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Fallahtafti F, Samson K, Salamifar Z, Johanning J, Pipinos I, Myers SA. Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis. Int J Cardiol 2024; 407:131992. [PMID: 38527630 DOI: 10.1016/j.ijcard.2024.131992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.
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Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA.
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Zahra Salamifar
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA
| | - Jason Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Iraklis Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA.
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Waterval NFJ, Nollet F, Brehm MA. Effect of stiffness-optimized ankle foot orthoses on joint work in adults with neuromuscular diseases is related to severity of push-off deficits. Gait Posture 2024; 111:162-168. [PMID: 38703445 DOI: 10.1016/j.gaitpost.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/19/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND People with plantar flexor weakness generate less ankle push-off work during walking, resulting in inefficient proximal joint compensations. To increase push-off work, spring-like ankle foot orthoses (AFOs) can be provided. However, whether and in which patients AFOs increase push-off work and reduce compensatory hip and knee work is unknown. METHODS In 18 people with bilateral plantar flexor weakness, we performed a 3D gait analysis at comfortable walking speed with shoes-only and with AFOs of which the stiffness was optimized. To account for walking speed differences between conditions, we compared relative joint work of the hip, knee and ankle joint. The relationships between relative work generated with shoes-only and changes in joint work with AFO were tested with Pearson correlations. RESULTS No differences in relative ankle, knee and hip work over the gait cycle were found between shoes-only and AFO (p>0.499). Percentage of total ankle work generated during pre-swing increased with the AFO (AFO: 85.3±9.1% vs Shoes: 72.4±27.1%, p=0.026). At the hip, the AFO reduced relative work in pre-swing (AFO: 31.9±7.4% vs Shoes: 34.1±10.4%, p=0.038) and increased in loading response (AFO: 18.0±11.0% vs Shoes: 11.9±9.8%, p=0.022). Ankle work with shoes-only was inversely correlated with an increase in ankle work with AFO (r=-0.839, p<0.001) and this increase correlated with reduction in hip work with AFO (r=-0.650, p=0.004). DISCUSSION Although stiffness-optimized AFOs did not alter the work distribution across the ankle, knee and hip joint compared to shoes-only walking, relative more ankle work was generated during push-off, causing a shift in hip work from pre-swing to loading response. Furthermore, larger ankle push-off deficits when walking with shoes-only were related with an increase in ankle work with AFO and reduction in compensatory hip work, indicating that more severely affected individuals benefit more from the energy storing-and-releasing capacity of AFOs.
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Affiliation(s)
- N F J Waterval
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands.
| | - F Nollet
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - M A Brehm
- Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
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Dobler F, Mayr R, Lengnick H, Federolf P, Alexander N. Efficacy of hinged and carbon fiber ankle-foot orthoses in children with unilateral spastic cerebral palsy and drop-foot gait pattern. Prosthet Orthot Int 2024:00006479-990000000-00239. [PMID: 38579167 DOI: 10.1097/pxr.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/21/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND In children with unilateral spastic cerebral palsy (USCP), ankle-foot orthoses (AFOs) are widely used to correct common gait deviations such as a drop-foot pattern. Most studies on this topic have investigated specific time points while omitting other parts of the gait cycle. OBJECTIVES This study investigated the separate effects of prefabricated carbon fiber AFOs and custom-made hinged AFOs compared with barefoot walking in children with USCP with a drop-foot gait pattern using statistical parametric mapping. STUDY DESIGN Retrospective, cross-sectional, repeated measures study. METHODS Twenty ambulatory children (9.9 ± 2.5 years) with USCP and a drop-foot gait pattern were included. Kinematics, kinetics, and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking. Statistical parametric mapping was used to compare joint angles and moment waveforms. Kinematics, kinetics and spatiotemporal parameters assessed during 3-dimensional gait analysis were compared between barefoot and AFO walking for each AFO type but not between the 2 AFO types. RESULTS Compared with barefoot walking, there was a steeper sole angle at initial contact, corresponding to a heel strike pattern, and an increased ankle dorsiflexion in swing with the use of both AFOs. The ankle plantar flexion moment during loading response increased. Ankle power generation during pre-swing decreased in the carbon fiber AFO group when walking with AFOs. CONCLUSIONS Both AFOs were beneficial for improving a drop-foot gait pattern in these small patient groups and can, therefore, be recommended to treat this gait deviation in patients with unilateral cerebral palsy. However, the reduction in ankle power generation during push-off and additional goals targeted by AFOs, such as correction of structural or flexible foot deformities, should be considered for prescription.
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Affiliation(s)
- Florian Dobler
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Robin Mayr
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Harald Lengnick
- Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Nathalie Alexander
- Laboratory for Motion Analysis, Department of Paediatric Orthopaedics, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Gravesteijn AS, Timmermans ST, Aarts J, Hulst HE, De Jong BA, Beckerman H, De Groot V. Relative aerobic load of walking in people with multiple sclerosis. J Rehabil Med 2024; 56:jrm13352. [PMID: 38353255 PMCID: PMC10875758 DOI: 10.2340/jrm.v56.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To examine the energy demand of walking relative to aerobic capacity in people with multiple sclerosis. DESIGN Cross-sectional cohort study. PATIENTS A total of 45 people with multiple sclerosis (32 females), median disease duration 15 years (interquartile range (IQR) 9; 20), median Expanded Disability Status Scale 4 (min-max range: 2.0; 6.0). METHODS Aerobic capacity, derived from a cardiopulmonary exercise test and gas exchange measurements, assessed during a 6-min overground walk test at comfortable speed, were analysed. The relative aerobic load of walking was determined as the energy demand of walking relative to oxygen uptake at peak and at the first ventilatory threshold. Healthy reference data were used for clinical inference. RESULTS People with multiple sclerosis walk at a mean relative aerobic load of 60.0% (standard deviation 12.8%) relative to peak aerobic capacity, and 89.1% (standard deviation 19.9%) relative to the first ventilatory threshold. Fourteen participants walked above the first ventilatory threshold (31%). Peak aerobic capacity was reduced in 45% of participants, and energy demands were increased in 52% of participants. CONCLUSION People with multiple sclerosis walk at a relative aerobic load close to their first ventilatory threshold. A high relative aerobic load can guide clinicians to improve aerobic capacity or reduce the energy demands of walking.
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Affiliation(s)
- Arianne S Gravesteijn
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands.
| | - Sjoerd T Timmermans
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jip Aarts
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Hanneke E Hulst
- Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands; Leiden University, Faculty of Social Sciences, Institute of Psychology, Health, Medical and Neuropsychology unit, Leiden, The Netherlands; MS Center Amsterdam, Anatomy and Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Brigit A De Jong
- Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands; MS Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Heleen Beckerman
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands
| | - Vincent De Groot
- MS Center Amsterdam, Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands; Amsterdam Movement Sciences Research Institute, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam Neuroscience Research Institute, Neuroinfection & Neuroinflammation, Amsterdam, The Netherlands
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Jor A, Lau NWK, Daryabor A, Kobayashi T. Effects of ankle-foot orthoses on step activities in the community: a systematic review. Disabil Rehabil 2024; 46:464-477. [PMID: 36710007 DOI: 10.1080/09638288.2023.2169774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders. METHODS Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale. RESULTS Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life. CONCLUSIONS Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.
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Affiliation(s)
- Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Noelle W K Lau
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aliyeh Daryabor
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Fu AQ, Shih AJ, Armstrong TJ. Examination of the prediction of the planar piecewise continuous lumped muscle parameter model for walking gait with ankle-foot orthosis. Med Eng Phys 2023; 121:104068. [PMID: 37985025 DOI: 10.1016/j.medengphy.2023.104068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
GOAL This work examines the use of a previously described piecewise continuous lumped muscle parameter (PPCLMP) model for predicting selected gait parameters for walking without and with ankle-foot orthoses (AFOs) of varying stiffnesses. METHODS Two AFOs with low (3.4 Nm/deg) and high (6.9 Nm/deg) stiffnesses were tested on the left leg of six healthy subjects to examine the model prediction on the influence of different AFO stiffnesses on gait. RESULTS The model prediction errors ranged from 0 % to 70 % for step lengths with root mean square error (RMSE) of 0.15 m and ranged from 0 % to 67 % for swing time with RMSE of 0.07 s. The prediction precision of step length was more consistent among subjects than of swing time. DISCUSSIONS AND CONCLUSIONS The model predicts the observed shortened step lengths and swing times, but there were significant differences between predicted and observed swing times and step lengths. The causes of these differences might be differences in the lumped muscle parameters taken from the literature and those of the subjects tested. Also, the model assumption that muscle stiffness is proportional to joint angle may not be corrected.
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Affiliation(s)
- Albert Qianyi Fu
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Albert J Shih
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J Armstrong
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Grunst MM, Wiederien RC, Wilken JM. Carbon fiber ankle-foot orthoses in impaired populations: A systematic review. Prosthet Orthot Int 2023; 47:457-465. [PMID: 36779973 DOI: 10.1097/pxr.0000000000000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/14/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Carbon fiber is increasingly being used in ankle-foot orthoses (AFOs). Orthotic devices and carbon fiber-containing devices have been shown to reduce pain and improve function in multiple patient populations. Although the number of publications and interest in carbon fiber AFOs is growing, a systematic evaluation of their effects is lacking. OBJECTIVES To characterize the effects of carbon fiber AFOs in impaired individuals. STUDY DESIGN Qualitative systematic review. METHODS Systematic searches in PubMed, Embase, CINAHL, and Cochrane Library were completed in July 2020. The results were deduplicated, screened, and assessed for quality by independent reviewers. Articles were excluded if they had nonhuman subjects, only healthy subjects, or included active control systems, motors, or other power sources. RESULTS Seventy-eight articles were included in the qualitative synthesis. Most articles were of low to moderate methodological quality. Five commonly used devices were identified: the Intrepid Dynamic Exoskeletal Orthosis, ToeOff, WalkOn, Neuro Swing, and Chignon. The devices have unique designs and are associated with specific populations. The Intrepid Dynamic Exoskeletal Orthosis was used in individuals with lower-limb trauma, the Neuro Swing and ToeOff in individuals with neurological disorders, the Chignon in individuals with hemiplegia and stroke, and the WalkOn in people with hemiplegia and cerebral palsy. Each device produced favorable outcomes in their respective populations of interest, such as increased walking speed, reduced pain, or improved balance. CONCLUSIONS The mechanical characteristics and designs of carbon fiber AFOs improve outcomes in the populations in which they are most studied. Future literature should diligently report patient population, device used, and fitting procedures.
