year and Month: 2019 12

Abstract: Background
The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.

Methods
A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.

Results
Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.

Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

Outcome of Research: More research required

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Category: Orthoses

Title: Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey
Author: Bart Raijmakers, Roelofine A Berendsen-de Gooijer, Hilde E Ploeger, Fieke S Koopman, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. [email protected].
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: 54:jrm00261
doi: 10.2340/jrm.v53.1122.
Publication Year and Month: 2022 02

Abstract: Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.

Design: Cross-sectional survey study.

Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.

Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.

Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).

Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.

Keywords: poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation

Conclusions: A majority of 76% of the polio survivors provided with a custom-made KAFO used their orthosis in daily life. Important usability factors were low perceived walking ability status without orthosis, previous orthosis experience, prescribed KAFO type, high perceived effectiveness and satisfaction when standing and walking with a KAFO. When prescribing a KAFO, it is important to consider these factors and discuss goals of use and expected benefits of the KAFO with the individuals concerned, especially in relation to perceived walking limitations and activities in daily life. Providing proper guidance and training upon delivery of the KAFO may especially be important in the case of first-time orthosis users.

Outcome of Research: Effective

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Assistive Technology, Orthoses

Title: Wearable monitoring devices for assistive technology: case studies in post-polio syndrome
Author: Andreoni G (1), Mazzola M (1), Perego P (1), Standoli CE (1), Manzoni S (1), Piccini L (2), Molteni F (3)
Affiliation: (1) Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy; (2) 6SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy; (3) Villa Beretta Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy
Journal: Sensors
Citation: Sensors (Basel). 2014 Jan 24;14(2):2012-27. doi: 10.3390/s140202012
Publication Year and Month: 2014 01

Abstract: 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.

Conclusions:

Outcome of Research: More research required

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There are currently 18 papers in this category.

Category: Orthoses

Title: Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode
Author: Sarah Schroder, Eva Probsting, Thomas Schmalz, Andreas Kannenberg, Hartmut Stinus
Affiliation: Ottobock SE & Co. KGaA, Duderstadt, Germany
Journal: Physical Medicine and Rehabilitation Research (PM&R)
Citation: DOI: 10.15761/PMRR.1000168
Publication Year and Month: 2018

Abstract: People with a paresis or paralysis of the knee extensors depend on knee-ankle-foot orthoses (KAFOs) to restore walking ability. Unlike locked KAFOs whose orthotic
knee joints are only unlocked for sitting down, stance control orthoses (SCOs) may utilize various mechanisms to lock the orthotic knee joint during the stance phase
and unlock it for a free swing phase. Thus far, all studies comparing SCOs to locked KAFOs have only used laboratory-based measures, but no clinical performance
measures commonly used in rehabilitation medicine. Therefore, the aim of this study was to investigate functional walking capacity using the 6-minute walk test
(6MWT), combined with objective 3D gait measurements, in established SCO users when using the orthosis in the unlocked and locked mode, respectively. In
addition, satisfaction with the SCO was surveyed using the QUEST questionnaire. A total of eight subjects participated in this study. The results show that in the
locked condition, subjects walked a significantly shorter distance (284.4±53.0 m vs. 316.9±59.6 m, p=.04) in the 6MWT than in the unlocked condition. Gait was
more physiological in the unlocked mode with a mean knee flexion angle during swing of 57°±15° vs. full extension in the locked mode. QUEST scores showed a
high overall satisfaction with the E-MAG Active SCO.

Conclusions: Compared to the unlocked condition, the locked mode imposed a clinically meaningful restriction to the functional walking capacity on the subjects. Therefore, fitting
of an SCO may be considered beneficial in individuals dependent on a KAFO to improve their functional walking capacity.

Outcome of Research: More research required

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Category: Assistive Technology, Orthoses

Title: Wearable monitoring devices for assistive technology: case studies in post-polio syndrome
Author: Andreoni G (1), Mazzola M (1), Perego P (1), Standoli CE (1), Manzoni S (1), Piccini L (2), Molteni F (3)
Affiliation: (1) Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy; (2) 6SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy; (3) Villa Beretta Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy
Journal: Sensors
Citation: Sensors (Basel). 2014 Jan 24;14(2):2012-27. doi: 10.3390/s140202012
Publication Year and Month: 2014 01

Abstract: 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.

Conclusions:

Outcome of Research: More research required

Availability of Paper: Paid subscription required to view or download full text.

Comments (if any):

Link to Paper (if available): Click here to view Abstract


Category: Assistive Technology, Orthoses

Title: Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis
Author: Arazpour M (1), Ahmadi F (2), Bahramizadeh M (2), Samadian M (3), Mousavi ME (2), Bani MA (4), Hutchins SW (5)
Affiliation: (1) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; (2) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (3) Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; (4) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (5) Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
Journal: Prosthetics and Orthotics International
Citation: Prosthet Orthot Int. 2015 Aug 12. pii: 0309364615596063
Publication Year and Month: 2015 08

Abstract: BACKGROUND: 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.

OBJECTIVES: 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.

STUDY DESIGN: Quasi experimental study.

METHODS: 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.

RESULTS: 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.

Conclusions: 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.

CLINICAL RELEVANCE: 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.

Outcome of Research: Effective

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Category: Orthoses

Title: Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey
Author: Bart Raijmakers, Roelofine A Berendsen-de Gooijer, Hilde E Ploeger, Fieke S Koopman, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. [email protected].
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: 54:jrm00261
doi: 10.2340/jrm.v53.1122.
Publication Year and Month: 2022 02

Abstract: Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.

Design: Cross-sectional survey study.

Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.

Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.

Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).

Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.

Keywords: poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation

Conclusions: A majority of 76% of the polio survivors provided with a custom-made KAFO used their orthosis in daily life. Important usability factors were low perceived walking ability status without orthosis, previous orthosis experience, prescribed KAFO type, high perceived effectiveness and satisfaction when standing and walking with a KAFO. When prescribing a KAFO, it is important to consider these factors and discuss goals of use and expected benefits of the KAFO with the individuals concerned, especially in relation to perceived walking limitations and activities in daily life. Providing proper guidance and training upon delivery of the KAFO may especially be important in the case of first-time orthosis users.

Outcome of Research: Effective

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Diagnosis and Management, Orthoses, Surgery

Title: Polio revisited: reviving knowledge and skills to meet the challenge of resurgence
Author: Benjamin Joseph (1) and Hugh Watts (2)
Affiliation: (1) Aster Medcity, Kochi, Kerala India, 18 HIG HUDCO Colony, Manipal, Karnataka 576104 India

(2) Shriners Hospital for Children, Los Angeles, CA USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Children's Orthopaedics

9 (5): 325–338, doi: 10.1007/s11832-015-0678-4
Publication Year and Month: 2015 09

Abstract: Purpose
To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.

Methods
Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.

Results
The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.

Conclusions
As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.

Keywords: Poliomyelitis, Resurgence, Surgical decision-making, Bracing, Paralytic deformity

Conclusions: Polio has not been eradicated and there is a risk of resurgence of the disease. Paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques of managing the effects of paralysis following polio is needed.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Ankle-foot orthoses for rehabilitation and reducing metabolic cost of walking: Possibilities and challenges
Author: Bing Chen, Bin Zi, Yishan Zeng, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
Journal: Mechatronics
Citation: Volume 53, August 2018, Pages 241-250
Publication Year and Month: 2018 08

Abstract: People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Knee exoskeletons for gait rehabilitation and human performance augmentation: A state-of-the-art
Author: Bing Chen, Bin Zi, Zhengyu Wang, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal: Mechanism and Machine Theory
Citation: Volume 134, April 2019, Pages 499-511

Publication Year and Month: 2019

Abstract: The number of patients with knee impairments caused by a stroke, spinal cord injury, post-polio, injury, osteoarthritis, or other related diseases is increasing worldwide. Robotic devices such as knee exoskeletons have been studied and adopted in gait rehabilitation, as they can provide effective gait training for the patients and release the physical therapists from the intensive labor required by the traditional physical therapy. In addition, knee exoskeletons can augment human performance in normal walking, loaded walking, and even running by enhancing the strength of the wearers’ knee joints. A systematic review of knee exoskeletons is presented in this paper. The biomechanics of the human knee joint is firstly presented. Then, the design concepts of knee exoskeletons, including the actuators and sensors, are provided, followed by the introduction of the corresponding control strategies. Finally, the limitations of the available devices and the research and development directions in the field of knee exoskeletons are discussed, thus providing useful information to the researchers developing knee exoskeletons that are suitable for practical applications.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Predictors of changes in gait performance over four years in persons with late effects of polio.
Author: Flansbjer, Lexell, Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden.

Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.

Department of Health Science, Luleå University of Technology, Luleå, Sweden.
Journal: NeuroRehabilitation
Citation: 2017;41(2):403-411.
Publication Year and Month: 2017

Abstract: BACKGROUND:
Reduced gait performance is common in persons with late effects of polio.

OBJECTIVE:
To identify predictors of change in gait performance over four years in persons with late effects of polio.

METHODS:
Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

RESULTS:
There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

Conclusions: CONCLUSION:
The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.

Outcome of Research: More research required

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Category: Orthoses

Title: Gait Analysis Techniques
Author: JoAnne K. Gronley and Jacquelin Perry

Affiliation: Physical Therapist, Pathokinesiology Service, Rancho Los Amigos Hospital; Director, Pathokinesiology Service, Rancho Los Amigos Hospital, and Professor of Orthopaedic Surgery, University of Southern California
Journal:
Citation: The Journal of American Physical Therapy Assn. Vol. 63, No. 12, December 1984 1831-1838
Publication Year and Month: 1984 12

Abstract: In the gait laboratory at Rancho Los Amigos Hospital, the emphasis is on patient testing to identify functional problems and determine the effectiveness of treatment programs. Footswitch stride analysis, dynamic EMG, energy-cost measurements, force plate, and instrumented motion analysis are the techniques most often used. Stride data define the temporal and distance factors of gait. We use this information to classify the patient's ability to walk and measure response to treatment programs. Inappropriate muscle action in the patient disabled by an upper motor neuron lesion is identified with dynamic EMG. Intramuscular wire electrodes are used to differentiate the action of adjacent muscles. We use the information to localize the source of abnormal function so that selection of treatment procedures is more precise. Force and motion data aid in determining the functional requirement and the muscular response necessary to meet the demand. Determining the optimum mode of locomotion and developing criteria for program planning have become more realistic with the aid of energy-cost measurements. Microprocessors and personal computer systems have made compact and reliable single-concept instrumentation available for basic gait analysis in the standard clinical environment at a modest cost. The more elaborate composite systems, however, still require custom instrumentation and engineering support.

Conclusions: This review of the RLAH gait laboratory has emphasized our clinical focus on patient care. Research projects have followed two directions. Technical developments have related to developing the footswitch, energy cost, and dynamic EMG systems. Functional research has assessed normal performance to provide baselines for interpreting pathological activities.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome
Author: Kiriakos Daniilidis, Eike Jakubowitz, Daiwei Yao
Affiliation:
Journal: Part of the Biosystems &amp; Biorobotics book series (BIOSYSROB, volume 19) pp 399-414
Citation: Daniilidis K., Jakubowitz E., Yao D. (2018) Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome. In: Sandrini G., Homberg V., Saltuari L., Smania N., Pedrocchi A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_27
Publication Year and Month: 2018 01

Abstract: The adult paralytic foot or drop foot is a secondary related foot deformity, which usually arises due to neurogenic damage (Kunst et al. in Stroke 42:2126–2130, 2011; Truelsen et al. in European Journal of Neurology 13:581–598, 2006). The lack of neural innervation of the muscles, which play a major role in ankle dorsiflexion—M. tibialis anterior, Mm. peronei, M. extensor digitorum longus, and M. extensor halluces longus—can cause a secondary malposition of the foot. As a dorsiflexion of the ankle cannot be actively provoked, this leads to a domination of the flexors and as a secondary outcome to a shortening of these muscles and their tendons. Similarly, it may also lead to a malposition in supination (www.mayoclinic.org/diseases-conditions/foot-drop/basics/definition/con-20032918).

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Quality of life of prosthetic and orthotic users in South India: a cross-sectional study
Author: Lina Magnusson, Ritu GhoshKatrine Randbøll JensenKatharina GöbelJenny WågbergSofia WallénAlma SvenssonRebecka StavenheimGerd Ahlström
Affiliation: 1.Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
2.Mobility India Rehabilitation Research and Training Centre Bangalore India
Journal: Health and Quality of Life Outcomes
Citation: December 2019, 17:50
Publication Year and Month: 2019 12

Abstract: Background
The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.

Methods
A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.

Results
Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.

Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

Outcome of Research: More research required

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Category: Orthoses

Title: Manufacture of Passive Dynamic Ankle–Foot Orthoses Using Selective Laser Sintering
Author: Mario C. Faustini ; Richard R. Neptune ; Richard H. Crawford ; Steven J. Stanhope
Affiliation: Department of Mechanical Engineering, the University of Texas at Austin.
Journal: IEEE Transactions on Biomedical Engineering
Citation: Volume: 55 , Issue: 2 , Feb. 2008
Publication Year and Month: 2008 02

Abstract: Ankle-foot orthosis (AFO) designs vary in size, shape, and functional characteristics depending on the desired clinical application. Passive Dynamic (PD) Response ankle-foot orthoses (PD-AFOs) constitute a design that seeks to improve walking ability for persons with various neuromuscular disorders by passively (like a spring) providing variable levels of support during the stance phase of gait. Current PD-AFO manufacturing technology is either labor intensive or not well suited for the detailed refinement of PD-AFO bending stiffness characteristics. The primary objective of this study was to explore the feasibility of using a rapid freeform prototyping technique, selective laser sintering (SLS), as a PD-AFO manufacturing process. Feasibility was determined by replicating the shape and functional characteristics of a carbon fiber AFO (CF-AFO). The study showed that a SLS-based framework is ideally suited for this application. A second objective was to determine the optimal SLS material for PD-AFOs to store and release elastic energy; considering minimizing energy dissipation through internal friction is a desired material characteristic. This study compared the mechanical damping of the CF-AFO to PD-AFOs manufactured by SLS using three different materials. Mechanical damping evaluation ranked the materials as Rilsantrade D80 (best), followed by DuraFormtrade PA and DuraFormtrade GF. In addition, Rilsantrade D80 was the only SLS material able to withstand large deformations.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness
Author: Niels F.J.Waterval, Merel-AnneBrehm, Hilde E.Ploegera, Frans Nollet, Jaap Harlaar
Affiliation: Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
Department of Biomechanical Engineering, Delft University of Technology, The Netherlands
Journal: Gait & Posture
Citation: Volume 66, October 2018, Pages 38-44

Publication Year and Month: 2018 10

Abstract: Background
Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost.

Research question
Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost?

Methods
Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost.

Results
Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122).

Conclusions: Significance
Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration.

Outcome of Research: More research required

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Category: Orthoses

Title: Biomechanical abnormalities of post-polio patients and the implications for orthotic management.
Author: Perry J, Clark D
Affiliation: Rancho Los Amigos Medical Center, 7601 East Imperial Highway, Bldg. 304, Downey, CA 90242, USA.
Journal: NeuroRehabilitation
Citation: 1997;8(2):119-38
Publication Year and Month: 1997

Abstract: Muscle weakness resulting from the combined effects of acute and late motor neuron pathology is the basic cause of post-polio dysfunction. Through their normal sensation and moter control, post-polio patients minimize their disability by useful substitutions. Orthoses are needed only when these substitutions either are inadequate or result in muscle or joint overuse. The areas most commonly showing late disability are the lower extremities, shoulders and low-back. In the lower extremities, the major muscle groups are the hip extensors and abductors, the knee extensors (quadriceps), ankle plantar flexors and dorsi flexors. Each group has a specific function which relates to one of the basic tasks of walking, weight acceptance, single limb support and swing. To determine orthotic needs, polio gait deviations representing useful substitutions must be differentiated from symptomatic dysfunction. Weight acceptance utilizes the quadriceps, hip extensors and hip abductors to establish a stable limb and provide shock absorbing mechanics. Substitutions to preserve weight bearing stability include sacrifice of normal shock absorbing knee flexion for quadriceps weakness, backward or lateral trunk lean for hip extensor and abductor weakness. Knee pain, excessive hyperextension and flexion contractures are indications for orthotic assistance with a KAFO. Orthotic designs relate to the type of knee joint (off-set, free, locked) and completeness of the AFO component. Low-back pain from hip substitutions or over use of the hip muscles requires a walking aid. Single limb support is the period when the limb and body advance over the supporting foot. The key muscle group is the soleus-gastrocnemius complex. Swing involves lifting and advancing the unloaded limb. While all three joints flex simultaneously, the hip flexors and ankle dorsi flexors are the critical muscles. A drop foot from ankle dorsiflexor weakness is the common disability. Excessive hip flexion is the usual substitution.

Conclusions: An orthosis which assists dorsiflexion without obstructing loading response plantar flexion is the most functional design.

Outcome of Research: More research required

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Category: Orthoses

Title: Findings in Post-Poliomyelitis Syndrome
Author: Perry, J.P., Fontaine, J.D., Mulroy, S., Downey, P.T.
Affiliation: Pathokinesiology Service, Rancho Los Amigos Medical Center, Downey
Journal:
Citation: The Journal of Bone and Joint Surgery Vol. 77-A, No. 8, August 1995, 1148-1153
Publication Year and Month: 1995 08

Abstract: The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing.

Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris. the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded.

The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution.

These obervations support the theory that postpoliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment -- based on the early identification of overuse of muscles and ligamentous strain -- should aim at modification of lifestyle and include use of a brace.

Conclusions:

Outcome of Research:

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Category: Orthoses

Title: Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Author: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A.
Affiliation: Nil identified
Journal:
Citation: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait & Posture. 2017 58:146-153. doi: 10.1016/j.gaitpost.2017.07.107.
Publication Year and Month: 2017 07

Abstract: 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 clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.

Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20 and 32% of the variance in individual gait parameters.

Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.

Conclusions:

Outcome of Research: Effective

Availability of Paper: Paid subscription required to view or download full text.

Comments (if any): There are many differences in gait patterns and it can be difficult to detect the forces and weight distribution from observation. 3D gait analysis appears to be more effective in combination with physical examination of muscle weakness in prescription of effective orthoses.

Link to Paper (if available): Click here to view Abstract


Category: Orthoses

Title: Mechanoadaptation: articular cartilage through thick and thin
Author: Tonia L. Vincent, Angus K. T. Wann
Affiliation:
Journal: The Journal of Physiology
Citation: https://doi.org/10.1113/JP275451
Publication Year and Month: 2018 06

Abstract: The articular cartilage is exquisitely sensitive to mechanical load. Its structure is largely defined by the mechanical environment and destruction in osteoarthritis is the pathophysiological consequence of abnormal mechanics. It is often overlooked that disuse of joints causes profound loss of volume in the articular cartilage, a clinical observation first described in polio patients and stroke victims. Through the 1980s, the results of studies exploiting experimental joint immobilisation supported this. Importantly, this substantial body of work was also the first to describe metabolic changes that resulted in decreased synthesis of matrix molecules, especially sulfated proteoglycans. The molecular mechanisms that underlie disuse atrophy are poorly understood despite the identification of multiple mechanosensing mechanisms in cartilage. Moreover, there has been a tendency to equate cartilage loss with osteoarthritic degeneration. Here, we review the historic literature and clarify the structural, metabolic and clinical features that clearly distinguish cartilage loss due to disuse atrophy and those due to osteoarthritis. We speculate on the molecular sensing pathways in cartilage that may be responsible for cartilage mechanoadaptation.

Conclusions: Mechanoadaptation in cartilage is rapid and reversible, and potentially of a similar scale to that seen in muscle and bone. Comprehensive studies of cartilage atrophy in vivo have been carried out although largely during the ‘pre‐molecular’ era and prior to the discovery of direct chondrocyte mechanosensing mechanisms. Advances in newly available glycobiology and proteomic techniques, in combination with genetic modification in rodents, will add considerable value to future studies. Cartilage atrophy is readily distinguished from osteoarthritis at the clinical, tissue and molecular level but cannot be discerned on a plain radiograph except by noting the absence of bone remodelling. As joint space narrowing is typically used to diagnose OA, it is important to consider atrophy as a differential diagnosis. Harnessing the molecules that drive mechanoadaption in articular cartilage may provide novel strategies to prevent or treat OA.

Outcome of Research: More research required

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Category: Assistive Technology, Orthoses

Title: Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review
Author: Yoo Jin Choo and Min Cheol Chang
Affiliation: Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Healthcare 2021, 9(8), 1046; https://doi.org/10.3390/healthcare9081046
Publication Year and Month: 2021 08

Abstract: (1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO.

(2) Methods: narrative review.

(3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed.

(4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.

Keywords: ankle-foot orthosis; orthosis; review

Conclusions: In this study, we described the most commonly used and recently developed AFO. Compared to conventional AFOs, recently developed AFOs have better durability, shorter production time, more sophisticated shape-making ability, easier donning, or improved appearance, depending on their types. However, these superior qualities do not necessarily preclude conventional AFOs. The convergence of high-intensity materials and high technology may be economically burdensome, and patients may not want to prematurely use recently developed AFOs because they have no confidence in the products. A variety of new AFOs have been developed, but the most widely used in clinical practice is plastic AFOs because they are relatively inexpensive, vary in type depending on the additional materials used, and can be worn regardless of shoe type. However, plastic AFOs are slightly less durable than recently developed AFOs.

The selection of an appropriate AFO that considers both the physical and psychological state of the user is important to achieve the most successful rehabilitation and increase convenience in daily living. Because different AFOs have different indications, contraindications, features, and user preferences, the appropriate AFO should be selected depending on the status of the user. Future research should consistently be conducted to continuously update AFO selection guidelines and systematically classify which AFO type is most effective for each disease, increasing user preference. In addition, the effectiveness of AFOs that are still being developed should be obtained through clinical trials.

We consider our review to be useful for clinicians when prescribing the appropriate AFO for the specific needs of patients in the future. In addition, this review provides information to broaden the choices of AFO during AFO prescription by clinicians.

Outcome of Research: Not applicable

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There are currently 18 papers in this category.

Category: Orthoses

Title: Gait Analysis Techniques
Author: JoAnne K. Gronley and Jacquelin Perry

Affiliation: Physical Therapist, Pathokinesiology Service, Rancho Los Amigos Hospital; Director, Pathokinesiology Service, Rancho Los Amigos Hospital, and Professor of Orthopaedic Surgery, University of Southern California
Journal:
Citation: The Journal of American Physical Therapy Assn. Vol. 63, No. 12, December 1984 1831-1838
Publication Year and Month: 1984 12

Abstract: In the gait laboratory at Rancho Los Amigos Hospital, the emphasis is on patient testing to identify functional problems and determine the effectiveness of treatment programs. Footswitch stride analysis, dynamic EMG, energy-cost measurements, force plate, and instrumented motion analysis are the techniques most often used. Stride data define the temporal and distance factors of gait. We use this information to classify the patient's ability to walk and measure response to treatment programs. Inappropriate muscle action in the patient disabled by an upper motor neuron lesion is identified with dynamic EMG. Intramuscular wire electrodes are used to differentiate the action of adjacent muscles. We use the information to localize the source of abnormal function so that selection of treatment procedures is more precise. Force and motion data aid in determining the functional requirement and the muscular response necessary to meet the demand. Determining the optimum mode of locomotion and developing criteria for program planning have become more realistic with the aid of energy-cost measurements. Microprocessors and personal computer systems have made compact and reliable single-concept instrumentation available for basic gait analysis in the standard clinical environment at a modest cost. The more elaborate composite systems, however, still require custom instrumentation and engineering support.