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Affiliation(s)
- Megan M Grunst
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
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Borghi C, Sassi S, Pandarese D, Messori S, Faccioli S. Effect of Ankle-Foot Orthoses in Pediatric Patients with Hereditary Motor-Sensory Neuropathy: A Case Series Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1529. [PMID: 37761490 PMCID: PMC10529230 DOI: 10.3390/children10091529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
(1) Aims: to evaluate the effect on gait performance and standing stability of ankle-foot orthoses (AFO) in pediatric patients with hereditary motor-sensory neuropathy (HMSN). (2) Methods: a retrospective case-series study including three adolescents (S1, S2, S3, mean age 14 years) with HMSN. The subjects were evaluated barefoot, with carbon AFO (Botter) and with solid AFO (SAFO) by means of: gait analysis, stabilometry and gait functional tests (10 Meter Walk Test, 2 Minute Walk Test). Finally, the CSD-OPUS questionnaire was administered to the assess satisfaction and impact of the orthoses on life quality. (3) Results: orthoses improved gait and stability performance. Botter allowed greater ankle movement than SAFO and provided greater push-off power. This, combined with the carbon elastic energy return, might explain better performances in the 2MWT, with a larger distance traveled compared to SAFO for both S1 (110 m vs. 72 m) and S2 (170 m vs. 155 m) and, compared to barefoot walking, also for S3 (211 m vs. 160 m), for which SAFO analysis was not available. Both orthoses improved performance at the stabilometric analysis. The CSD-OPUS questionnaire showed a significantly higher level of satisfaction with Botter for the subjects (S1, S2) who completed the comparison. (4) Conclusions: Both orthoses improved gait and standing, though Botter proved to be better tolerated and more effective in improving gait endurance.
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Affiliation(s)
- Corrado Borghi
- Children Rehabilitation Unit—UDGEE, Santa Maria Nuova Hospital, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.S.); (D.P.); (S.M.); (S.F.)
| | - Silvia Sassi
- Children Rehabilitation Unit—UDGEE, Santa Maria Nuova Hospital, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.S.); (D.P.); (S.M.); (S.F.)
| | - Daniela Pandarese
- Children Rehabilitation Unit—UDGEE, Santa Maria Nuova Hospital, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.S.); (D.P.); (S.M.); (S.F.)
| | - Samuele Messori
- Children Rehabilitation Unit—UDGEE, Santa Maria Nuova Hospital, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.S.); (D.P.); (S.M.); (S.F.)
| | - Silvia Faccioli
- Children Rehabilitation Unit—UDGEE, Santa Maria Nuova Hospital, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.S.); (D.P.); (S.M.); (S.F.)
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Waterval NFJ, van der Krogt MM, Veerkamp K, Geijtenbeek T, Harlaar J, Nollet F, Brehm MA. The interaction between muscle pathophysiology, body mass, walking speed and ankle foot orthosis stiffness on walking energy cost: a predictive simulation study. J Neuroeng Rehabil 2023; 20:117. [PMID: 37679784 PMCID: PMC10483766 DOI: 10.1186/s12984-023-01239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND The stiffness of a dorsal leaf AFO that minimizes walking energy cost in people with plantarflexor weakness varies between individuals. Using predictive simulations, we studied the effects of plantarflexor weakness, passive plantarflexor stiffness, body mass, and walking speed on the optimal AFO stiffness for energy cost reduction. METHODS We employed a planar, nine degrees-of-freedom musculoskeletal model, in which for validation maximal strength of the plantar flexors was reduced by 80%. Walking simulations, driven by minimizing a comprehensive cost function of which energy cost was the main contributor, were generated using a reflex-based controller. Simulations of walking without and with an AFO with stiffnesses between 0.9 and 8.7 Nm/degree were generated. After validation against experimental data of 11 people with plantarflexor weakness using the Root-mean-square error (RMSE), we systematically changed plantarflexor weakness (range 40-90% weakness), passive plantarflexor stiffness (range: 20-200% of normal), body mass (+ 30%) and walking speed (range: 0.8-1.2 m/s) in our baseline model to evaluate their effect on the optimal AFO stiffness for energy cost minimization. RESULTS Our simulations had a RMSE < 2 for all lower limb joint kinetics and kinematics except the knee and hip power for walking without AFO. When systematically varying model parameters, more severe plantarflexor weakness, lower passive plantarflexor stiffness, higher body mass and walking speed increased the optimal AFO stiffness for energy cost minimization, with the largest effects for severity of plantarflexor weakness. CONCLUSIONS Our forward simulations demonstrate that in individuals with bilateral plantarflexor the necessary AFO stiffness for walking energy cost minimization is largely affected by severity of plantarflexor weakness, while variation in walking speed, passive muscle stiffness and body mass influence the optimal stiffness to a lesser extent. That gait deviations without AFO are overestimated may have exaggerated the required support of the AFO to minimize walking energy cost. Future research should focus on improving predictive simulations in order to implement personalized predictions in usual care. Trial Registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170.
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Affiliation(s)
- N. F. J. Waterval
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - M. M. van der Krogt
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - K. Veerkamp
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, and Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, Australia
| | - T. Geijtenbeek
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - J. Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F. Nollet
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - M. A. Brehm
- Amsterdam UMC Location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
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10
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Dinkel D, Rech JP, Hassan M, DeSpiegelaere H, Johanning J, Pipinos I, Myers S. A comparison of the perceptions of wearing an ankle foot orthosis by individuals with peripheral artery disease according to their baseline-level of physical activity. J Bodyw Mov Ther 2023; 35:268-272. [PMID: 37330780 PMCID: PMC10288562 DOI: 10.1016/j.jbmt.2023.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/15/2023] [Accepted: 04/12/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a prevalent cardiovascular disease that limits an individual's ability to walk. One potential way to improve physical activity for patients with PAD is an ankle foot orthosis (AFO). Previous research has found that various factors may influence an individual's willingness to wear AFOs. However, one factor that has been understudied is an individual's baseline physical activity level prior to wearing AFOs. Therefore, the purpose of this study was to compare the perceptions of wearing AFOs for 3 months among individuals with PAD according to their baseline level of physical activity. METHODS Accelerometer-derived physical activity prior to AFO prescription was used to classify participants into either a higher or lower activity group. Semi-structured interviews were conducted at 1.5 and 3-months after wearing the AFOs to assess participants' perceptions of using the orthosis. Data were analyzed by a directed content analysis approach, then the percentage of respondents for each theme were calculated and compared between higher and lower activity groups. FINDINGS Several differences were found. Participants in the higher activity group more often reported positive impacts from wearing the AFOs. Additionally, participants who were in the lower activity group more often reported the AFOs caused physical pain while participants in the higher activity group more often reported the device was uncomfortable during daily activities. CONCLUSION Baseline physical activity levels may help to better understand barriers to wear and needed support to increase adherence to an AFO wear prescription, especially for patients with PAD with limited activity.
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Affiliation(s)
- Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, United States.
| | - John P Rech
- School of Health & Kinesiology, University of Nebraska at Omaha, United States
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha, United States; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, United States; Department of Internal Medicine, University of Nebraska Medical Center, United States
| | - Holly DeSpiegelaere
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, United States
| | - Jason Johanning
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, United States; Department of Surgery, University of Nebraska Medical Center, United States
| | - Iraklis Pipinos
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, United States; Department of Surgery, University of Nebraska Medical Center, United States
| | - Sara Myers
- Department of Biomechanics, University of Nebraska at Omaha, United States; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, United States
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11
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Mizner RL, Mays AA, Mays RJ. Mechanical adaptations in walking using carbon fiber ankle foot orthoses for patients with peripheral artery disease. Gait Posture 2023; 101:14-20. [PMID: 36696821 PMCID: PMC10023472 DOI: 10.1016/j.gaitpost.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND The effectiveness of community-based walking programs for patients with peripheral artery disease (PAD) can be limited by calf claudication during exercise. Recent evidence finds adding carbon fiber ankle foot orthoses (AFO) to a walking program can result in improvements in patient mobility and delay claudication onset when walking. RESEARCH QUESTION How may carbon fiber AFO alter ankle walking mechanics and corresponding triceps surae muscle recruitment in a manner that could improve patient mobility? METHODS In this repeated measures cohort study, fifteen patients with PAD were fit with bilateral AFO before completing self-paced gait analysis including electromyography. Patients were then given standard advice to walk at home using the devices for 12 weeks. Twelve patients completed follow-up testing. RESULTS There were no significant interactions between main effects for any variable of interest (p ≥ 0.189). Further, there were no within-subjects main effects for testing time for self-selected gait speed or any of the kinetic or kinematic variables (p ≥ 0.435). There were significant main effects for AFO use with reductions in dorsi flexion (p < 0.001), plantar flexion at toe off (p < 0.001), ankle plantar flexor moment (p = 0.037), and ankle plantar flexor power (p < 0.001). Triceps surae recruitment did not change between AFO conditions (p > 0.05). SIGNIFICANCE Adding carbon fiber AFO limits peak ankle motion and joint power during self-paced walking for people with PAD while maintaining their walking speed. These gait adaptions were maintained over our 12 weeks of walking practice time. A resulting decrease in plantar flexor power while maintaining gait speed may provide the mechanism by which AFO can delay claudication onset which are major barrier to PAD walking programs. Calf muscle recruitment was maintained when adding the AFO which suggests sufficient muscle exertion could exist to maintain muscle integrity with sustained AFO use.
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Affiliation(s)
- Ryan L Mizner
- University of Montana, School of Physical Therapy and Rehabilitation Science, Missoula, MT, United States.
| | - Ashley A Mays
- North Memorial Medical Center, Heart and Vascular Center, Robbinsdale, MN, United States
| | - Ryan J Mays
- University of Minnesota, School of Nursing, Adult and Gerontological Health Cooperative, Minneapolis, MN, United States
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12
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Visch L, Oudenhoven LM, Timmermans ST, Beckerman H, Rietberg MB, de Groot V, van der Krogt MM. The relationship between energy cost of walking, ankle push-off and walking speed in persons with multiple sclerosis. Gait Posture 2022; 98:160-166. [PMID: 36126536 DOI: 10.1016/j.gaitpost.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The energy cost of walking (ECw) is an important indicator of walking dysfunction in persons with multiple sclerosis (PwMS). However, its underlying causes and its relation with ankle push-off and walking speed are not well understood. RESEARCH QUESTION What is the contribution of ankle push-off and walking speed to increased ECw in PwMS? METHODS Ten PwMS with walking limitations and 10 individually gender- and age-matched healthy controls (HC) were included. All participants performed two 6-min walking trials on a treadmill at comfortable walking speed (CWS of PwMS) and fast walking speed (FWS, 130 % of CWS of PwMS). Kinetics and metabolic cost were evaluated. Generalized estimating equations were performed to investigate effects of group and walking speed, and their interaction. Spearman correlations were conducted to examine whether ECw was related to ankle push-off in PwMS, controlling for differences in walking speed in PwMS. RESULTS ECw at matched walking speed was significantly higher in PwMS compared to HC. Kinetic parameters were not different between the most impaired leg in PwMS and HC at matched walking speed, but asymmetry between both legs of PwMS was observed. At FWS, ECw reduced and ankle push-off increased similarly in both groups. ECw was inversely related to peak ankle power of the most impaired leg in PwMS at CWS. SIGNIFICANCE Slow walking speed is one factor that contributes to increased ECw in PwMS. Furthermore, PwMS who had a higher ECw showed a lower peak ankle power, independent of walking speed. This indicates that ankle push-off could be a contributor to increased ECw.