Conclusions: This review of the RLAH gait laboratory has emphasized our clinical focus on patient care. Research projects have followed two directions. Technical developments have related to developing the footswitch, energy cost, and dynamic EMG systems. Functional research has assessed normal performance to provide baselines for interpreting pathological activities.

Outcome of Research: Not applicable

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any):

Link to Paper (if available): Click here to view full text or to download


Category: Orthoses

Title: Findings in Post-Poliomyelitis Syndrome
Author: Perry, J.P., Fontaine, J.D., Mulroy, S., Downey, P.T.
Affiliation: Pathokinesiology Service, Rancho Los Amigos Medical Center, Downey
Journal:
Citation: The Journal of Bone and Joint Surgery Vol. 77-A, No. 8, August 1995, 1148-1153
Publication Year and Month: 1995 08

Abstract: The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing.

Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris. the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded.

The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution.

These obervations support the theory that postpoliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment -- based on the early identification of overuse of muscles and ligamentous strain -- should aim at modification of lifestyle and include use of a brace.

Conclusions:

Outcome of Research:

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any):

Link to Paper (if available): Click here to view full text or to download


Category: Orthoses

Title: Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Author: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A.
Affiliation: Nil identified
Journal:
Citation: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait & Posture. 2017 58:146-153. doi: 10.1016/j.gaitpost.2017.07.107.
Publication Year and Month: 2017 07

Abstract: 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 clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.

Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20 and 32% of the variance in individual gait parameters.

Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.

Conclusions:

Outcome of Research: Effective

Availability of Paper: Paid subscription required to view or download full text.

Comments (if any): There are many differences in gait patterns and it can be difficult to detect the forces and weight distribution from observation. 3D gait analysis appears to be more effective in combination with physical examination of muscle weakness in prescription of effective orthoses.

Link to Paper (if available): Click here to view Abstract


Category: Orthoses

Title: Manufacture of Passive Dynamic Ankle–Foot Orthoses Using Selective Laser Sintering
Author: Mario C. Faustini ; Richard R. Neptune ; Richard H. Crawford ; Steven J. Stanhope
Affiliation: Department of Mechanical Engineering, the University of Texas at Austin.
Journal: IEEE Transactions on Biomedical Engineering
Citation: Volume: 55 , Issue: 2 , Feb. 2008
Publication Year and Month: 2008 02

Abstract: Ankle-foot orthosis (AFO) designs vary in size, shape, and functional characteristics depending on the desired clinical application. Passive Dynamic (PD) Response ankle-foot orthoses (PD-AFOs) constitute a design that seeks to improve walking ability for persons with various neuromuscular disorders by passively (like a spring) providing variable levels of support during the stance phase of gait. Current PD-AFO manufacturing technology is either labor intensive or not well suited for the detailed refinement of PD-AFO bending stiffness characteristics. The primary objective of this study was to explore the feasibility of using a rapid freeform prototyping technique, selective laser sintering (SLS), as a PD-AFO manufacturing process. Feasibility was determined by replicating the shape and functional characteristics of a carbon fiber AFO (CF-AFO). The study showed that a SLS-based framework is ideally suited for this application. A second objective was to determine the optimal SLS material for PD-AFOs to store and release elastic energy; considering minimizing energy dissipation through internal friction is a desired material characteristic. This study compared the mechanical damping of the CF-AFO to PD-AFOs manufactured by SLS using three different materials. Mechanical damping evaluation ranked the materials as Rilsantrade D80 (best), followed by DuraFormtrade PA and DuraFormtrade GF. In addition, Rilsantrade D80 was the only SLS material able to withstand large deformations.

Conclusions:

Outcome of Research: More research required

Availability of Paper:

Comments (if any):

Link to Paper (if available): Click here for preview


Category: Orthoses

Title: Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness
Author: Niels F.J.Waterval, Merel-AnneBrehm, Hilde E.Ploegera, Frans Nollet, Jaap Harlaar
Affiliation: Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
Department of Biomechanical Engineering, Delft University of Technology, The Netherlands
Journal: Gait & Posture
Citation: Volume 66, October 2018, Pages 38-44

Publication Year and Month: 2018 10

Abstract: Background
Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost.

Research question
Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost?

Methods
Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost.

Results
Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122).

Conclusions: Significance
Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration.

Outcome of Research: More research required

Availability of Paper:

Comments (if any):

Link to Paper (if available): Click here for preview


Category: Orthoses

Title: Quality of life of prosthetic and orthotic users in South India: a cross-sectional study
Author: Lina Magnusson, Ritu GhoshKatrine Randbøll JensenKatharina GöbelJenny WågbergSofia WallénAlma SvenssonRebecka StavenheimGerd Ahlström
Affiliation: 1.Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
2.Mobility India Rehabilitation Research and Training Centre Bangalore India
Journal: Health and Quality of Life Outcomes
Citation: December 2019, 17:50
Publication Year and Month: 2019 12

Abstract: Background
The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.

Methods
A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.

Results
Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.

Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

Outcome of Research: More research required

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Category: Orthoses

Title: Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey
Author: Bart Raijmakers, Roelofine A Berendsen-de Gooijer, Hilde E Ploeger, Fieke S Koopman, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. [email protected].
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: 54:jrm00261
doi: 10.2340/jrm.v53.1122.
Publication Year and Month: 2022 02

Abstract: Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.

Design: Cross-sectional survey study.

Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.

Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.

Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).

Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.

Keywords: poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation

Conclusions: A majority of 76% of the polio survivors provided with a custom-made KAFO used their orthosis in daily life. Important usability factors were low perceived walking ability status without orthosis, previous orthosis experience, prescribed KAFO type, high perceived effectiveness and satisfaction when standing and walking with a KAFO. When prescribing a KAFO, it is important to consider these factors and discuss goals of use and expected benefits of the KAFO with the individuals concerned, especially in relation to perceived walking limitations and activities in daily life. Providing proper guidance and training upon delivery of the KAFO may especially be important in the case of first-time orthosis users.

Outcome of Research: Effective

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Category: Orthoses

Title: Knee exoskeletons for gait rehabilitation and human performance augmentation: A state-of-the-art
Author: Bing Chen, Bin Zi, Zhengyu Wang, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal: Mechanism and Machine Theory
Citation: Volume 134, April 2019, Pages 499-511

Publication Year and Month: 2019

Abstract: The number of patients with knee impairments caused by a stroke, spinal cord injury, post-polio, injury, osteoarthritis, or other related diseases is increasing worldwide. Robotic devices such as knee exoskeletons have been studied and adopted in gait rehabilitation, as they can provide effective gait training for the patients and release the physical therapists from the intensive labor required by the traditional physical therapy. In addition, knee exoskeletons can augment human performance in normal walking, loaded walking, and even running by enhancing the strength of the wearers’ knee joints. A systematic review of knee exoskeletons is presented in this paper. The biomechanics of the human knee joint is firstly presented. Then, the design concepts of knee exoskeletons, including the actuators and sensors, are provided, followed by the introduction of the corresponding control strategies. Finally, the limitations of the available devices and the research and development directions in the field of knee exoskeletons are discussed, thus providing useful information to the researchers developing knee exoskeletons that are suitable for practical applications.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Ankle-foot orthoses for rehabilitation and reducing metabolic cost of walking: Possibilities and challenges
Author: Bing Chen, Bin Zi, Yishan Zeng, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
Journal: Mechatronics
Citation: Volume 53, August 2018, Pages 241-250
Publication Year and Month: 2018 08

Abstract: People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Biomechanical abnormalities of post-polio patients and the implications for orthotic management.
Author: Perry J, Clark D
Affiliation: Rancho Los Amigos Medical Center, 7601 East Imperial Highway, Bldg. 304, Downey, CA 90242, USA.
Journal: NeuroRehabilitation
Citation: 1997;8(2):119-38
Publication Year and Month: 1997