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Affiliation(s)
- Lara Visch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, the Netherlands.
| | - Laura M Oudenhoven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Sjoerd T Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Heleen Beckerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Marc B Rietberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Vincent de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands.
| | - Marjolein M van der Krogt
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, MS Center Amsterdam, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, the Netherlands.
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13
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Zhou C, Yang Z, Li K, Ye X. Research and Development of Ankle-Foot Orthoses: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176596. [PMID: 36081055 PMCID: PMC9460335 DOI: 10.3390/s22176596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 05/14/2023]
Abstract
The ankle joint is one of the important joints of the human body to maintain the ability to walk. Diseases such as stroke and ankle osteoarthritis could weaken the body's ability to control joints, causing people's gait to be out of balance. Ankle-foot orthoses can assist users with neuro/muscular or ankle injuries to restore their natural gait. Currently, passive ankle-foot orthoses are mostly designed to fix the ankle joint and provide support for walking. With the development of materials, sensing, and control science, semi-active orthoses that release mechanical energy to assist walking when needed and can store the energy generated by body movement in elastic units, as well as active ankle-foot orthoses that use external energy to transmit enhanced torque to the ankle, have received increasing attention. This article reviews the development process of ankle-foot orthoses and proposes that the integration of new ankle-foot orthoses with rehabilitation technologies such as monitoring or myoelectric stimulation will play an important role in reducing the walking energy consumption of patients in the study of human-in-the-loop models and promoting neuro/muscular rehabilitation.
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Affiliation(s)
- Congcong Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Zhao Yang
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Kaitai Li
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Xuesong Ye
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
- Correspondence:
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14
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Dinkel D, Hassan M, Rech JP, Despiegelaere H, Johanning J, Pipinos I, Myers S. Assessing Wear Time and Perceptions of Wearing an Ankle Foot Orthosis in Patients with Peripheral Artery Disease. PM R 2022; 15:493-500. [PMID: 35488854 PMCID: PMC9617808 DOI: 10.1002/pmrj.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a cardiovascular disease that effects patients' walking ability. An ankle foot orthosis (AFO) may improve patients' walking distances. Little research has explored if patients wear a prescribed AFO and their perceptions of wearing the device. OBJECTIVE To assess wear time of an AFO and explore perceptions of wearing the device in patients with peripheral artery disease. DESIGN Convergent mixed methods. SETTING The study was administered through a tertiary care medical center and the research subjects used the device in an outpatient setting in and out of their homes during their regular activities. PARTICIPANTS Patients were referred to the study by their vascular surgeon. Thirty-six patients, all older adult males, were enrolled in this study. Fourteen patients completed the study and 11 supplied sufficient accelerometer data. INTERVENTIONS An AFO was worn for 3 months. An accelerometer was placed on the AFO for 7 days at midpoint (1.5 months) and endpoint of the intervention (3 months) to assess wear time. Semi-structured interviews explored patients' perceptions of wearing the AFO. MAIN OUTCOME MEASURE The primary outcome measure was wear time measured objectively via accelerometer and subjectively via interview. RESULTS Patients (n = 14) wore the AFO around 8 hours/day. Most patients felt they wore the AFO a majority of the time. Patients reported barriers such as challenges wearing the AFO during daily household activities (using stairs, being on uneven terrain), discomfort, clothing or footwear issues, and driving challenges. Positive impacts of wearing the AFO were also reported, primarily the ability to walk further. CONCLUSIONS An AFO may be an acceptable therapeutic intervention to improve perceived walking performance in older adult males with PAD. Addressing patients' perceptions of the AFO and barriers to wear are essential to increasing the positive impact the device has on patients' ambulatory activity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha
| | - Mahdi Hassan
- Department of Biomechanics, University of Nebraska at Omaha.,Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System
| | - John P Rech
- School of Health & Kinesiology, University of Nebraska at Omaha
| | - Holly Despiegelaere
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System
| | - Jason Johanning
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System.,Department of Surgery, University of Nebraska Medical Center
| | - Iraklis Pipinos
- Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System.,Department of Surgery, University of Nebraska Medical Center
| | - Sara Myers
- Department of Biomechanics, University of Nebraska at Omaha.,Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System
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15
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Ihmels WD, Ohm KA, Oludare S, Elrod J, Esposito ER. Effect of custom carbon ankle-foot orthosis use on energetic demands of walking and comparisons to individuals with amputation. Arch Phys Med Rehabil 2022; 103:2114-2119. [DOI: 10.1016/j.apmr.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/01/2022] [Accepted: 02/23/2022] [Indexed: 12/01/2022]
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16
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Hassanzadeh H, Bell J, Dooley E, Puvanesarajah V, Kamalapathy P, Labaran L, Shimer A, Shen F, Russell S. Evaluation of Gait and Functional Stability in Preoperative Cervical Spondylotic Myelopathy Patients. Spine (Phila Pa 1976) 2022; 47:317-323. [PMID: 34593732 DOI: 10.1097/brs.0000000000004235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE The aim of this study was to 1) determine postural stability and spatiotemporal gait parameters and 2) characterize dynamic stability and variances in angular momentum (AM) of preoperative cervical spondylotic myelopathy (CSM) patients compared with healthy controls. SUMMARY OF BACKGROUND DATA CSM is the most common cause of spinal cord dysfunction in the world and can lead to significant functional deficits including proprioception and gait disturbances. Biomechanical feedback mechanisms compensating for these deficits, specifically AM regulation, have remained largely unexplored. METHODS Fifty-six subjects: 32 preoperative Nurick grade 2 or 3 CSM patients and 24 controls were included. Standing balance trials were performed on a single force plate, while walking trials were conducted at self-selected pace over a 15 m runway and a series of five force plates. All trials were recorded with three-dimensional motion analysis cameras and gait modeling software was utilized to calculate stability, spatiotemporal gait parameters, and joint kinematics. RESULTS Tilted ellipse area, a measure of center of pressure variance and postural stability, was significantly greater among CSM patients (847.54 ± 764.33 mm2vs. 258.18 ± 103.35 mm2, P < 0.001). These patients had two times as much variance medial-lateral (72.12 ± 51.83 mm vs. 29.15 ± 14.95 mm, P = 0.001) and over three times as much anterior-posterior (42.25 ± 55.01 mm vs. 9.17 ± 4.83 mm, P = 0.001) compared with controls. Spatiotemporal parameters indicated that the CSM patients tending to have slower, shorter, and wider gait compared with controls, while spending greater amount of time in double support. Compensatory AM among CSM patients was significantly increased in all three anatomic planes, where whole-body AM was approximately double that of controls (0.057 ± 0.034 vs. 0.023 ± 0.006), P < 0.001). CONCLUSION Preoperative CSM patients showed significant alterations in spatiotemporal gait parameters and postural stability compared with controls, consistent with prior literature. Likewise, angular momentum analysis demonstrates that these patients have globally increased body excursion to maintain dynamic balance.Level of Evidence: 3.
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Affiliation(s)
- Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Evan Dooley
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | | | - Pramod Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Lawal Labaran
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Adam Shimer
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Francis Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Shawn Russell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
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17
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Shuman BR, Russell Esposito E. Multiplanar Stiffness of Commercial Carbon Composite Ankle-Foot Orthoses. J Biomech Eng 2022; 144:1114804. [PMID: 34286822 PMCID: PMC8420787 DOI: 10.1115/1.4051845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 01/03/2023]
Abstract
The mechanical properties of an ankle-foot orthosis (AFO) can impact how a user's movement is either restricted or augmented by the device. However, standardized methods for assessing stiffness properties of AFOs are lacking, posing a challenge for comparing between devices and across vendors. Therefore, the purpose of this study was to quantify the rotational stiffness of thirteen commercial, nonarticulated, carbon composite ankle-foot orthoses. A custom, instrumented test fixture, for evaluating mechanical properties in rotating exoskeletons (EMPIRE), deflected an AFO through 20 deg of plantar/dorsiflexion motion about a specified, but adjustable, ankle axis. Sagittal, frontal, and transverse plane rotational stiffness were calculated, and reliability was assessed between cycles, sessions, and testers. The EMPIRE demonstrated good-to-excellent reliability between testers, sessions, and cycles (intraclass correlation coefficients all ≥0.95 for sagittal plane stiffness measures). Sagittal plane AFO stiffness ranged from 0.58 N·m/deg to 3.66 N·m/deg. AFOs with a lateral strut demonstrated frontal plane stiffnesses up to 0.71 N·m/deg of eversion while those with a medial strut demonstrated frontal plane stiffnesses up to 0.53 N·m/deg of inversion. Transverse plane stiffnesses were less than 0.30 N·m/deg of internal or external rotation. These results directly compare AFOs of different models and from different manufacturers using consistent methodology and are intended as a resource for clinicians in identifying a device with stiffness properties for individual patients.
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Affiliation(s)
- Benjamin R. Shuman
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX 78234; Center for Limb Loss and Mobility, VA Puget Sound, 1660 S Columbian Way, Seattle, WA 98108,e-mail:
| | - Elizabeth Russell Esposito
- DoD-VA Extremity Trauma and Amputation Center of Excellence, San Antonio, TX 78234; Center for Limb Loss and Mobility, VA Puget Sound, 660 S Columbian Way, Seattle, WA 98108; Department of Mechanical Engineering, University of Washington, Seattle, WA 98195,e-mail:
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18
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Riddick RC, Farris DJ, Brown NAT, Kelly LA. Stiffening the human foot with a biomimetic exotendon. Sci Rep 2021; 11:22778. [PMID: 34815463 PMCID: PMC8610986 DOI: 10.1038/s41598-021-02059-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/27/2021] [Indexed: 11/08/2022] Open
Abstract
Shoes are generally designed protect the feet against repetitive collisions with the ground, often using thick viscoelastic midsoles to add in-series compliance under the human. Recent footwear design developments have shown that this approach may also produce metabolic energy savings. Here we test an alternative approach to modify the foot-ground interface by adding additional stiffness in parallel to the plantar aponeurosis, targeting the windlass mechanism. Stiffening the windlass mechanism by about 9% led to decreases in peak activation of the ankle plantarflexors soleus (~ 5%, p < 0.001) and medial gastrocnemius (~ 4%, p < 0.001), as well as a ~ 6% decrease in positive ankle work (p < 0.001) during fixed-frequency bilateral hopping (2.33 Hz). These results suggest that stiffening the foot may reduce cost in dynamic tasks primarily by reducing the effort required to plantarflex the ankle, since peak activation of the intrinsic foot muscle abductor hallucis was unchanged (p = 0.31). Because the novel exotendon design does not operate via the compression or bending of a bulky midsole, the device is light (55 g) and its profile is low enough that it can be worn within an existing shoe.
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Affiliation(s)
- Ryan C Riddick
- Centre for Sensorimotor Performance, University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Dominic J Farris
- Sport and Health Sciences, University of Exeter, Exeter, EX4 4PY, UK
| | - Nicholas A T Brown
- Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Luke A Kelly
- Centre for Sensorimotor Performance, University of Queensland, Brisbane, QLD, 4072, Australia
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19
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Classification of Ankle Joint Stiffness during Walking to Determine the Use of Ankle Foot Orthosis after Stroke. Brain Sci 2021; 11:brainsci11111512. [PMID: 34827512 PMCID: PMC8615379 DOI: 10.3390/brainsci11111512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Categorization based on quasi-joint stiffness (QJS) may help clinicians select appropriate ankle foot orthoses (AFOs). The objectives of the present study were to classify the gait pattern based on ankle joint stiffness, also called QJS, of the gait in patients after stroke and to clarify differences in the type of AFO among 72 patients after stroke. Hierarchical cluster analysis was used to classify gait patterns based on QJS at least one month before the study, which revealed three distinct subgroups (SGs 1, 2, and 3). The proportion of use of AFOs, articulated AFOs, and non-articulated AFOs were significantly different among SGs 1-3. In SG1, with a higher QJS in the early and middle stance, the proportion of the patients using articulated AFOs was higher, whereas in SG3, with a lower QJS in both stances, the proportion of patients using non-articulated AFOs was higher. In SG2, with a lower QJS in the early stance and higher QJS in the middle stance, the proportion of patients using AFOs was lower. These findings indicate that classification of gait patterns based on QJS in patients after stroke may be helpful in selecting AFO. However, large sample sizes are required to confirm these results.
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20
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Ries AJ, Schwartz MH, Novacheck TF, Walt K, Klein J. Alternative methods for measuring ankle-foot orthosis alignment in clinical care. Gait Posture 2021; 90:86-91. [PMID: 34418869 DOI: 10.1016/j.gaitpost.2021.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Changes in gait due to an ankle foot orthosis (AFO) have been shown to be impacted by the sagittal plane alignment of the AFO, but there is variability in practice and lack of consensus as to how this alignment should be measured. The neutral angle is a measure of AFO alignment that has the potential to be used by various specialties that prescribe, provide, and analyze AFOs. Currently, a lack of validated measurement methods prevents the neutral angle from being used in various clinical settings. Two experimental neutral angle measurement methods are proposed to address this shortcoming: a portable low-cost method for use during AFO fabrication and fitting, and a laboratory-based method for use during dynamic three-dimensional gait analysis (3DGA). RESEARCH QUESTION What is the concurrent validity of the two experimental neutral angle measurement methods against the gold standard? METHODS The gold standard neutral angle measurement (NAGOLD) was prospectively collected during a static 3DGA trial for 19 pediatric AFOs from 10 individuals. While NAGOLD was being collected, the neutral angle was simultaneously measured using digital differential inclinometers (NAINCL). Within the same 3DGA session, the neutral angle was also measured during the swing phase of gait (NASWING). The NAINCL and NASWING measurements were compared to NAGOLD using repeated measures ANOVA, ICC, and bootstrapped errors-in-variables regressions. RESULTS Repeated measures ANOVA indicated no differences between measurement methods (p = 0.43) and ICC analysis indicated good absolute agreement (ICC(A-1) = 0.85). Mean absolute deviations between the NAINCL and NASWING with NAGOLD measurements were 2.4 ° and 1.9 °, with standard deviations of 2.9 ° and 2.7 °, respectively. Maximum observed differences were less than 7 °. The NAINCL and NASWING methods explained 74 % and 81 % of the variance in NAGOLD, respectively. SIGNIFICANCE The concurrent validity of two new neutral angle measurement methods provides alternative means to assess AFO alignment in the clinic.
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Affiliation(s)
- Andrew J Ries
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States.
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States; Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Tom F Novacheck
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States; Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Kathryn Walt
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States
| | - Jennifer Klein
- Gillette Children's Specialty Healthcare, St. Paul, MN, United States
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21
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van Duijnhoven E, Waterval NF, Koopman FS, Esquenazi A, Tyson S, Nollet F, Brehm MA. Ankle-foot orthoses for improving walking in people with calf muscle weakness due to neuromuscular disorders. Hippokratia 2021. [DOI: 10.1002/14651858.cd014871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elza van Duijnhoven
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Niels F Waterval
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Fieke Sophia Koopman
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Alberto Esquenazi
- Department of Rehabilitation Medicine; Jefferson University School of Medicine; Elkins Park PA USA
| | - Sarah Tyson
- Division of Nursing, Midwifery & Social Work; University of Manchester; Manchester UK
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
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22
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Abe D, Sakata S, Motoyama K, Toyota N, Nishizono H, Horiuchi M. Economical and preferred walking speed using body weight support apparatus with a spring-like characteristics. BMC Sports Sci Med Rehabil 2021; 13:107. [PMID: 34488873 PMCID: PMC8422757 DOI: 10.1186/s13102-021-00336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND A specific walking speed minimizing the U-shaped relationship between energy cost of transport per unit distance (CoT) and speed is called economical speed (ES). To investigate the effects of reduced body weight on the ES, we installed a body weight support (BWS) apparatus with a spring-like characteristics. We also examined whether the 'calculated' ES was equivalent to the 'preferred' walking speed (PWS) with 30% BWS. METHODS We measured oxygen uptake and carbon dioxide output to calculate CoT values at seven treadmill walking speeds (0.67-2.00 m s- 1) in 40 healthy young males under normal walking (NW) and BWS. The PWS was determined under both conditions on a different day. RESULTS A spring-like behavior of our BWS apparatus reduced the CoT values at 1.56, 1.78, and 2.00 m s- 1. The ES with BWS (1.61 ± 0.11 m s- 1) was faster than NW condition (1.39 ± 0.06 m s- 1). A Bland-Altman analysis indicated that there were no systematic biases between ES and PWS in both conditions. CONCLUSIONS The use of BWS apparatus with a spring-like behavior reduced the CoT values at faster walking speeds, resulting in the faster ES with 30% BWS compared to NW. Since the ES was equivalent to the PWS in both conditions, the PWS could be mainly determined by the metabolic minimization in healthy young males. This result also derives that the PWS can be a substitutable index of the individual ES in these populations.
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Affiliation(s)
- Daijiro Abe
- Center for Health and Sports Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi- ku, Fukuoka, 813-8503, Japan.
| | - Shunsuke Sakata
- Center for Health and Sports Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi- ku, Fukuoka, 813-8503, Japan.,Department of Management and Information, Faculty of Commerce, Yokohama College of Commerce, Yokohama, Kanagawa, Japan
| | - Kiyotaka Motoyama
- Center for Health and Sports Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi- ku, Fukuoka, 813-8503, Japan
| | - Naoki Toyota
- Center for Health and Sports Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi- ku, Fukuoka, 813-8503, Japan
| | - Hidetsugu Nishizono
- Center for Health and Sports Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higashi- ku, Fukuoka, 813-8503, Japan.,Department of Sport Science and Health, Faculty of Human Sciences, Kyushu Sangyo University, Fukuoka, Japan
| | - Masahiro Horiuchi
- Division of Human Environmental Science, Mt. Fuji Research Institute, Fujiyoshida, Yamanashi, Japan
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23
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Understanding the effects of quantitatively prescribing passive-dynamic ankle-foot orthosis bending stiffness for individuals after stroke. Prosthet Orthot Int 2021; 45:313-321. [PMID: 33840749 DOI: 10.1097/pxr.0000000000000012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 11/17/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Passive-dynamic ankle-foot orthosis (PD-AFO) bending stiffness, which assists plantar flexor function, can be prescribed to improve poststroke gait. However, outcomes with PD-AFOs are variable likely because of improper personalization. We implemented a prescription model that objectively personalizes PD-AFO bending stiffness based on each individual's level of plantar flexor weakness (quantitatively prescribed PD-AFO). OBJECTIVES To evaluate whether a quantitatively prescribed PD-AFO improves peak paretic plantar flexion moment compared with the original AFO for individuals after stroke and to examine the immediate effects of wearing a quantitatively prescribed PD-AFO. STUDY DESIGN This is a repeated-measures study. METHODS PD-AFO bending stiffness was personalized for 10 individuals after stroke through the previously developed prescription model. Participants underwent an instrumented gait analysis while wearing their original AFO and the quantitatively prescribed PD-AFO. RESULTS Participants' peak paretic plantar flexion moment significantly increased while wearing the quantitatively prescribed PD-AFO compared with the original AFO. In addition, participants showed different levels of improvements in a series of other key biomechanical and walking performance parameters with PD-AFO use. Some participants showed improvements in all parameters, whereas others showed moderate to no improvements. CONCLUSIONS Quantitatively prescribed PD-AFO bending stiffness resulted in inconsistent improvements in biomechanical and walking performance parameters, which warrants further investigation. Future work should investigate whether more consistent benefits are seen with faster walking speeds and longer-term PD-AFO use. In addition, future work should conduct larger-scale studies that aim to understand and optimize orthosis-patient matching for all AFO designs/characteristics.
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24
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Kerkum YL, Philippart W, Houdijk H. The effects of footplate stiffness on push-off power when walking with posterior leaf spring ankle-foot orthoses. Clin Biomech (Bristol, Avon) 2021; 88:105422. [PMID: 34271367 DOI: 10.1016/j.clinbiomech.2021.105422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many studies on ankle-foot orthoses investigated the optimal stiffness around the ankle, while the effect of footplate stiffness has been largely ignored. This study investigated the effects of ankle-foot orthosis footplate stiffness on ankle-foot push-off power during walking in able-bodied persons. METHODS Twelve healthy participants walked at a fixed speed (1.25 m·s-1) on an instrumented treadmill in four conditions: shod and with a posterior leaf-spring orthosis with a flexible, stiff or rigid footplate. For each trial, ankle kinematics and kinetics were averaged over one-minute walking. Separate contributions of the ankle joint complex and distal hindfoot to total ankle-foot power and work were calculated using a deformable foot model. FINDINGS Peak ankle joint power was significantly higher with the rigid footplate compared to the flexible and stiff footplate and not different from shod walking. The stiff footplate increased peak hindfoot power compared to the flexible and rigid footplate and shod walking. Total ankle-foot power showed a significant increase with increasing footplate stiffness, where walking with the rigid footplate was comparable to shod walking. Similar effects were found for positive mechanical work. INTERPRETATION A rigid footplate increases the lever of the foot, resulting in an increased ankle moment and energy storage and release of the orthosis' posterior leaf-spring as reflected in higher ankle joint power. This effect dominates the power generation of the foot, which was highest with the intermediate footplate stiffness. Future studies should focus on how tuning footplate stiffness could contribute to optimizing ankle-foot orthosis efficacy in clinical populations.