Abstract: Muscle weakness resulting from the combined effects of acute and late motor neuron pathology is the basic cause of post-polio dysfunction. Through their normal sensation and moter control, post-polio patients minimize their disability by useful substitutions. Orthoses are needed only when these substitutions either are inadequate or result in muscle or joint overuse. The areas most commonly showing late disability are the lower extremities, shoulders and low-back. In the lower extremities, the major muscle groups are the hip extensors and abductors, the knee extensors (quadriceps), ankle plantar flexors and dorsi flexors. Each group has a specific function which relates to one of the basic tasks of walking, weight acceptance, single limb support and swing. To determine orthotic needs, polio gait deviations representing useful substitutions must be differentiated from symptomatic dysfunction. Weight acceptance utilizes the quadriceps, hip extensors and hip abductors to establish a stable limb and provide shock absorbing mechanics. Substitutions to preserve weight bearing stability include sacrifice of normal shock absorbing knee flexion for quadriceps weakness, backward or lateral trunk lean for hip extensor and abductor weakness. Knee pain, excessive hyperextension and flexion contractures are indications for orthotic assistance with a KAFO. Orthotic designs relate to the type of knee joint (off-set, free, locked) and completeness of the AFO component. Low-back pain from hip substitutions or over use of the hip muscles requires a walking aid. Single limb support is the period when the limb and body advance over the supporting foot. The key muscle group is the soleus-gastrocnemius complex. Swing involves lifting and advancing the unloaded limb. While all three joints flex simultaneously, the hip flexors and ankle dorsi flexors are the critical muscles. A drop foot from ankle dorsiflexor weakness is the common disability. Excessive hip flexion is the usual substitution.

Conclusions: An orthosis which assists dorsiflexion without obstructing loading response plantar flexion is the most functional design.

Outcome of Research: More research required

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Category: Orthoses

Title: Predictors of changes in gait performance over four years in persons with late effects of polio.
Author: Flansbjer, Lexell, Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden.

Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.

Department of Health Science, Luleå University of Technology, Luleå, Sweden.
Journal: NeuroRehabilitation
Citation: 2017;41(2):403-411.
Publication Year and Month: 2017

Abstract: BACKGROUND:
Reduced gait performance is common in persons with late effects of polio.

OBJECTIVE:
To identify predictors of change in gait performance over four years in persons with late effects of polio.

METHODS:
Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

RESULTS:
There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

Conclusions: CONCLUSION:
The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.

Outcome of Research: More research required

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Category: Assistive Technology, Orthoses

Title: Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review
Author: Yoo Jin Choo and Min Cheol Chang
Affiliation: Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Healthcare 2021, 9(8), 1046; https://doi.org/10.3390/healthcare9081046
Publication Year and Month: 2021 08

Abstract: (1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO.

(2) Methods: narrative review.

(3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed.

(4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.

Keywords: ankle-foot orthosis; orthosis; review

Conclusions: In this study, we described the most commonly used and recently developed AFO. Compared to conventional AFOs, recently developed AFOs have better durability, shorter production time, more sophisticated shape-making ability, easier donning, or improved appearance, depending on their types. However, these superior qualities do not necessarily preclude conventional AFOs. The convergence of high-intensity materials and high technology may be economically burdensome, and patients may not want to prematurely use recently developed AFOs because they have no confidence in the products. A variety of new AFOs have been developed, but the most widely used in clinical practice is plastic AFOs because they are relatively inexpensive, vary in type depending on the additional materials used, and can be worn regardless of shoe type. However, plastic AFOs are slightly less durable than recently developed AFOs.

The selection of an appropriate AFO that considers both the physical and psychological state of the user is important to achieve the most successful rehabilitation and increase convenience in daily living. Because different AFOs have different indications, contraindications, features, and user preferences, the appropriate AFO should be selected depending on the status of the user. Future research should consistently be conducted to continuously update AFO selection guidelines and systematically classify which AFO type is most effective for each disease, increasing user preference. In addition, the effectiveness of AFOs that are still being developed should be obtained through clinical trials.

We consider our review to be useful for clinicians when prescribing the appropriate AFO for the specific needs of patients in the future. In addition, this review provides information to broaden the choices of AFO during AFO prescription by clinicians.

Outcome of Research: Not applicable

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Category: Diagnosis and Management, Orthoses, Surgery

Title: Polio revisited: reviving knowledge and skills to meet the challenge of resurgence
Author: Benjamin Joseph (1) and Hugh Watts (2)
Affiliation: (1) Aster Medcity, Kochi, Kerala India, 18 HIG HUDCO Colony, Manipal, Karnataka 576104 India

(2) Shriners Hospital for Children, Los Angeles, CA USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Children's Orthopaedics

9 (5): 325–338, doi: 10.1007/s11832-015-0678-4
Publication Year and Month: 2015 09

Abstract: Purpose
To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.

Methods
Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.

Results
The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.

Conclusions
As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.

Keywords: Poliomyelitis, Resurgence, Surgical decision-making, Bracing, Paralytic deformity

Conclusions: Polio has not been eradicated and there is a risk of resurgence of the disease. Paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques of managing the effects of paralysis following polio is needed.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome
Author: Kiriakos Daniilidis, Eike Jakubowitz, Daiwei Yao
Affiliation:
Journal: Part of the Biosystems &amp; Biorobotics book series (BIOSYSROB, volume 19) pp 399-414
Citation: Daniilidis K., Jakubowitz E., Yao D. (2018) Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome. In: Sandrini G., Homberg V., Saltuari L., Smania N., Pedrocchi A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_27
Publication Year and Month: 2018 01

Abstract: The adult paralytic foot or drop foot is a secondary related foot deformity, which usually arises due to neurogenic damage (Kunst et al. in Stroke 42:2126–2130, 2011; Truelsen et al. in European Journal of Neurology 13:581–598, 2006). The lack of neural innervation of the muscles, which play a major role in ankle dorsiflexion—M. tibialis anterior, Mm. peronei, M. extensor digitorum longus, and M. extensor halluces longus—can cause a secondary malposition of the foot. As a dorsiflexion of the ankle cannot be actively provoked, this leads to a domination of the flexors and as a secondary outcome to a shortening of these muscles and their tendons. Similarly, it may also lead to a malposition in supination (www.mayoclinic.org/diseases-conditions/foot-drop/basics/definition/con-20032918).

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode
Author: Sarah Schroder, Eva Probsting, Thomas Schmalz, Andreas Kannenberg, Hartmut Stinus
Affiliation: Ottobock SE & Co. KGaA, Duderstadt, Germany
Journal: Physical Medicine and Rehabilitation Research (PM&R)
Citation: DOI: 10.15761/PMRR.1000168
Publication Year and Month: 2018

Abstract: People with a paresis or paralysis of the knee extensors depend on knee-ankle-foot orthoses (KAFOs) to restore walking ability. Unlike locked KAFOs whose orthotic
knee joints are only unlocked for sitting down, stance control orthoses (SCOs) may utilize various mechanisms to lock the orthotic knee joint during the stance phase
and unlock it for a free swing phase. Thus far, all studies comparing SCOs to locked KAFOs have only used laboratory-based measures, but no clinical performance
measures commonly used in rehabilitation medicine. Therefore, the aim of this study was to investigate functional walking capacity using the 6-minute walk test
(6MWT), combined with objective 3D gait measurements, in established SCO users when using the orthosis in the unlocked and locked mode, respectively. In
addition, satisfaction with the SCO was surveyed using the QUEST questionnaire. A total of eight subjects participated in this study. The results show that in the
locked condition, subjects walked a significantly shorter distance (284.4±53.0 m vs. 316.9±59.6 m, p=.04) in the 6MWT than in the unlocked condition. Gait was
more physiological in the unlocked mode with a mean knee flexion angle during swing of 57°±15° vs. full extension in the locked mode. QUEST scores showed a
high overall satisfaction with the E-MAG Active SCO.

Conclusions: Compared to the unlocked condition, the locked mode imposed a clinically meaningful restriction to the functional walking capacity on the subjects. Therefore, fitting
of an SCO may be considered beneficial in individuals dependent on a KAFO to improve their functional walking capacity.