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Affiliation(s)
- Y L Kerkum
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium; Research and Development, OIM Orthopedie, Assen, the Netherlands.
| | - W Philippart
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H Houdijk
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, the Netherlands
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25
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Takeda I, Yasunaga W, Kobayashi S, Tagawa Y, Onodera H. Gait assist brace with double carbon fiber reinforced plastic spring blades to allow ankle joint movement and change in walking direction. Adv Robot 2021. [DOI: 10.1080/01691864.2021.1946422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Iwori Takeda
- Department of Mechanical Systems Engineering, School of Engineering, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Wataru Yasunaga
- Graduate School of Science and Engineering, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Mechanical Systems Engineering, Graduate School of Systems Design, Tokyo Metropolitan University, Hino, Tokyo, Japan
| | - Yusaku Tagawa
- Department of Mechanical Systems Engineering, School of Engineering, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Hiroshi Onodera
- Department of Mechanical Systems Engineering, School of Engineering, The University of Tokyo, Bunkyo, Tokyo, Japan
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26
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Waterval NFJ, Brehm MA, Harlaar J, Nollet F. Individual stiffness optimization of dorsal leaf spring ankle-foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations. J Neuroeng Rehabil 2021; 18:97. [PMID: 34103064 PMCID: PMC8186056 DOI: 10.1186/s12984-021-00890-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier's recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness. METHODS Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected. RESULTS In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (- 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s, p = 0.003). Additionally, a larger ankle range of motion (+ 1.3 ± 0.3 degrees, p < 0.001) and higher ankle power (+ 0.16 ± 0.04 W/kg, p < 0.001) were found with the experimentally optimized stiffness compared to the supplier recommended stiffness. CONCLUSIONS In people with calf muscle weakness, current supplier's recommendations for the CA7 stiffness level result in the provision of DLS-AFOs that are too stiff and only achieve 80% of the reduction in energy cost achieved with an individual optimized stiffness. It is recommended to experimentally optimize the CA7 stiffness in people with calf muscle weakness in order to maximize treatment outcomes. Trial registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170 .
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Affiliation(s)
- Niels F J Waterval
- Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Merel-Anne Brehm
- Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jaap Harlaar
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frans Nollet
- Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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27
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Theunissen K, Plasqui G, Boonen A, Brauwers B, Timmermans A, Meyns P, Meijer K, Feys P. The Relationship Between Walking Speed and the Energetic Cost of Walking in Persons With Multiple Sclerosis and Healthy Controls: A Systematic Review. Neurorehabil Neural Repair 2021; 35:486-500. [PMID: 33847188 PMCID: PMC8135251 DOI: 10.1177/15459683211005028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (pwMS) experience walking impairments, characterized by decreased walking speeds. In healthy subjects, the self-selected walking speed is the energetically most optimal. In pwMS, the energetically most optimal walking speed remains underexposed. Therefore, this review aimed to determine the relationship between walking speed and energetic cost of walking (Cw) in pwMS, compared with healthy subjects, thereby assessing the walking speed with the lowest energetic cost. As it is unclear whether the Cw in pwMS differs between overground and treadmill walking, as reported in healthy subjects, a second review aim was to compare both conditions. METHOD PubMed and Web of Science were systematically searched. Studies assessing pwMS, reporting walking speed (converted to meters per second), and reporting oxygen consumption were included. Study quality was assessed with a modified National Heart, Lung and Blood Institute checklist. The relationship between Cw and walking speed was calculated with a second-order polynomial function and compared between groups and conditions. RESULTS Twenty-nine studies were included (n = 1535 pwMS) of which 8 included healthy subjects (n = 179 healthy subjects). PwMS showed a similar energetically most optimal walking speed of 1.44 m/s with a Cw of 0.16, compared with 0.14 mL O2/kg/m in healthy subjects. The most optimal walking speed in treadmill was 1.48 m/s, compared with 1.28 m/s in overground walking with a similar Cw. CONCLUSION Overall, the Cw is elevated in pwMS but with a similar energetically most optimal walking speed, compared with healthy subjects. Treadmill walking showed a similar most optimal Cw but a higher speed, compared with overground walking.
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Affiliation(s)
- Kyra Theunissen
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands.,Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Care and Public Health Research Institute, The Netherlands.,Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Guy Plasqui
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, and Care and Public Health Research Institute, The Netherlands
| | - Bente Brauwers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Annick Timmermans
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Pieter Meyns
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, The Netherlands
| | - Peter Feys
- Rehabilitation Research Center, REVAL, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.,Universitair MS Centrum, Belgium
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Pourhoseingholi E, Kamali M, Saeedi H, Jalali M. The comparison of the effect of innovative designed storing-restoring hybrid passive AFO versus posterior leaf spring AFO on ankle joint kinematic in drop foot patients: A case series using a single subject design. Med J Islam Repub Iran 2021; 34:173. [PMID: 33816372 PMCID: PMC8004578 DOI: 10.47176/mjiri.34.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 11/15/2022] Open
Abstract
Background: Drop foot syndrome is a disorder characterized by foot slapping after the initial contact and foot-dragging during the swing phase. Passive and hybrid passive ankle foot orthoses (AFOs) are often prescribed in these patients; however, the effects of these AFO designs on kinematic parameters during gait are unclear. The aim of this study was to compare the effect of innovative designed storing-restoring hybrid passive AFOs versus posterior leaf spring AFO on ankle joint kinematics in drop foot patients.
Methods: The present study was a case series where a single case and 3 cases with drop foot syndrome were recruited. This study was designed in 2 phases: the baseline phase with their PLS AFOs and an intervention phase in which innovative designed AFO were assessed. Each phase included 5 measurement sessions which were performed in 5 consecutive weeks. The celeration line method was used to detect the significant differences between the phases.
Results: The results of this study showed a significant increase in the kinematic angles parameters at the initial contact, the loading response, the mid stance, terminal stance, pre swing, initial swing, mid swing, and terminal swing with the innovative designed AFO than with PLS AFO (p<0.05).
Conclusion: The results of the present study suggested that use of the innovative designed AFO may have a positive effect on ankle joint kinematics parameters in people with drop foot.
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Affiliation(s)
- Ensieh Pourhoseingholi
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kamali
- Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Saeedi
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Department of Orthotics & Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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29
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Jeon HM, Lee KK, Lee JY, Shin JH, Eom GM. Energy absorption at lower limb joints in different foot contact strategies while descending stairs. Technol Health Care 2021; 29:433-440. [PMID: 33682780 PMCID: PMC8150500 DOI: 10.3233/thc-218041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Joint loads in different walking strategies during stair descent have been investigated in terms of the joint moment in association with the risk of osteoarthritis. However, the absorption mechanisms of the potential energy loss are not known. OBJECTIVE: This study aims to compare the mechanical energy absorptions in lower limb joints in different initial foot contact strategies. METHODS: Nineteen young subjects walked down on instrumented stairs with two different strategies, i.e., forefoot and rearfoot strike. Power and energy at lower limb joints during stance phase were compared between strategies. RESULTS: Lower limb joints absorbed 73 ± 11% of the potential energy released by descending stairs and there was no difference between strategies. Rearfoot strategy absorbed less energy than forefoot strategy at the ankle joint in the 1st phase, which was compensated mainly by more energy absorption at the knee in the 2nd phase and less energy generation at the hip joints in the 3rd phase. CONCLUSION: The results suggest that a leg absorbs most of the potential energy while descending stairs irrespective of the walking strategies and that any reduction of energy absorption at one joint is compensated by other joints. Greater energy absorption at the knee joint compared to the other joints suggests high burden of knee joint muscles and connective tissues during stair-descent, which is even more significant for the rearfoot strike strategy.
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Affiliation(s)
| | - Ki-Kwang Lee
- Biomechanics and Sport Engineering Laboratory, Kookmin University, Seoul, Korea
| | - Jun-Young Lee
- Biomedical Engineering, Konkuk University, Choongju, Korea
| | - Ju-Hwan Shin
- Biomedical Engineering, Konkuk University, Choongju, Korea
| | - Gwang-Moon Eom
- Biomedical Engineering, Konkuk University, Choongju, Korea
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30
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Borghi C, Costi S, Formisano D, Neviani R, Pandarese D, Ferrari A. Effectiveness comparison between carbon spring and hinged ankle-foot orthoses in crouch gait treatment of children with diplegic cerebral palsy: a randomized crossover trial. Eur J Phys Rehabil Med 2021; 57:577-584. [PMID: 33619943 DOI: 10.23736/s1973-9087.21.06566-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with cerebral palsy (CP) often present a loss of effectiveness of the plantarflexors/knee-extensors couple that leads to crouch gait. When treating a child with crouch gait by means of ankle foot orthoses, preserving or restoring push off power is a key issue. AIM To compare carbon-fiber spring (Carbon Ankle Seven® = CAFO) and hinged anklefoot orthoses (HAFO) effectiveness in improving functionality and walking ability in children with diplegic CP and crouch gait. DESIGN Randomized crossover trial. SETTING Hospital center. POPULATION Ten children with diplegic CP and crouch gait, 5 males and 5 females, aged 11 (4) years. METHODS The gait of each child was evaluated by means of instrumental gait analysis with both CAFO and HAFO, in a randomized order and after a 4-week adaptation period. The primary outcome measure was the change in ankle power generation. As secondary outcome measures, knee joint kinematics, stride length, walking speed, Observational Gait Scale, and preferred orthosis were considered. RESULTS The median of the energy produced in stance was superior with CAFO (+2.2 J/kg, IQR 4.7, p=0.006), and the energy absorbed inferior (-3.3 J/kg, IQR 4.3, p=0.011). No statistically significant difference was found for any other parameter. Preference of the children was equally distributed between the two orthoses. CONCLUSIONS No evident superiority of CAFO with respect to HAFO was found in improving gait performance of children with CP and crouch gait. Nevertheless, the results suggest the possibility that CAFO permits an energy saving and reduction of the more compromising deficits. CLINICAL REHABILITATION IMPACT The final choice of the participants indicates that CAFOs are preferred by older and heavier children, but the preference does not correlate with the performance of the orthoses during gait.
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Affiliation(s)
- Corrado Borghi
- Motion Analysis Laboratory LAMBDA, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy -
| | - Stefania Costi
- Scientific Directorate, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Debora Formisano
- Clinical Governance, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rita Neviani
- Children Rehabilitation Specialized Unit - UDGEE, Santa Maria Nuova Hospital, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Pandarese
- Motion Analysis Laboratory LAMBDA, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Adriano Ferrari
- Motion Analysis Laboratory LAMBDA, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
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31
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A KH, Gh A, M A, M B, Z S, A B, M K. Design and Preliminary Evaluation of a New Ankle Foot Orthosis on Kinetics and Kinematics parameters for Multiple Sclerosis Patients. J Biomed Phys Eng 2020; 10:783-792. [PMID: 33364216 PMCID: PMC7753254 DOI: 10.31661/jbpe.v0i0.2007-1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
Background: The damage of the central nervous system due to Multiple Sclerosis (MS) leads to many walking disorders in this population. However, current ankle-foot orthoses prescribed for improving walking disorders for these patients are not clinically cost-efficient. Objective: This study aimed to design and fabricate a dynamic ankle foot orthosis and a new spring-damper joint mechanism that could adapt the walking problems of MS patients and evaluate the immediate effect of the new orthosis on the speed, range of motion, moment, total work and ground reaction force during walking. Material and Methods: In this case-series study, after the design and fabrication of a new orthosis, the kinetics and kinematics of walking of four patients with MS were assessed in a case series study. Results: Walking speed improved with the new orthosis in two participants. The sagittal range of motion (ROM) increased for most of the participants. The sagittal moments increased for hip, knee and ankle joints in most of the measurements. The total joint work showed noticeable difference in the ankle joint. The increased values of vertical component of the ground reaction force (VGRF) were negligible and the increase in the impulse of VGRF was noticeable for only one participant. Conclusion: The new orthosis had positive effects kinetic and kinematic parameters of walking such as the increased velocity by two subjects and also a more normal sagittal ROM, moment and work, suggesting the potential usefulness of the new orthotic device for MS population.
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Affiliation(s)
- Keyvani Hafshejani A
- PhD Candidate, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Aminian Gh
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Azimian M
- MD, MS Clinic, Rofeideh Hospital, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahramizadeh M
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Safaeepour Z
- PhD, Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Biglarian A
- PhD, Department of Biostatistics and Epidemiology, Social Determinants of Health Research Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Keivani M
- MD, Department of Radiology, Shahrekord Univer-sity of Medical Sciences, Shahrekord, Iran
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32
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Ploeger HE, Bus SA, Brehm MA, Nollet F. Use and usability of custom-made dorsiflexion-restricting ankle-foot orthoses for calf muscle weakness in polio survivors: a cross-sectional survey. Eur J Phys Rehabil Med 2020; 56:575-584. [DOI: 10.23736/s1973-9087.20.06020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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33
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Waterval NFJ, Brehm MA, Altmann VC, Koopman FS, Den Boer JJ, Harlaar J, Nollet F. Stiffness-Optimized Ankle-Foot Orthoses Improve Walking Energy Cost Compared to Conventional Orthoses in Neuromuscular Disorders: A Prospective Uncontrolled Intervention Study. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2296-2304. [DOI: 10.1109/tnsre.2020.3018786] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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34
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Smith AD, Prokopiusova T, Jones R, Burge T, Rasova K. Functional electrical stimulation for foot drop in people with multiple sclerosis: The relevance and importance of addressing quality of movement. Mult Scler 2020; 27:653-660. [PMID: 32833562 DOI: 10.1177/1352458520923958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Impaired mobility is common in people with multiple sclerosis (MS). Changes in gait have different causes and require individualised gait rehabilitation. A common and often early cause of mobility impairment is footdrop, inability to lift the foot during the swing phase of gait, with increased risk of falls, effortful walking and fatigue. Using literature review, we have characterised published data on footdrop treatment in MS, specifically functional electrical stimulation (FES) to better understand the reported outcomes relevant to the user. We discuss the strengths and weaknesses of FES and how far it meets the needs of people with footdrop. Physiotherapy combined with FES may further enhance the benefits of FES. MS studies emphasise the value of maintaining activity levels in early MS but discussion on how to achieve this is lacking. We emphasise the value of qualitative measures to broaden our understanding and improve treatment and adherence and identify areas for further research. Supplementary video material illustrates key features of MS gait and its correction using FES and physiotherapy.
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Affiliation(s)
| | - Terezie Prokopiusova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Rosemary Jones
- The Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Tania Burge
- The Brain Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Kamila Rasova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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35
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Daryabor A, Yamamoto S, Orendurff M, Kobayashi T. Effect of types of ankle-foot orthoses on energy expenditure metrics during walking in individuals with stroke: a systematic review. Disabil Rehabil 2020; 44:166-176. [DOI: 10.1080/09638288.2020.1762767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- International University of Health and Welfare, Tokyo, Japan
| | - Sumiko Yamamoto
- International University of Health and Welfare, Tokyo, Japan
| | | | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, China
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36
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A D, M A, G A, M B, S Y. Design and Evaluation of an Articulated Ankle Foot Orthosis with Plantarflexion Resistance on the Gait: a Case Series of 2 Patients with Hemiplegia. J Biomed Phys Eng 2020; 10:119-128. [PMID: 32158719 PMCID: PMC7036417 DOI: 10.31661/jbpe.v0i0.1159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 03/15/2019] [Indexed: 06/10/2023]
Abstract
Ankle-foot orthoses (AFOs) have been described to have positive effects on the gait biomechanics in stroke patients. The plantarflexion resistance of an AFO is considered important for hemiplegic patients, but the evidence is still limited. The purpose of this case series was to design and evaluate the immediate effect of an articulated AFO on kinematics and kinetics of lower-limb joints in stroke patients. The articulated AFO with the adjustment of plantarflexion resistance was designed. The spring generates a plantarflexion resistance of the ankle joint at initial stance phase. The efficacy of orthosis was evaluated on two stroke patients in 2 conditions: without an AFO and with the AFO. Results showed the immediate improvements for walking speed, stride length and angular changes of dorsiflexion of the paretic ankle joint during a gait cycle of both subjects using the AFO compared with barefoot walking. The AFO also was able to reduce the paretic knee extension in the single-support phase of the stance and increase the vertical COM displacement during stance phase on the affected leg. In conclusion, the designed AFO affect not only the movement of the ankle joint but also the movements of the knee joint and the vertical COM height. These changes indicate improvement of the first and the second rockers and swing phase gait but not third rocker function. Further investigation is recently underway to compare its effect compared with other AFOs on the gait parameters of hemiplegic patients.
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Affiliation(s)
- Daryabor A
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- PhD, Researcher in International University of Health and Welfare, Japan, Tokyo
| | - Arazpour M
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Aminian G
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Baniasad M
- PhD, Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Yamamoto S
- PhD, International University of Health and Welfare, Tokyo, Japan
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Haufe FL, Wolf P, Riener R, Grimmer M. Biomechanical effects of passive hip springs during walking. J Biomech 2020; 98:109432. [PMID: 31662197 DOI: 10.1016/j.jbiomech.2019.109432] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/27/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022]
Abstract
Passive spring-like structures can store and return energy during cyclic movements and thereby reduce the energetic cost of locomotion. That makes them important components of the human body and wearable assistive devices alike. This study investigates how springs placed anteriorly across the hip joint affect leg joint angles and powers, and leg muscle activities during level walking at 0.5 to 2.1 m/s. We hypothesized that the anterior hip springs (I) load hip extension, (II) support hip flexion and (III) affect ankle muscle activity and dynamics during walking. Effects at the ankle were expected because hip and ankle redistribute segmental power in concert to achieve forward progression. We observed that the participants' contribution to hip power did not increase during hip extension as the spring stored energy. Simultaneously, the activities of plantarflexor muscles that modulate energy storage in the Achilles tendon were reduced by 28% (gastrocnemius medialis) and 9% (soleus). As the spring returned energy with the onset of hip flexion, the participants' contribution to hip power was reduced by as much as 23%. Soleus activity before push-off increased by up to 9%. Instead of loading hip extension, anterior hip springs seem to store and return parts of the energy normally exchanged with the Achilles tendon. Thereby, the springs support hip flexion but may reduce elastic energy storage in and hence recoil from the Achilles tendon. This interaction should be considered during the design and simulation of wearable assistive devices as it might - depending on user characteristics - enhance or diminish their overall functionality.
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Affiliation(s)
- Florian L Haufe
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Switzerland.
| | - Peter Wolf
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), ETH Zurich, Switzerland; Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Switzerland
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Modifying ankle foot orthosis stiffness in patients with calf muscle weakness: gait responses on group and individual level. J Neuroeng Rehabil 2019; 16:120. [PMID: 31623670 PMCID: PMC6798503 DOI: 10.1186/s12984-019-0600-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/24/2019] [Indexed: 01/31/2023] Open
Abstract
Background To improve gait, persons with calf muscle weakness can be provided with a dorsal leaf spring ankle foot orthosis (DLS-AFO). These AFOs can store energy during stance and return this energy during push-off, which, in turn, reduces walking energy cost. Simulations indicate that the effect of the DLS-AFO on walking energy cost and gait biomechanics depends on its stiffness and on patient characteristics. We therefore studied the effect of varying DLS-AFO stiffness on reducing walking energy cost, and improving gait biomechanics and AFO generated power in persons with non-spastic calf muscle weakness, and whether the optimal AFO stiffness for maximally reducing walking energy cost varies between persons. Methods Thirty-seven individuals with neuromuscular disorders and non-spastic calf muscle weakness were included. Participants were provided with a DLS-AFO of which the stiffness could be varied. For 5 stiffness configurations (ranging from 2.8 to 6.6 Nm/degree), walking energy cost (J/kg/m) was assessed using a 6-min comfortable walk test. Selected gait parameters, e.g. maximal dorsiflexion angle, ankle power, knee angle, knee moment and AFO generated power, were derived from 3D gait analysis. Results On group level, no significant effect of DLS-AFO stiffness on reducing walking energy cost was found (p = 0.059, largest difference: 0.14 J/kg/m). The AFO stiffness that reduced energy cost the most varied between persons. The difference in energy cost between the least and most efficient AFO stiffness was on average 10.7%. Regarding gait biomechanics, increasing AFO stiffness significantly decreased maximal ankle dorsiflexion angle (− 1.1 ± 0.1 degrees per 1 Nm/degree, p < 0.001) and peak ankle power (− 0.09 ± 0.01 W/kg, p < 0.001). The reduction in minimal knee angle (− 0.3 ± 0.1 degrees, p = 0.034), and increment in external knee extension moment in stance (− 0.01 ± 0.01 Nm/kg, p = 0.016) were small, although all stiffness’ substantially affected knee angle and knee moment compared to shoes only. No effect of stiffness on AFO generated power was found (p = 0.900). Conclusions The optimal efficient DLS-AFO stiffness varied largely between persons with non-spastic calf muscle weakness. Results indicate this is caused by an individual trade-off between ankle angle and ankle power affected differently by AFO stiffness. We therefore recommend that the AFO stiffness should be individually optimized to best improve gait. Trial registration number Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170
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Sankaranarayan H, Gupta A, Khanna M, Taly AB, Thennarasu K. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study. J Neurosci Rural Pract 2019; 7:544-549. [PMID: 27695234 PMCID: PMC5006466 DOI: 10.4103/0976-3147.185507] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To study role of ankle foot orthosis (AFO) in improving locomotion and functional recovery after stroke. Setting: Neurological Rehabilitation Department of a university research tertiary hospital. Patients and Methods: AFO and activity based rehabilitation. Main Outcome Measures: Distance (meters) covered during the 6-minute walk test (6MWT) and speed (meter/second) during the 10-meter walk test. Functional abilities assessed using Functional Independence Measure (FIM®). Results: Twenty-six patients (21 male) with stroke (mean duration 196.7 days, range 45–360 days) and mean age of 41.6 years (range 18–65 years, standard deviation [SD] 12.5) were included. Fourteen had right hemiplegia. The mean length of stay in the unit was 26.5 days (range 18–45 days, SD 5.5). All patients had equinus deformity with spastic foot drop and were provided with AFO. Walking endurance with 6MWT was 90 m on admission (without AFO). At discharge, it improved to 174 m with AFO and 121 m without AFOs (P < 0.001-with and without AFO at discharge). Walking speed improved from 0.4 m/s (admission) to 0.51 m/s with AFO, P = 0.004 and 0.45 m/s without AFO, P = 0.015) at discharge. Nine patients (34.6%) had clinically important difference-minimal clinically important difference (>0.16 m/s speed gain; >50 m endurance gain) at discharge. The mean FIM® score on admission was 84.3 ± 18.6. At discharge FIM® improved to 101.9 ± 13.7 (P < 0.001). Conclusions: Use of AFOs improve gait parameters significantly in only one-third stroke patients in the study when combined with activity-based inpatient-rehabilitation.
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Affiliation(s)
- H Sankaranarayan
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Arun B Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India; Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Ploeger HE, Waterval NFJ, Nollet F, Bus SA, Brehm MA. Stiffness modification of two ankle-foot orthosis types to optimize gait in individuals with non-spastic calf muscle weakness - a proof-of-concept study. J Foot Ankle Res 2019; 12:41. [PMID: 31406508 PMCID: PMC6686412 DOI: 10.1186/s13047-019-0348-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022] Open
Abstract
Background To reduce gait problems in individuals with non-spastic calf muscle weakness, spring-like ankle-foot orthoses (AFOs) are often applied, but they are not individually optimized to treatment outcome. The aim of this proof-of-concept study was to evaluate the effects of modifying the stiffness for two spring-like AFO types with shoes-only as reference on gait outcomes in three individuals with calf muscle weakness due to polio. Methods We assessed 3D gait biomechanics, walking speed and walking energy cost for shoes-only and five stiffness conditions of a dorsal-leaf-spring AFO and a spring-hinged AFO. Outcomes were compared between stiffness conditions in the two AFOs and three subjects. Results Maximum ankle dorsiflexion angle decreased with increasing stiffness in both AFOs (up to 6–8°) and all subjects. Maximum knee extension angle changed little between stiffness conditions, however different responses between the AFOs and subjects were observed compared to shoes-only. Walking speed remained unchanged across conditions. For walking energy cost, we found fairly large differences across stiffness conditions with both AFOs and between subjects (range 3–15%). Conclusions Modifying AFO stiffness in individuals with non-spastic calf muscle weakness resulted in substantial differences in ankle biomechanics and walking energy cost with no effect on speed. Our results provide proof-of-concept that individually optimizing AFO stiffness can clinically beneficially improve gait performance. Electronic supplementary material The online version of this article (10.1186/s13047-019-0348-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hilde E Ploeger
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Niels F J Waterval
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands
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Vasiliauskaite E, Ielapi A, De Beule M, Van Paepegem W, Deckers JP, Vermandel M, Forward M, Plasschaert F. A study on the efficacy of AFO stiffness prescriptions. Disabil Rehabil Assist Technol 2019; 16:27-39. [PMID: 31226898 DOI: 10.1080/17483107.2019.1629114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Ankle foot orthosis (AFO) stiffness is a key characteristic that determines how much support or restraint an AFO can provide. Thus, the goal of the current study is twofold: (1) to quantify AFO prescriptions for a group of patients; (2) to evaluate what impact these AFO have on the push-off phase. METHOD Six patients were included in the study. Three patients were prescribed an AFO for ankle support and three patients were prescribed an AFO for ankle and knee support. Two types of AFO - a traditional polypropylene AFO (AFOPP) and a novel carbon-selective laser sintered polyamide AFO (AFOPA), were produced for each patient. AFO ankle stiffness was measured in a dedicated test rig. Gait analysis was performed under shod and orthotic conditions. RESULTS Patient mass normalized AFOPP stiffness for ankle support ranged from 0.042 to 0.069 N·m·deg-1·kg-1, while for ankle and knee support it ranged from 0.081 to 0.127 N·m·deg-1·kg-1. On the group level, the ankle range of motion and mean ankle velocity in the push-off phase significantly decreased in both orthotic conditions, while peak ankle push-off power decreased non-significantly. Accordingly, on the group level, no significant improvements in walking speed were observed. However, after patient differentiation into good and bad responders it was found that in good responders peak ankle push-off power tended to be preserved and walking speed tended to increase. CONCLUSIONS Quantification of AFO stiffness may help to understand why certain orthotic interventions are successful (unsuccessful) and ultimately lead to better AFO prescriptions. Implications for rehabilitation AFO ankle stiffness is key characteristic that determines how much support or restraint an AFO can provide. In a typical clinical setting, AFO ankle stiffness is not quantified. AFO has to meet individual patient's biomechanical needs. More objective AFO prescription and more controlled AFO production methods are needed to increase AFO success rate.
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Affiliation(s)
- Egle Vasiliauskaite
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium.,Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Alessio Ielapi
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Matthieu De Beule
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Wim Van Paepegem
- Department of Materials Science and Engineering, Ghent University, Ghent, Belgium
| | | | | | - Malcolm Forward
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium.,Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Frank Plasschaert
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
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Ielapi A, Lammens N, Van Paepegem W, Forward M, Deckers JP, Vermandel M, De Beule M. A validated computational framework to evaluate the stiffness of 3D printed ankle foot orthoses. Comput Methods Biomech Biomed Engin 2019; 22:880-887. [PMID: 30958030 DOI: 10.1080/10255842.2019.1601712] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to create and validate a standardized framework for the evaluation of the ankle stiffness of two designs of 3D printed ankle foot orthoses (AFOs). The creation of four finite element (FE) models allowed patient-specific quantification of the stiffness and stress distribution over their specific range of motion during the second rocker of the gait. Validation was performed by comparing the model outputs with the results obtained from a dedicated experimental setup, which showed an overall good agreement with a maximum relative error of 10.38% in plantarflexion and 10.66% in dorsiflexion. The combination of advanced computer modelling algorithms and 3D printing techniques clearly shows potential to further improve the manufacturing process of AFOs.
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Affiliation(s)
- Alessio Ielapi
- a Department of Electronics and Information Systems , Institute Biomedical Technology (IBiTech) - bioMMeda, Ghent University , Gent , Belgium.,b SIM vzw , Zwijnaarde , Belgium
| | - Nicolas Lammens
- c Belgian company, Siemens Industry Software N.V , Leuven , Belgium.,d Department of Materials Science & Engineering , Ghent University , Zwijnaarde , Belgium
| | - Wim Van Paepegem
- d Department of Materials Science & Engineering , Ghent University , Zwijnaarde , Belgium
| | - Malcolm Forward
- e Gait & Movement Analysis Laboratory - Cerebral Palsy Reference Centrum , University Hospital Ghent , Gent , Belgium
| | | | | | - Matthieu De Beule
- a Department of Electronics and Information Systems , Institute Biomedical Technology (IBiTech) - bioMMeda, Ghent University , Gent , Belgium
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Yandell MB, Tacca JR, Zelik KE. Design of a Low Profile, Unpowered Ankle Exoskeleton That Fits Under Clothes: Overcoming Practical Barriers to Widespread Societal Adoption. IEEE Trans Neural Syst Rehabil Eng 2019; 27:712-723. [PMID: 30872237 PMCID: PMC6592282 DOI: 10.1109/tnsre.2019.2904924] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Here, we present the design of a novel unpowered ankle exoskeleton that is low profile, lightweight, quiet, and low cost to manufacture, intrinsically adapts to different walking speeds, and does not restrict non-sagittal joint motion; while still providing assistive ankle torque that can reduce demands on the biological calf musculature. This paper is an extension of the previously-successful ankle exoskeleton concept by Collins, Wiggin, and Sawicki. We created a device that blends the torque assistance of the prior exoskeleton with the form-factor benefits of clothing. Our design integrates a low profile under-the-foot clutch and a soft conformal shank interface, coupled by an ankle assistance spring that operates in parallel with the user's calf muscles. We fabricated and characterized technical performance of a prototype through benchtop testing and then validated device functionality in two gait analysis case studies. To our knowledge, this is the first ankle plantarflexion assistance exoskeleton that could be feasibly worn under typical daily clothing, without restricting ankle motion, and without components protruding substantially from the shoe, leg, waist, or back. Our new design highlights the potential for performance-enhancing exoskeletons that are inexpensive, unobtrusive, and can be used on a wide scale to benefit a broad range of individuals throughout society, such as the elderly, individuals with impaired plantarflexor muscle strength, or recreational users. In summary, this paper demonstrates how an unpowered ankle exoskeleton could be redesigned to more seamlessly integrate into daily life, while still providing performance benefits for common locomotion tasks.
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Itokazu M. Effect of ankle-foot orthosis with a built-in spring on muscle activity during the sit-to-stand movement in healthy individuals. J Phys Ther Sci 2019; 31:287-290. [PMID: 30936647 PMCID: PMC6428643 DOI: 10.1589/jpts.31.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to evaluate the influence of a newly developed ankle-foot
orthosis with a built-in spring on the activity of lower limb muscles during the
sit-to-stand movement. [Participants and Methods] This cross-sectional study recruited 20
male volunteers. The sit-to-stand movement (rising from a chair) was performed under three
conditions: no ankle-foot orthosis (NA), ankle-foot orthosis with no spring (NS), and
ankle-foot orthosis with a built-in spring (SP). Muscle activity during the sit-to-stand
movement was measured using surface electrodes placed on the vastus medialis, tibialis
anterior, medial gastrocnemius, and soleus muscles. Root mean square and integral value
were calculated from the raw data, and statistical analysis was performed using SPSS
version 24.0. [Results] The electromyography data of the vastus medialis, medial
gastrocnemius, and soleus muscles showed a significant decrease in muscle activity in the
SP condition, whereas the activity of the tibialis anterior muscle increased significantly
in the SP condition compared to that in the NA and NS conditions. [Conclusion] Our data
showed that the use of an ankle-foot orthosis with a built-in spring affected not only the
muscle activity at the ankle joint but also the activity of the knee joint extensor
muscle. It is possible that the control of the ankle joint motion affects movement above
the knee joint; this finding may help development new physical therapy techniques. Further
research is warranted in this regard.
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Affiliation(s)
- Masafumi Itokazu
- Department of Physical Therapy, School of Health Science at Narita, International University of Health and Welfare: 4-3 Kouzunomori, Narita City, Chiba 286-8686, Japan
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Heine M, Richards R, Geurtz B, Los F, Rietberg M, Harlaar J, Gerrits K, Beckerman H, de Groot V. Preliminary effectiveness of a sequential exercise intervention on gait function in ambulant patients with multiple sclerosis - A pilot study. Clin Biomech (Bristol, Avon) 2019; 62:1-6. [PMID: 30614444 DOI: 10.1016/j.clinbiomech.2018.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 10/16/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with multiple sclerosis (pwMS) often experience a decline in motor function and performance during prolonged walking, which potentially is associated with reduced ankle push-off power and might be alleviated through structured exercise. The objectives of this pilot study were to assess ankle push-off power and walking performance in pwMS and healthy controls, and the preliminary effectiveness of a sequential exercise program (resistance training followed by walking-specific endurance training) on ankle push-off power and walking performance. METHODS PwMS (N = 10) with self-reported reduced walking performance and healthy controls (N = 10; at baseline only) underwent 3D gait analysis during a self-paced 12-minute walking test to assess walking performance prior to and following a sequential exercise program. Secondary testing paradigms comprised isometric muscle testing (triceps surae), cardiopulmonary exercise testing and self-report measures. FINDINGS PwMS had a shorter 12-minute walking distance, and lower peak ankle push-off power (most-affected leg) in comparison to healthy controls. There was no minute-to-minute decline in walking performance. The 8-week resistance training significantly improved walking distance. In parallel, higher peak and speed-normalized ankle push-off power were found in the less-affected side. No additional changes were found following the walking-specific endurance training phase. INTERPRETATION There was no walking-related motor fatigue found during a self-paced 12-minute walking test despite reduced ankle push-off power, and self-reported walking problems. Preliminary effects suggest a positive effect of resistance training on walking performance, potentially associated with increases in ankle push-off power, interestingly, in the less-affected leg. The added effect of the walking-specific endurance training remains unclear.
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Affiliation(s)
- Martin Heine
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands.
| | - Rosie Richards
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Bibi Geurtz
- Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Felicia Los
- Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Marc Rietberg
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Karin Gerrits
- Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Heleen Beckerman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - Vincent de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, MS Center Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
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Lefeber N, De Buyzer S, Dassen N, De Keersmaecker E, Kerckhofs E, Swinnen E. Energy consumption and cost during walking with different modalities of assistance after stroke: a systematic review and meta-analysis. Disabil Rehabil 2019; 42:1650-1666. [DOI: 10.1080/09638288.2018.1531943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Nina Lefeber
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sam De Buyzer
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikkie Dassen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emma De Keersmaecker
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research—Neurological Rehabilitation research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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Altschuck N, Bauer C, Nehring I, Böhm H, Jakobeit M, Schröder AS, Mall V, Jung NH. Efficacy of prefabricated carbon-composite ankle foot orthoses for children with unilateral spastic cerebral palsy exhibiting a drop foot pattern. J Pediatr Rehabil Med 2019; 12:171-180. [PMID: 31227662 DOI: 10.3233/prm-170524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study aims to evaluate the effectiveness of a prefabricated carbon-composite ankle foot orthoses (c-AFOs) on gait parameters in children with unilateral spastic cerebral palsy (USCP) exhibiting a drop foot pattern. METHODS Sixteen ambulatory children with USCP and a drop foot pattern were included (mean age: 9 years; gross motor function classification system: I = 14, II = 2) and three-dimensional gait analysis was applied under randomly assigned conditions (barefoot; shoe; c-AFO). Kinematics, kinetics, time-distance parameters and gait indices were investigated. RESULTS Effects on the drop foot pattern were investigated while the children walked in shoes only. The shoes already increased the maximum ankle dorsiflexion in swing (p= 0.004) and initiated more knee flexion during single support (p⩽ 0.013). Compared to shoe walking, the c-AFO led to additional benefits regarding further ankle dorsiflexion during swing (p⩽ 0.001) and initial contact (p< 0.001), ankle movement during loading response (p= 0.002), improved the sole angle during initial contact (p< 0.001) and during mid stance (p= 0.015). Plantarflexion and ankle power generation during push-off decreased when wearing the c-AFO (p⩽ 0.008). CONCLUSION Investigated c-AFOs are beneficial for improving drop foot patterns in children with USCP. Significant effects on pathological barefoot pattern were already achieved with the child's regular shoes. This could be considered in clinical decision processes. In comparison to shoe walking, c-AFO additionally improved foot clearance and normalized initial heel contact. The third rocker deteriorates with the c-AFO. Since kinematics improved with the orthoses during swing and early stance phase, c-AFOs might reduce tripping and falling caused by a drop foot during long distance walking.
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Affiliation(s)
- Natalie Altschuck
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany
| | | | - Ina Nehring
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany
| | - Harald Böhm
- Behandlungszentrum Aschau, Aschau im Chiemgau, Germany
| | | | - A Sebastian Schröder
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Center of Vertigo and Balance Disorders, IFBLMU, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Volker Mall
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany.,kbo-Kinderzentrum München, Munich, Germany
| | - Nikolai H Jung
- School of Medicine, Social Pediatrics, Technical University of Munich, Munich, Germany.,kbo-Kinderzentrum München, Munich, Germany
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Chen J, Hu J, Leung AKL, Chen C, Zhang J, Zhang Y, Zhu Y, Han J. Shape Memory Ankle-Foot Orthoses. ACS APPLIED MATERIALS & INTERFACES 2018; 10:32935-32941. [PMID: 30221507 DOI: 10.1021/acsami.8b08851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Electrically actuated ankle-foot orthoses (AFOs) were designed and prototyped using shape memory textile composites. Acrylic copolymers were synthesized as the matrix to demonstrate shape memory effects, whereas electrothermal fabrics were embedded to generate uniform heat as a trigger. Superior to conventional polymeric orthoses, shape memory AFOs (SM-AFOs) could be repeatedly programmed at least 20 times with stable shape fixity and recovery. Evidenced by clinical practice, SM-AFOs were effectively actuated at 10 V, allowing the correction of ankle angles with 10° plantarflexion. Ultimately, we envision a smart orthopedic system that can advance progressive rehabilitation with manipulation under safe and convenient conditions.
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Ferreira LAB, Cimolin V, Neto HP, Grecco LAC, Lazzari RD, Dumont AJL, Galli M, Oliveira CS. Effect of postural insoles on gait pattern in individuals with hemiparesis: A randomized controlled clinical trial. J Bodyw Mov Ther 2018; 22:792-797. [PMID: 30100314 DOI: 10.1016/j.jbmt.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Recovering the ability to walk is an important goal of physical therapy for patients who have survived cerebrovascular accident (stroke). Orthotics can provide a reduction in plantar flexion of the ankle, leading to greater stability in the stance phase of the gait cycle. Postural insoles can be used to reorganize the tone of muscle chains, which exerts an influence on postural control through correction reflexes. The aim of the present study was to perform kinematic and spatiotemporal analyses of gait in stroke survivors with hemiparesis during postural insole usage. MATERIAL AND METHODS Twenty stroke victims were randomly divided into two groups: 12 in the experimental group, who used insoles with corrective elements specifically designed for equinovarus foot, and eight in the control group, who used placebo insoles with no corrective elements. Both groups were also submitted to conventional physical therapy. The subjects were analyzed immediately following insole placement and after three months of insole usage. The SMART-D 140® system (BTS Engineering) with eight cameras sensitive to infrared light and the 32-channel SMART-D INTEGRATED WORKSTATION® were used for the three-dimensional gait evaluation. RESULTS Significant improvements were found in kinematic range of movement in the ankle and knee as well as gains in ankle dorsiflexion and knee flexion in the experimental group in comparison to the control group after three months of using the insoles. CONCLUSION Postural insoles offer significant benefits to stroke survivors regarding the kinematics of gait, as evidenced by gains in ankle dorsiflexion and knee flexion after three months of usage in combination with conventional physical therapy.
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Affiliation(s)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | | | | | | | | | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy; IRCCS "San Raffaele Pisana", San Raffaele SpA, Roma, Italy
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Swinnen E, Lefeber N, Werbrouck A, Gesthuizen Y, Ceulemans L, Christiaens S, De Wael L, Buyl R, Ilsbroukx S, Van Nieuwenhoven J, Michielsen M, Lafosse C, Kerckhofs E. Male and female opinions about orthotic devices of the lower limb: A multicentre, observational study in patients with central neurological movement disorders. NeuroRehabilitation 2018; 42:121-130. [PMID: 29400677 DOI: 10.3233/nre-172214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Because user-satisfaction and acceptance may partly determine the grade of compliance to an orthotic device (OD), the aim of this multicentre observational study was to inquire the reasons for acceptance and the user-satisfaction of an OD of the lower limb in male and female central neurological movement disorders (CNMD) patients. METHODS Persons with CNMD having at least one prescribed OD of the lower limb were included. Two questionnaires were used: the MIRAD-ACCORT-II (reasons for acceptance) and a modified version of the D-QUEST 2.0 (user-satisfaction). Descriptive analyses were performed and to analyse the differences between the males' and females' answers Chi2- and Mann-Whitney U tests were used. RESULTS Twenty-six stroke and 23 multiple sclerosis patients participated (53% males). "Comfort", "safety", "effectiveness" and "ease of use" were reported as most important aspects. 86% of the patients were (very) satisfied about their OD. Only for the aspect safety, compared to males, significant more females reported that if the OD is not safe enough they will not use it. CONCLUSION For both, males and females, aspects related to comfort and functionality were reported as much more important than the esthetical aspects, and in general they are quite satisfied with the OD and the process of providing the OD. Orthopaedic technicians and health care providers can take these aspects into account when developing, constructing and providing OD's.
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Affiliation(s)
- Eva Swinnen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nina Lefeber
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Amber Werbrouck
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yelena Gesthuizen
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Ceulemans
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Sofie Christiaens
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lise De Wael
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronald Buyl
- Faculty of Medicine and Pharmacy, Department of Biostatistics and Medical Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Marc Michielsen
- Sint Ursula Rehabilitation Center, Jessa Hospital, Herk-de-Stad, Belgium
| | | | - Eric Kerckhofs
- Faculty of Physical Education and Physiotherapy, Rehabilitation Research- Neurological Rehabilitation (RERE-NEURO), Vrije Universiteit Brussel, Brussels, Belgium.,C4N, Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.,BRUBOTICS, Brussels Human Robotics Research Center, Vrije Universiteit Brussel, Brussels, Belgium
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