Outcome of Research: More research required

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Category: Assistive Technology, Orthoses

Title: Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis
Author: Arazpour M (1), Ahmadi F (2), Bahramizadeh M (2), Samadian M (3), Mousavi ME (2), Bani MA (4), Hutchins SW (5)
Affiliation: (1) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; (2) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (3) Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; (4) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (5) Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
Journal: Prosthetics and Orthotics International
Citation: Prosthet Orthot Int. 2015 Aug 12. pii: 0309364615596063
Publication Year and Month: 2015 08

Abstract: BACKGROUND: 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.

OBJECTIVES: 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.

STUDY DESIGN: Quasi experimental study.

METHODS: 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.

RESULTS: 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.

Conclusions: 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.

CLINICAL RELEVANCE: 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.

Outcome of Research: Effective

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Category: Assistive Technology, Orthoses

Title: Wearable monitoring devices for assistive technology: case studies in post-polio syndrome
Author: Andreoni G (1), Mazzola M (1), Perego P (1), Standoli CE (1), Manzoni S (1), Piccini L (2), Molteni F (3)
Affiliation: (1) Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy; (2) 6SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy; (3) Villa Beretta Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy
Journal: Sensors
Citation: Sensors (Basel). 2014 Jan 24;14(2):2012-27. doi: 10.3390/s140202012
Publication Year and Month: 2014 01

Abstract: 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.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Mechanoadaptation: articular cartilage through thick and thin
Author: Tonia L. Vincent, Angus K. T. Wann
Affiliation:
Journal: The Journal of Physiology
Citation: https://doi.org/10.1113/JP275451
Publication Year and Month: 2018 06

Abstract: The articular cartilage is exquisitely sensitive to mechanical load. Its structure is largely defined by the mechanical environment and destruction in osteoarthritis is the pathophysiological consequence of abnormal mechanics. It is often overlooked that disuse of joints causes profound loss of volume in the articular cartilage, a clinical observation first described in polio patients and stroke victims. Through the 1980s, the results of studies exploiting experimental joint immobilisation supported this. Importantly, this substantial body of work was also the first to describe metabolic changes that resulted in decreased synthesis of matrix molecules, especially sulfated proteoglycans. The molecular mechanisms that underlie disuse atrophy are poorly understood despite the identification of multiple mechanosensing mechanisms in cartilage. Moreover, there has been a tendency to equate cartilage loss with osteoarthritic degeneration. Here, we review the historic literature and clarify the structural, metabolic and clinical features that clearly distinguish cartilage loss due to disuse atrophy and those due to osteoarthritis. We speculate on the molecular sensing pathways in cartilage that may be responsible for cartilage mechanoadaptation.

Conclusions: Mechanoadaptation in cartilage is rapid and reversible, and potentially of a similar scale to that seen in muscle and bone. Comprehensive studies of cartilage atrophy in vivo have been carried out although largely during the ‘pre‐molecular’ era and prior to the discovery of direct chondrocyte mechanosensing mechanisms. Advances in newly available glycobiology and proteomic techniques, in combination with genetic modification in rodents, will add considerable value to future studies. Cartilage atrophy is readily distinguished from osteoarthritis at the clinical, tissue and molecular level but cannot be discerned on a plain radiograph except by noting the absence of bone remodelling. As joint space narrowing is typically used to diagnose OA, it is important to consider atrophy as a differential diagnosis. Harnessing the molecules that drive mechanoadaption in articular cartilage may provide novel strategies to prevent or treat OA.

Outcome of Research: More research required

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There are currently 18 papers in this category.

Category: Orthoses

Title: Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey
Author: Bart Raijmakers, Roelofine A Berendsen-de Gooijer, Hilde E Ploeger, Fieke S Koopman, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. [email protected].
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: 54:jrm00261
doi: 10.2340/jrm.v53.1122.
Publication Year and Month: 2022 02

Abstract: Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.

Design: Cross-sectional survey study.

Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.

Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.

Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).

Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.

Keywords: poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation

Conclusions: A majority of 76% of the polio survivors provided with a custom-made KAFO used their orthosis in daily life. Important usability factors were low perceived walking ability status without orthosis, previous orthosis experience, prescribed KAFO type, high perceived effectiveness and satisfaction when standing and walking with a KAFO. When prescribing a KAFO, it is important to consider these factors and discuss goals of use and expected benefits of the KAFO with the individuals concerned, especially in relation to perceived walking limitations and activities in daily life. Providing proper guidance and training upon delivery of the KAFO may especially be important in the case of first-time orthosis users.

Outcome of Research: Effective

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Assistive Technology, Orthoses

Title: Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review
Author: Yoo Jin Choo and Min Cheol Chang
Affiliation: Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Healthcare 2021, 9(8), 1046; https://doi.org/10.3390/healthcare9081046
Publication Year and Month: 2021 08

Abstract: (1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO.

(2) Methods: narrative review.

(3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed.

(4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.

Keywords: ankle-foot orthosis; orthosis; review

Conclusions: In this study, we described the most commonly used and recently developed AFO. Compared to conventional AFOs, recently developed AFOs have better durability, shorter production time, more sophisticated shape-making ability, easier donning, or improved appearance, depending on their types. However, these superior qualities do not necessarily preclude conventional AFOs. The convergence of high-intensity materials and high technology may be economically burdensome, and patients may not want to prematurely use recently developed AFOs because they have no confidence in the products. A variety of new AFOs have been developed, but the most widely used in clinical practice is plastic AFOs because they are relatively inexpensive, vary in type depending on the additional materials used, and can be worn regardless of shoe type. However, plastic AFOs are slightly less durable than recently developed AFOs.

The selection of an appropriate AFO that considers both the physical and psychological state of the user is important to achieve the most successful rehabilitation and increase convenience in daily living. Because different AFOs have different indications, contraindications, features, and user preferences, the appropriate AFO should be selected depending on the status of the user. Future research should consistently be conducted to continuously update AFO selection guidelines and systematically classify which AFO type is most effective for each disease, increasing user preference. In addition, the effectiveness of AFOs that are still being developed should be obtained through clinical trials.

We consider our review to be useful for clinicians when prescribing the appropriate AFO for the specific needs of patients in the future. In addition, this review provides information to broaden the choices of AFO during AFO prescription by clinicians.

Outcome of Research: Not applicable

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Category: Orthoses

Title: Quality of life of prosthetic and orthotic users in South India: a cross-sectional study
Author: Lina Magnusson, Ritu GhoshKatrine Randbøll JensenKatharina GöbelJenny WågbergSofia WallénAlma SvenssonRebecka StavenheimGerd Ahlström
Affiliation: 1.Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
2.Mobility India Rehabilitation Research and Training Centre Bangalore India
Journal: Health and Quality of Life Outcomes
Citation: December 2019, 17:50
Publication Year and Month: 2019 12

Abstract: Background
The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.

Methods
A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.

Results
Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.

Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.

Outcome of Research: More research required

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Category: Orthoses

Title: Knee exoskeletons for gait rehabilitation and human performance augmentation: A state-of-the-art
Author: Bing Chen, Bin Zi, Zhengyu Wang, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal: Mechanism and Machine Theory
Citation: Volume 134, April 2019, Pages 499-511

Publication Year and Month: 2019

Abstract: The number of patients with knee impairments caused by a stroke, spinal cord injury, post-polio, injury, osteoarthritis, or other related diseases is increasing worldwide. Robotic devices such as knee exoskeletons have been studied and adopted in gait rehabilitation, as they can provide effective gait training for the patients and release the physical therapists from the intensive labor required by the traditional physical therapy. In addition, knee exoskeletons can augment human performance in normal walking, loaded walking, and even running by enhancing the strength of the wearers’ knee joints. A systematic review of knee exoskeletons is presented in this paper. The biomechanics of the human knee joint is firstly presented. Then, the design concepts of knee exoskeletons, including the actuators and sensors, are provided, followed by the introduction of the corresponding control strategies. Finally, the limitations of the available devices and the research and development directions in the field of knee exoskeletons are discussed, thus providing useful information to the researchers developing knee exoskeletons that are suitable for practical applications.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness
Author: Niels F.J.Waterval, Merel-AnneBrehm, Hilde E.Ploegera, Frans Nollet, Jaap Harlaar
Affiliation: Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
Department of Biomechanical Engineering, Delft University of Technology, The Netherlands
Journal: Gait & Posture
Citation: Volume 66, October 2018, Pages 38-44

Publication Year and Month: 2018 10

Abstract: Background
Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost.

Research question
Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost?

Methods
Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost.

Results
Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122).

Conclusions: Significance
Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration.

Outcome of Research: More research required

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Category: Orthoses

Title: Ankle-foot orthoses for rehabilitation and reducing metabolic cost of walking: Possibilities and challenges
Author: Bing Chen, Bin Zi, Yishan Zeng, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
Journal: Mechatronics
Citation: Volume 53, August 2018, Pages 241-250
Publication Year and Month: 2018 08

Abstract: People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Mechanoadaptation: articular cartilage through thick and thin
Author: Tonia L. Vincent, Angus K. T. Wann
Affiliation:
Journal: The Journal of Physiology
Citation: https://doi.org/10.1113/JP275451
Publication Year and Month: 2018 06

Abstract: The articular cartilage is exquisitely sensitive to mechanical load. Its structure is largely defined by the mechanical environment and destruction in osteoarthritis is the pathophysiological consequence of abnormal mechanics. It is often overlooked that disuse of joints causes profound loss of volume in the articular cartilage, a clinical observation first described in polio patients and stroke victims. Through the 1980s, the results of studies exploiting experimental joint immobilisation supported this. Importantly, this substantial body of work was also the first to describe metabolic changes that resulted in decreased synthesis of matrix molecules, especially sulfated proteoglycans. The molecular mechanisms that underlie disuse atrophy are poorly understood despite the identification of multiple mechanosensing mechanisms in cartilage. Moreover, there has been a tendency to equate cartilage loss with osteoarthritic degeneration. Here, we review the historic literature and clarify the structural, metabolic and clinical features that clearly distinguish cartilage loss due to disuse atrophy and those due to osteoarthritis. We speculate on the molecular sensing pathways in cartilage that may be responsible for cartilage mechanoadaptation.

Conclusions: Mechanoadaptation in cartilage is rapid and reversible, and potentially of a similar scale to that seen in muscle and bone. Comprehensive studies of cartilage atrophy in vivo have been carried out although largely during the ‘pre‐molecular’ era and prior to the discovery of direct chondrocyte mechanosensing mechanisms. Advances in newly available glycobiology and proteomic techniques, in combination with genetic modification in rodents, will add considerable value to future studies. Cartilage atrophy is readily distinguished from osteoarthritis at the clinical, tissue and molecular level but cannot be discerned on a plain radiograph except by noting the absence of bone remodelling. As joint space narrowing is typically used to diagnose OA, it is important to consider atrophy as a differential diagnosis. Harnessing the molecules that drive mechanoadaption in articular cartilage may provide novel strategies to prevent or treat OA.

Outcome of Research: More research required

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Category: Orthoses

Title: Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome
Author: Kiriakos Daniilidis, Eike Jakubowitz, Daiwei Yao
Affiliation:
Journal: Part of the Biosystems &amp; Biorobotics book series (BIOSYSROB, volume 19) pp 399-414
Citation: Daniilidis K., Jakubowitz E., Yao D. (2018) Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome. In: Sandrini G., Homberg V., Saltuari L., Smania N., Pedrocchi A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_27
Publication Year and Month: 2018 01

Abstract: The adult paralytic foot or drop foot is a secondary related foot deformity, which usually arises due to neurogenic damage (Kunst et al. in Stroke 42:2126–2130, 2011; Truelsen et al. in European Journal of Neurology 13:581–598, 2006). The lack of neural innervation of the muscles, which play a major role in ankle dorsiflexion—M. tibialis anterior, Mm. peronei, M. extensor digitorum longus, and M. extensor halluces longus—can cause a secondary malposition of the foot. As a dorsiflexion of the ankle cannot be actively provoked, this leads to a domination of the flexors and as a secondary outcome to a shortening of these muscles and their tendons. Similarly, it may also lead to a malposition in supination (www.mayoclinic.org/diseases-conditions/foot-drop/basics/definition/con-20032918).

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode
Author: Sarah Schroder, Eva Probsting, Thomas Schmalz, Andreas Kannenberg, Hartmut Stinus
Affiliation: Ottobock SE & Co. KGaA, Duderstadt, Germany
Journal: Physical Medicine and Rehabilitation Research (PM&R)
Citation: DOI: 10.15761/PMRR.1000168
Publication Year and Month: 2018

Abstract: People with a paresis or paralysis of the knee extensors depend on knee-ankle-foot orthoses (KAFOs) to restore walking ability. Unlike locked KAFOs whose orthotic
knee joints are only unlocked for sitting down, stance control orthoses (SCOs) may utilize various mechanisms to lock the orthotic knee joint during the stance phase
and unlock it for a free swing phase. Thus far, all studies comparing SCOs to locked KAFOs have only used laboratory-based measures, but no clinical performance
measures commonly used in rehabilitation medicine. Therefore, the aim of this study was to investigate functional walking capacity using the 6-minute walk test
(6MWT), combined with objective 3D gait measurements, in established SCO users when using the orthosis in the unlocked and locked mode, respectively. In
addition, satisfaction with the SCO was surveyed using the QUEST questionnaire. A total of eight subjects participated in this study. The results show that in the
locked condition, subjects walked a significantly shorter distance (284.4±53.0 m vs. 316.9±59.6 m, p=.04) in the 6MWT than in the unlocked condition. Gait was
more physiological in the unlocked mode with a mean knee flexion angle during swing of 57°±15° vs. full extension in the locked mode. QUEST scores showed a
high overall satisfaction with the E-MAG Active SCO.

Conclusions: Compared to the unlocked condition, the locked mode imposed a clinically meaningful restriction to the functional walking capacity on the subjects. Therefore, fitting
of an SCO may be considered beneficial in individuals dependent on a KAFO to improve their functional walking capacity.

Outcome of Research: More research required

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Category: Orthoses

Title: Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Author: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A.
Affiliation: Nil identified
Journal:
Citation: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait & Posture. 2017 58:146-153. doi: 10.1016/j.gaitpost.2017.07.107.
Publication Year and Month: 2017 07

Abstract: 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 clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.

Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20 and 32% of the variance in individual gait parameters.

Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.

Conclusions:

Outcome of Research: Effective

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Comments (if any): There are many differences in gait patterns and it can be difficult to detect the forces and weight distribution from observation. 3D gait analysis appears to be more effective in combination with physical examination of muscle weakness in prescription of effective orthoses.

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Category: Orthoses

Title: Predictors of changes in gait performance over four years in persons with late effects of polio.
Author: Flansbjer, Lexell, Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden.

Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.

Department of Health Science, Luleå University of Technology, Luleå, Sweden.
Journal: NeuroRehabilitation
Citation: 2017;41(2):403-411.
Publication Year and Month: 2017

Abstract: BACKGROUND:
Reduced gait performance is common in persons with late effects of polio.

OBJECTIVE:
To identify predictors of change in gait performance over four years in persons with late effects of polio.

METHODS:
Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

RESULTS:
There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

Conclusions: CONCLUSION:
The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.

Outcome of Research: More research required

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Category: Diagnosis and Management, Orthoses, Surgery

Title: Polio revisited: reviving knowledge and skills to meet the challenge of resurgence
Author: Benjamin Joseph (1) and Hugh Watts (2)
Affiliation: (1) Aster Medcity, Kochi, Kerala India, 18 HIG HUDCO Colony, Manipal, Karnataka 576104 India

(2) Shriners Hospital for Children, Los Angeles, CA USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Children's Orthopaedics

9 (5): 325–338, doi: 10.1007/s11832-015-0678-4
Publication Year and Month: 2015 09

Abstract: Purpose
To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.

Methods
Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.

Results
The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.

Conclusions
As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.

Keywords: Poliomyelitis, Resurgence, Surgical decision-making, Bracing, Paralytic deformity

Conclusions: Polio has not been eradicated and there is a risk of resurgence of the disease. Paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques of managing the effects of paralysis following polio is needed.

Outcome of Research: Not applicable

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Category: Assistive Technology, Orthoses

Title: Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis
Author: Arazpour M (1), Ahmadi F (2), Bahramizadeh M (2), Samadian M (3), Mousavi ME (2), Bani MA (4), Hutchins SW (5)
Affiliation: (1) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; (2) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (3) Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; (4) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (5) Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
Journal: Prosthetics and Orthotics International
Citation: Prosthet Orthot Int. 2015 Aug 12. pii: 0309364615596063
Publication Year and Month: 2015 08

Abstract: BACKGROUND: 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.

OBJECTIVES: 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.

STUDY DESIGN: Quasi experimental study.

METHODS: 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.

RESULTS: 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.

Conclusions: 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.

CLINICAL RELEVANCE: 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.

Outcome of Research: Effective

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Category: Assistive Technology, Orthoses

Title: Wearable monitoring devices for assistive technology: case studies in post-polio syndrome
Author: Andreoni G (1), Mazzola M (1), Perego P (1), Standoli CE (1), Manzoni S (1), Piccini L (2), Molteni F (3)
Affiliation: (1) Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy; (2) 6SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy; (3) Villa Beretta Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy
Journal: Sensors
Citation: Sensors (Basel). 2014 Jan 24;14(2):2012-27. doi: 10.3390/s140202012
Publication Year and Month: 2014 01

Abstract: 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.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Manufacture of Passive Dynamic Ankle–Foot Orthoses Using Selective Laser Sintering
Author: Mario C. Faustini ; Richard R. Neptune ; Richard H. Crawford ; Steven J. Stanhope
Affiliation: Department of Mechanical Engineering, the University of Texas at Austin.
Journal: IEEE Transactions on Biomedical Engineering
Citation: Volume: 55 , Issue: 2 , Feb. 2008
Publication Year and Month: 2008 02

Abstract: Ankle-foot orthosis (AFO) designs vary in size, shape, and functional characteristics depending on the desired clinical application. Passive Dynamic (PD) Response ankle-foot orthoses (PD-AFOs) constitute a design that seeks to improve walking ability for persons with various neuromuscular disorders by passively (like a spring) providing variable levels of support during the stance phase of gait. Current PD-AFO manufacturing technology is either labor intensive or not well suited for the detailed refinement of PD-AFO bending stiffness characteristics. The primary objective of this study was to explore the feasibility of using a rapid freeform prototyping technique, selective laser sintering (SLS), as a PD-AFO manufacturing process. Feasibility was determined by replicating the shape and functional characteristics of a carbon fiber AFO (CF-AFO). The study showed that a SLS-based framework is ideally suited for this application. A second objective was to determine the optimal SLS material for PD-AFOs to store and release elastic energy; considering minimizing energy dissipation through internal friction is a desired material characteristic. This study compared the mechanical damping of the CF-AFO to PD-AFOs manufactured by SLS using three different materials. Mechanical damping evaluation ranked the materials as Rilsantrade D80 (best), followed by DuraFormtrade PA and DuraFormtrade GF. In addition, Rilsantrade D80 was the only SLS material able to withstand large deformations.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Biomechanical abnormalities of post-polio patients and the implications for orthotic management.
Author: Perry J, Clark D
Affiliation: Rancho Los Amigos Medical Center, 7601 East Imperial Highway, Bldg. 304, Downey, CA 90242, USA.
Journal: NeuroRehabilitation
Citation: 1997;8(2):119-38
Publication Year and Month: 1997

Abstract: Muscle weakness resulting from the combined effects of acute and late motor neuron pathology is the basic cause of post-polio dysfunction. Through their normal sensation and moter control, post-polio patients minimize their disability by useful substitutions. Orthoses are needed only when these substitutions either are inadequate or result in muscle or joint overuse. The areas most commonly showing late disability are the lower extremities, shoulders and low-back. In the lower extremities, the major muscle groups are the hip extensors and abductors, the knee extensors (quadriceps), ankle plantar flexors and dorsi flexors. Each group has a specific function which relates to one of the basic tasks of walking, weight acceptance, single limb support and swing. To determine orthotic needs, polio gait deviations representing useful substitutions must be differentiated from symptomatic dysfunction. Weight acceptance utilizes the quadriceps, hip extensors and hip abductors to establish a stable limb and provide shock absorbing mechanics. Substitutions to preserve weight bearing stability include sacrifice of normal shock absorbing knee flexion for quadriceps weakness, backward or lateral trunk lean for hip extensor and abductor weakness. Knee pain, excessive hyperextension and flexion contractures are indications for orthotic assistance with a KAFO. Orthotic designs relate to the type of knee joint (off-set, free, locked) and completeness of the AFO component. Low-back pain from hip substitutions or over use of the hip muscles requires a walking aid. Single limb support is the period when the limb and body advance over the supporting foot. The key muscle group is the soleus-gastrocnemius complex. Swing involves lifting and advancing the unloaded limb. While all three joints flex simultaneously, the hip flexors and ankle dorsi flexors are the critical muscles. A drop foot from ankle dorsiflexor weakness is the common disability. Excessive hip flexion is the usual substitution.

Conclusions: An orthosis which assists dorsiflexion without obstructing loading response plantar flexion is the most functional design.

Outcome of Research: More research required

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Category: Orthoses

Title: Findings in Post-Poliomyelitis Syndrome
Author: Perry, J.P., Fontaine, J.D., Mulroy, S., Downey, P.T.
Affiliation: Pathokinesiology Service, Rancho Los Amigos Medical Center, Downey
Journal:
Citation: The Journal of Bone and Joint Surgery Vol. 77-A, No. 8, August 1995, 1148-1153
Publication Year and Month: 1995 08

Abstract: The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing.

Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris. the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded.

The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution.

These obervations support the theory that postpoliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment -- based on the early identification of overuse of muscles and ligamentous strain -- should aim at modification of lifestyle and include use of a brace.

Conclusions:

Outcome of Research:

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Category: Orthoses

Title: Gait Analysis Techniques
Author: JoAnne K. Gronley and Jacquelin Perry

Affiliation: Physical Therapist, Pathokinesiology Service, Rancho Los Amigos Hospital; Director, Pathokinesiology Service, Rancho Los Amigos Hospital, and Professor of Orthopaedic Surgery, University of Southern California
Journal:
Citation: The Journal of American Physical Therapy Assn. Vol. 63, No. 12, December 1984 1831-1838
Publication Year and Month: 1984 12

Abstract: In the gait laboratory at Rancho Los Amigos Hospital, the emphasis is on patient testing to identify functional problems and determine the effectiveness of treatment programs. Footswitch stride analysis, dynamic EMG, energy-cost measurements, force plate, and instrumented motion analysis are the techniques most often used. Stride data define the temporal and distance factors of gait. We use this information to classify the patient's ability to walk and measure response to treatment programs. Inappropriate muscle action in the patient disabled by an upper motor neuron lesion is identified with dynamic EMG. Intramuscular wire electrodes are used to differentiate the action of adjacent muscles. We use the information to localize the source of abnormal function so that selection of treatment procedures is more precise. Force and motion data aid in determining the functional requirement and the muscular response necessary to meet the demand. Determining the optimum mode of locomotion and developing criteria for program planning have become more realistic with the aid of energy-cost measurements. Microprocessors and personal computer systems have made compact and reliable single-concept instrumentation available for basic gait analysis in the standard clinical environment at a modest cost. The more elaborate composite systems, however, still require custom instrumentation and engineering support.

Conclusions: This review of the RLAH gait laboratory has emphasized our clinical focus on patient care. Research projects have followed two directions. Technical developments have related to developing the footswitch, energy cost, and dynamic EMG systems. Functional research has assessed normal performance to provide baselines for interpreting pathological activities.

Outcome of Research: Not applicable

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Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications