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Gardner S, Frecklington M, Rose K, Carroll MR. Changes in functional outcomes in people with high-energy ankle trauma after the use of the ReAktiv Posterior Dynamic Element™ orthosis and a rehabilitation program: A case series. Prosthet Orthot Int 2024; 48:368-371. [PMID: 39140760 PMCID: PMC11323753 DOI: 10.1097/pxr.0000000000000291] [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: 12/02/2022] [Revised: 05/07/2023] [Accepted: 07/20/2023] [Indexed: 08/15/2024]
Abstract
The aim of this study was to examine lower-limb function in 2 patients that received a ReAktiv Posterior Dynamic Element™ (PDE) orthosis and 6-week rehabilitation program after a high-energy trauma injury to the lower limb. Lower-limb function was assessed using the lower extremity functional score, walking performance through the 2-minute walk test, and dynamic mobility and balance through the single-leg balance, timed stair ascent, and the 4-square step test. A 6-week physiotherapy-led rehabilitation program was also implemented. Data showed improvements in lower extremity function, walking performance, mobility, and balance measures after 8 weeks of wearing the ReAktiv PDE™ orthosis and completion of the rehabilitation program. The ReAktiv PDE™ orthosis combined with a lower-limb rehabilitation program shows potential as a treatment option to improve lower-limb function and walking performance and return sufferers of high-energy trauma injury to functional levels seen in healthy cohorts.
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Affiliation(s)
- Sarah Gardner
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Mike Frecklington
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | - Matthew R. Carroll
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Williamson JN, Grunst MM, Lynn J, Williamson GA, Blanck RV, Wilken JM. Predictors of long-term pain and function in individuals who received a custom dynamic orthosis and device-centric care pathway. Prosthet Orthot Int 2024; 48:372-379. [PMID: 37934175 DOI: 10.1097/pxr.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/20/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Carbon fiber custom dynamic orthoses (CDOs) have been shown to effectively reduce pain and improve function in military service members with lower-limb impairment, but data are limited for civilians. OBJECTIVES To evaluate the long-term outcomes of individuals who completed a CDO-centric care pathway in a civilian clinic by comparing baseline pain, mobility, and function with outcomes at long-term follow-up. To identify baseline characteristics and postintervention outcomes predictive of outcomes at long-term follow-up. METHODS Records of 131 adult patients who received a CDO and CDO-centric training were reviewed. Patient-reported measures of pain and physical function and timed assessment of walking and agility collected during routine clinical care were extracted. These patients were contacted on average 4 (±1) years postintervention to complete a survey including measures of pain and physical function. RESULTS The 63 participants who responded reported improved or greatly improved function, maximum pain, and typical pain on average, irrespective of age or sex ( P < 0.001). Change in function from baseline to long-term follow-up was predicted by short-term change in function (35.1% of the variance; P < 0.001). Change in pain from baseline to long-term follow-up was predicted by baseline typical pain and change in four square step test time (63% of variance; P < 0.001). CONCLUSIONS Most survey respondents reported positive outcomes. Long-term pain reduction and improved function were predicted by baseline status and by short-term changes associated with receiving a CDO and completing an intensive training program.
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Affiliation(s)
- Jared N Williamson
- Health Sciences Program, Rocky Mountain University of Health Professions, Provo, UT
| | - Megan M Grunst
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA
| | - Jeffrey Lynn
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA
| | | | | | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA
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Highsmith MJ, Miro RM, Kartel M, Ramrattan A, Courtade A, Heckman JT, Phillips SL, Wurdeman SR, DiBello TV, England DL, Stevens PM, Campbell JH, Hyre MJ, Maikos JT, Hill OT, Carey SL. Functional and perceptive differences between conventional and advanced ankle foot orthoses in community ambulators post-limb trauma: the injuries managed with advanced bracing of the lower extremity (IM ABLE) study. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1277509. [PMID: 39011087 PMCID: PMC11246986 DOI: 10.3389/fresc.2024.1277509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/15/2024] [Indexed: 07/17/2024]
Abstract
Introduction Many military service members and civilians suffer from lower extremity trauma. Despite recent advancements in lower limb bracing technology, it remains unclear whether these newer advanced braces offer improved comfort and functionality compared to conventional options. The IDEO (Intrepid Dynamic Exoskeletal Orthosis), a type of "advanced" orthosis was developed to assist in maintaining high functional performance in patients who have experienced high-energy lower extremity trauma and underwent limb salvage surgeries. Methods A cross-sector multi-site initiative was completed to study the efficacy of advanced ankle foot orthoses (AFO) for lower limb trauma and injury compared to a conventional AFO. Following fitting, training, and accommodation, the subjects were assessed in each AFO system for mobility, self-reported function, safety and pain, and preference. Results They preferred the advanced over the conventional AFO and the mobility and exertion perception improved with the advanced AFO with no difference in pain or overall health status scores. Discussion Thus, an advanced AFO is an option for trauma affecting the lower limb. Long-term studies are required to better understand the accommodation and learning process of using an advanced AFO.
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Affiliation(s)
- M. Jason Highsmith
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS) Program Office, Rehabilitation & Prosthetic Services, (12RPS4) US Department of Veterans Affairs, Washington, DC, United States
| | - Rebecca M. Miro
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Michael Kartel
- Orthotic, Prosthetic & Pedorthic Clinical Services (OPPCS), Physical Medicine & Rehabilitation, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Anita Ramrattan
- Research and Development Services, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Angela Courtade
- Southeastern Regional Amputation System of Care, (ASoC) Physical Medicine & Rehabilitation, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Jeffrey T. Heckman
- Southeastern Regional Amputation System of Care, (ASoC) Physical Medicine & Rehabilitation, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
- Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Samuel L. Phillips
- Research and Development Services, James A. Haley Veterans' Hospital, US Department of Veterans Affairs, Tampa, FL, United States
| | - Shane R. Wurdeman
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Thomas V. DiBello
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Dwiesha L. England
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Phillip M. Stevens
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - James H. Campbell
- Hanger Institute for Clinical Research and Education, Austin, TX, United States
| | - Michael J. Hyre
- Narrows Institute for Biomedical Research and Education, New York, NY, United States
| | - Jason T. Maikos
- Prosthetics and Sensory Aids Services, (PSAS) New York Harbor Healthcare System, US Department of Veterans Affairs, New York, NY, United States
| | - Owen T. Hill
- School of Health Professions, College of Medicine, Health Science Center, University of Texas, San Antonio, TX, United States
| | - Stephanie L. Carey
- Department of Mechanical Engineering, College of Engineering, University of South Florida, Tampa, FL, United States
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McGrath RL, Price CA, Johnson WB, Childers WL. Advancing Exoskeleton Development: Validation of a Robotic Surrogate to Measure Tibial Strain. Bioengineering (Basel) 2024; 11:490. [PMID: 38790357 PMCID: PMC11118925 DOI: 10.3390/bioengineering11050490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Bone stress injuries are prevalent among athletes and military recruits and can significantly compromise training schedules. The development of an ankle-foot orthosis to reduce tibial load and enable a faster return to activity will require new device testing methodologies capable of capturing the contribution of muscular force on tibial strain. Thus, an actuated robotic surrogate leg was developed to explore how tibial strain changes with different ankle-foot orthosis conditions. The purpose of this work was to assess the reliability, scalability, and behavior of the surrogate. A dual actuation system consisting of a Bowden cable and a vertical load applied to the femur via a material testing system, replicated the action-reaction of the Achilles-soleus complex. Maximum and minimum principal strain, maximum shear strain, and axial strain were measured by instrumented strain gauges at five locations on the tibia. Strains were highly repeatable across tests but did not consistently match in vivo data when scaled. However, the stiffness of the ankle-foot orthosis strut did not systematically affect tibial load, which is consistent with in vivo findings. Future work will involve improving the scalability of the results to match in vivo data and using the surrogate to inform exoskeletal designs for bone stress injuries.
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Affiliation(s)
- Robert L. McGrath
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD 20817, USA
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - Ciera A. Price
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD 20817, USA
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
| | - William Brett Johnson
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
- DoD/VA Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
| | - Walter Lee Childers
- Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
- DoD/VA Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
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Shuman BR, Hendershot BD, Morgenroth DC, Russell Esposito E. A patient-centered 'test-drive' strategy for ankle-foot orthosis prescription: Protocol for a randomized participant-blinded trial. PLoS One 2024; 19:e0302389. [PMID: 38696428 PMCID: PMC11065291 DOI: 10.1371/journal.pone.0302389] [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: 12/15/2023] [Accepted: 03/31/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are commonly used to overcome mobility limitations related to lower limb musculoskeletal injury. Despite a multitude of AFOs to choose from, there is scant evidence to guide AFO prescription and limited opportunities for AFO users to provide experiential input during the process. To address these limitations in the current prescription process, this study evaluates a novel, user-centered and personalized 'test-drive' strategy using a robotic exoskeleton ('AFO emulator') to emulate commercial AFO mechanical properties (i.e., stiffness). The study will determine if brief, in-lab trials (with emulated or actual AFOs) can predict longer term preference, satisfaction, and mobility outcomes after community trials (with the actual AFOs). Secondarily, it will compare the in-lab experience of walking between actual vs. emulated AFOs. METHODS AND ANALYSIS In this participant-blinded, randomized crossover study we will recruit up to fifty-eight individuals with lower limb musculoskeletal injuries who currently use an AFO. Participants will walk on a treadmill with three actual AFOs and corresponding emulated AFOs for the "in-lab" assessments. For the community trial assessment, participants will wear each of the actual AFOs for a two-week period during activities of daily living. Performance-based and user-reported measures of preference and mobility will be compared between short- and long-term trials (i.e., in-lab vs. two-week community trials), and between in-lab trials (emulated vs. actual AFOs). TRIAL REGISTRATION The study was prospectively registered at www.clininicaltrials.gov (Clinical Trials Study ID: NCT06113159). Date: November 1st 2023. https://classic.clinicaltrials.gov/ct2/show/NCT06113159.
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Affiliation(s)
- Benjamin R. Shuman
- VA RR&D Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, United States of America
- Seattle Institute for Biomedical and Clinical Research, Seattle, Washington, United States of America
| | - Brad D. Hendershot
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, United States of America
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - David C. Morgenroth
- VA RR&D Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth Russell Esposito
- VA RR&D Center for Limb Loss and Mobility, VA Puget Sound Health Care System, Seattle, Washington, United States of America
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, United States of America
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, Virginia, United States of America
- Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
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Williamson JN, Grunst MM, Lynn J, Williamson GA, Blanck RV, Wilken JM. Short-term effect of a carbon fiber custom dynamic orthosis and integrated rehabilitation on self-reported physical function, pain, speed, and agility in civilians. Prosthet Orthot Int 2023; 47:607-613. [PMID: 38064296 DOI: 10.1097/pxr.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/09/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are widely used to restore mobility and reduce pain in individuals with lower extremity pain and disability. The use of a carbon fiber custom dynamic orthosis (CDO) with integrated physical training and psychosocial intervention has been shown to improve outcomes in a military setting, but civilian data are limited. OBJECTIVES To use existing clinical data to evaluate the initial effectiveness of an integrated CDO and rehabilitative program and identify baseline characteristics that impact patient response to the intervention. STUDY DESIGN Retrospective cohort. METHODS Records of 131 adult patients who received a CDO and device specific training were reviewed. Patient-reported measures of pain and lower extremity function and physical measurements of walking and agility were extracted at baseline and on training completion. RESULTS A majority of patients reported improved or greatly improved physical function (92%), maximum pain (69%), and typical pain (55%) and experienced improved or greatly improved walking speed (92%) and agility (52%) irrespective of age and sex. Regression models for examining short-term improvement in pain and physical function accounted for 52% (p < 0.001) and 26% (p < 0.001) of the outcome variance, respectively. Improvement in typical pain was influenced by baseline typical and maximum pain, and functional improvement was influenced by sex and baseline physical function. CONCLUSIONS Most patients (92.4%) reported a positive initial outcome after intervention as measured using patient-reported and objective measures.
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Affiliation(s)
- Jared N Williamson
- Doctor of Philosophy in Health Sciences Program, Rocky Mountain University of Health Professions, Provo, UT
| | - Megan M Grunst
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA
| | - Jeffrey Lynn
- Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA
| | | | | | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA
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Paquette R, Highsmith MJ, Carnaby G, Reistetter T, Phillips S, Hill O. Duration, frequency, and factors related to lower extremity prosthesis use: systematic review and meta-analysis. Disabil Rehabil 2023:1-19. [PMID: 37927090 DOI: 10.1080/09638288.2023.2276838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE A systematic review and meta-analysis investigating the duration and frequency of lower extremity prosthesis use and what factors were associated with changes in their use. MATERIALS AND METHODS A search of PubMed, CINAHL, and Scopus over 20 years revealed 2409 articles. After review, 29 studies remained, representing 4814 participants with lower limb loss. Quality, funding, publication, and quantitative analyses were addressed. RESULTS The mean prosthesis use was 9.6 (5.3) hours/day and 6.4 (1.9) days/week. Distal amputation sites averaged more hours/day of prostheses use than proximal amputations (13.2 [3.2] vs. 10.8 [5.0], p < .001). After hemipelvectomy or hip dislocations, average prostheses use was less hours/day (6.0 [4.7]) than after transfemoral (12.9 [4.8]) or transtibial amputations (14.0 [4.5]) (p < .05). Pooled effects revealed an association between comorbidities and abandonment (OR 0.35, p = .03). The data supported six empirical evidence statements concerning age, sex, social support, amputation proximity, balance, skin condition, comorbidities, pain, falls, and fitness in association with changes in prosthesis utilization. CONCLUSIONS The study provided systematic data on lower-extremity prosthesis use, thus helping to inform clinical decision-making and patient education. It also elucidated a path for future studies focused on modifiable factors related to prosthesis use and related outcomes.Implications for rehabilitationLower limb loss can trigger costly and debilitating sequela, which could be mitigated by increased prosthesis use and functionality, but there is no consensus on how often prostheses are being used and what affects changes in their use.When counseling patients on what they can expect after a lower extremity amputation and to set goals, the aggregated means of 9.6 (5.3) hours per day and 6.4 (1.9) days per week can be informative.Individuals who use a lower extremity prosthesis or may have to use one in the future can increase their prosthesis use and mobility by limiting further health deterioration.Rehabilitative care involving the multidisciplinary prioritization of proper socket fit, fitness training, gait training, and social support is associated with increased prosthetic device usage.
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Affiliation(s)
- Roland Paquette
- Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Physician Assistant Studies, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - M Jason Highsmith
- Mechanical Engineering Department, College of Engineering, University of South Florida, Tampa, FL, USA
- School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Giselle Carnaby
- Department of Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Communication Sciences and Disorders, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Otolaryngology, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Timothy Reistetter
- Department of Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Occupational Therapy, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | | | - Owen Hill
- Department of Physician Assistant Studies, University of Texas Health San Antonio, San Antonio, TX, USA
- Department of Health Sciences, University of Texas Health San Antonio, San Antonio, TX, 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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Li W, Baddour N, Lemaire E. A Novel Quick Release Mechanism for Ankle Foot Orthosis Struts. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 2022; 5:38802. [PMID: 37614637 PMCID: PMC10443491 DOI: 10.33137/cpoj.v5i2.38802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A posterior dynamic element ankle-foot orthosis (PDEAFO) uses a stiff carbon fibre strut to store and release energy during various mobility tasks, with the strut securely attached to the foot and shank-cuff sections. A design that allows the user to swap struts for specific activities could improve mobility by varying PDEAFO stiffness, but current approaches where bolts securely connect the strut to the orthosis make quick strut swapping time-consuming and impractical. OBJECTIVES Design a novel quick release AFO (QRAFO) that can enable daily living strut-swapping and thereby enable better ankle biomechanics for the person's chosen activity. METHODOLOGY The novel QRAFO enables device stiffness changes through a quick release mechanism that includes a quick-release key, weight-bearing pin, receptacle anchor, and immobilization pin. A prototype was modelled and simulated with SolidWorks. Mechanical tests were performed with an Instron 4482 machine to evaluate quick release mechanism strength with running and 20° slope downhill walking loads. Quick release efficiency was then evaluated via two quick release functional tests, with four participants wearing a 3D printed QRAFO. FINDINGS Simulated stress on the weight bearing pin, anchor, and surrounding carbon fibre structure under running and downhill walking loads did not exceed the yielding stress. Mechanical tests verified the simulation results. Four participants successfully swapped the strut within 25.01 ± 3.66 seconds, outperforming the 60.48 ± 10.88 seconds result for the hand-tightened bolted strut. A learning evaluation with one participant showed that, after approximately 30 swapping iterations, swap time was consistently below 10 seconds. CONCLUSION The quick release mechanism accommodated running and slope walking loads, and allowed easy and fast strut removal and attachment, greatly reducing strut swap time compared to screw-anchor connections. Overall, the novel quick release AFO improved strut-swapping time without sacrificing device strength, thereby enabling people to use the most appropriate AFO stiffness for their current activity and hence improve mobility and quality of life.
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Affiliation(s)
- W Li
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - N Baddour
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada
| | - E.D Lemaire
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Centre for Rehabilitation Research and Development, Ottawa Hospital Research Institute, Ottawa, Canada
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10
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A modified passive-dynamic ankle-foot orthosis: can it prevent amputation and arthrodesis in patients with ankle-foot trauma? Arch Orthop Trauma Surg 2022; 142:2719-2726. [PMID: 34319472 DOI: 10.1007/s00402-021-04083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION High-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET. MATERIALS AND METHODS A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP). RESULTS A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore. CONCLUSIONS Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach.
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Rogati G, Caravaggi P, Leardini A. Design principles, manufacturing and evaluation techniques of custom dynamic ankle-foot orthoses: a review study. J Foot Ankle Res 2022; 15:38. [PMID: 35585544 PMCID: PMC9118871 DOI: 10.1186/s13047-022-00547-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
Ankle-Foot Orthoses (AFO) can be prescribed to allow drop-foot patients to restore a quasi-normal gait pattern. Standard off-the-shelf AFOs are cost-effective solutions to treat most patients with foot and ankle weakness, but these devices have several limitations, especially in terms of comfort. Therefore, custom AFOs are increasingly adopted to address drop-foot when standard solutions are not adequate. While the solid ones are the most common type of AFO, providing full stability and strong resistance to ankle plantarflexion, passive dynamic AFOs (PD-AFOs) represent the ideal solution for patients with less severe ankle weakness. PD-AFOs have a flexible calf shell, which can bend during the stance phase of walking and absorb energy that can be released to support the limb in the push-off phase. The aim of this review is to assess the state-of-the-art and identify the current limitations of PD-AFOs. An extensive literature review was performed in Google Scholar to identify all studies on custom PD-AFOs. Only those papers reporting on custom PD-AFOs were included in the review. Non peer-reviewed papers, abstract shorter than three pages, lecture notes and thesis dissertations were excluded from the analysis. Particular attention was given to the customization principles and the mechanical and functional tests. For each topic, the main results from all relevant papers are reported and summarized herein. There were 75 papers that corresponded to the search criteria. These were grouped according to the following macro-topics: 16 focusing on scanning technologies and geometry acquisition; 14 on customization criteria; 19 on production techniques; 16 on mechanical testing, and 33 on functional testing. According to the present review, design and production of custom PD-AFOs are becoming increasingly feasible due to advancements in 3D scanning techniques and additive manufacturing. In general, custom PD-AFOs were shown to provide better comfort and improved spatio-temporal parameters with respect to standard solutions. However, no customization principle to adapt PD-AFO stiffness to the patient's degree of ankle impairment or mechanical/functional demand has thus far been proposed.
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Affiliation(s)
- Giulia Rogati
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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12
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Zhang H, Hu Y, Chen X, Wang S, Cao L, Dong S, Shi Z, Chen Y, Xiong L, Zhang Y, Zhang D, Yu B, Chen W, Wang Q, Tong P, Liu X, Zhang J, Zhou Q, Niu F, Yang W, Zhang W, Wang Y, Chen S, Jia J, Yang Q, Zhang P, Zhang Y, Miao J, Sun K, Shen T, Yu B, Yang L, Zhang L, Wang D, Liu G, Zhang Y, Su J. Expert consensus on the bone repair strategy for osteoporotic fractures in China. Front Endocrinol (Lausanne) 2022; 13:989648. [PMID: 36387842 PMCID: PMC9643410 DOI: 10.3389/fendo.2022.989648] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022] Open
Abstract
Osteoporotic fractures, also known as fragility fractures, are prevalent in the elderly and bring tremendous social burdens. Poor bone quality, weak repair capacity, instability, and high failure rate of internal fixation are main characteristics of osteoporotic fractures. Osteoporotic bone defects are common and need to be repaired by appropriate materials. Proximal humerus, distal radius, tibia plateau, calcaneus, and spine are common osteoporotic fractures with bone defect. Here, the consensus from the Osteoporosis Group of Chinese Orthopaedic Association concentrates on the epidemiology, characters, and management strategies of common osteoporotic fractures with bone defect to standardize clinical practice in bone repair of osteoporotic fractures.
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Affiliation(s)
- Hao Zhang
- Institute of Translational Medicine, Shanghai University, Shanghai, China
- Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yan Hu
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Xiao Chen
- Changhai Hospital, Naval Medical University, Shanghai, China
| | - Sicheng Wang
- Department of Orthopedics, Shanghai Zhongye Hospital, Shanghai, China
| | - Liehu Cao
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai, China
| | - Shiwu Dong
- Department of Biomedical Materials Science, Army Medical University, Chongqing, China
| | - Zhongmin Shi
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yanxi Chen
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liming Xiong
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunfei Zhang
- Tangdu Hospital, Air Force Medical University, Xi'an, China
| | | | - Baoqing Yu
- Department of Orthopedics, Shanghai Pudong Hospital, Shanghai, China
| | - Wenming Chen
- Institute of Biomedical Engineering, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Qining Wang
- Department of Advanced Manufacturing and Robotics, College of Engineering, Peking University, Beijing, China
| | - Peijian Tong
- Department of Orthopedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, Wuhan, China
| | - Jianzheng Zhang
- Department of Orthopedic Surgery, People's Liberation Army (PLA), Army General Hospital, Beijing, China
| | - Qiang Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Niu
- Department of Orthopedics, The First Hospital of Jilin University, Changchun, China
| | - Weiguo Yang
- Li Ka Shing Faculty of Medicine, Hongkong University, Hong Kong, Hong Kong SAR, China
| | - Wencai Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou University of Traditional Chinese medicine (TCM), Guangzhou, China
| | - Yong Wang
- Department of Orthopedics, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Shijie Chen
- Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jinpeng Jia
- Department of Orthopedics, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qiang Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Peng Zhang
- Department of Orthopedics, Shandong Province Hospital, Jinan, China
| | - Yong Zhang
- Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Jun Miao
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Kuo Sun
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Shen
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Yu
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Lei Yang
- Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lei Zhang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dongliang Wang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Dongliang Wang, ; Guohui Liu, ; Yingze Zhang, ; Jiacan Su,
| | - Guohui Liu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Dongliang Wang, ; Guohui Liu, ; Yingze Zhang, ; Jiacan Su,
| | - Yingze Zhang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Dongliang Wang, ; Guohui Liu, ; Yingze Zhang, ; Jiacan Su,
| | - Jiacan Su
- Institute of Translational Medicine, Shanghai University, Shanghai, China
- Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Dongliang Wang, ; Guohui Liu, ; Yingze Zhang, ; Jiacan Su,
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Hoyt BW, Nelson SY, Fay JG, Wade SM, Brooks DI, Potter BK. IDEO energy-storing orthosis: Effects on lower extremity function and preservation. Injury 2021; 52:3505-3510. [PMID: 34311958 DOI: 10.1016/j.injury.2021.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Intrepid Dynamic Exoskeletal Orthosis (IDEO) brace is a custom energy-storing orthosis design meant to improve gait, stability, and function after lower extremity injury or limb salvage. Early studies demonstrated the potential for the IDEO to improve functional performance, in conjunction with its paired return to run (RTR) rehabilitation program, compared to other brace types, and an impressively decreased rate of late amputation. The current study aimed to investigate these functional and revision outcomes from our institution to determine which patients may benefit most from IDEO bracing and what factors of the IDEO design and rehabilitation program are most important for improved outcomes after lower extremity trauma and/or loss of function. METHODS We performed a retrospective review of all patients treated with a IDEO style brace at a single military lower extremity trauma referral center between May 2003 and November 2017. We reviewed the medical records for initial diagnosis, post-orthotic rehabilitation program, IDEO use characteristics, pain, change in desire for amputation, and whether patient underwent eventual amputation. RESULTS We identified 213 patients with 222 lower extremities treated with IDEO brace. Of these, 76 limbs were treated for combat-related injuries. At one year follow-up, use status could not be determined for 37 extremities (16.7%). Of the 185 limbs with use data available, 116 (61.1%) continued regular brace use, and 37 (15.7%) reported intermittent use. Patients diagnosed with footdrop or weakness were more likely to continue use (OR 2.33, p=0.04), while patients with a previous fusion were less likely to continue use (OR 0.45, p=0.049). Undergoing any dedicated therapy increased chances of continued use (OR 3.37, p<0.001). At final follow-up, 16 patients (7.5%) underwent delayed lower extremity amputations following IDEO treatment. Overall, 27.2% of patients who initially desired amputation eventually underwent amputation despite IDEO brace use. Patients who underwent amputation reported higher pain levels (2 versus 5, p<0.001). DISCUSSION In select patients, the IDEO may decrease the desire for delayed amputation and permit higher levels of activity; however, its efficacy appears tied to the rehabilitative regimen, pain levels, and initial diagnosis. These findings should guide post-surgical extremity bracing prescriptions and expectations.
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Affiliation(s)
- Benjamin W Hoyt
- USU-WRNMMC Department of Surgery, Bethesda, MD, United States.
| | - Sarah Y Nelson
- USU-WRNMMC Department of Surgery, Bethesda, MD, United States
| | - Jeffrey G Fay
- Department of Orthotics and Prosthetics, WRNMMC, Bethesda, MD, United States
| | - Sean M Wade
- USU-WRNMMC Department of Surgery, Bethesda, MD, United States
| | - Daniel I Brooks
- Department of Research Programs, WRNMMC, Bethesda, MD, United States
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Sheehan RC, Fain AC, Wilson JB, Wilken JM, Rábago CA. Inclusion of a Military-specific, Virtual Reality-based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma. Mil Med 2021; 186:e777-e783. [PMID: 33201245 DOI: 10.1093/milmed/usaa483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/12/2020] [Accepted: 10/28/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands. Thus, the goal of the study was to evaluate the effectiveness of a military-specific virtual reality-based rehabilitation (VR) intervention supplemental to standard care (SC) in improving military performance in SMs with lower extremity injuries. MATERIALS AND METHODS As part of an institutional review board-approved randomized control trial, SMs receiving care at an advanced rehabilitation center were randomized to receive either SC or VR in addition to SC (VR+SC). Participants were evaluated before treatment and ∼3 weeks later using a previously developed and validated military-specific assessment. Perceived improvement in physical function was measured using a Global Rating of Change (GROC) questionnaire. A repeated measures ANOVA was used to evaluate the effects of adding VR on the military-specific assessment measures. Linear regression was used to determine the relationship between perceived improvement, measured improvement, and VR volume. RESULTS The VR+SC group was able to traverse a greater distance in the assessment following the VR intervention. There was no significant difference in GROC between groups. For the VR+SC group, change in distance completed was not correlated with GROC, but GROC was correlated with VR volume. CONCLUSION VR improved the distance that participants were able to traverse in the assessment. However, the VR+SC group demonstrated a disconnect between their perceived functional improvement as measured by the GROC and functional improvement as measured by the change in the distance completed. Rather, the perceived improvement appears to be more correlated with the volume of VR received. The way in which the treatment progression is structured and communicated may influence how patients perceive their change in physical function.
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Affiliation(s)
- Riley C Sheehan
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - AuraLea C Fain
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
| | - Jonathan B Wilson
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Jason M Wilken
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
| | - Christopher A Rábago
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, Sam Houston, TX 78234, USA
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, MD 20814, USA
- Extremity Trauma and Amputation Center of Excellence, Sam Houston, TX 78234, USA
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15
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Anderson KM, Evans RE, Connerly CE, Pacha M, Wilken JM. Custom Dynamic Orthoses and Physical Therapist Intervention for Bilateral Midfoot Amputation: A Case Report. Phys Ther 2021; 101:6123365. [PMID: 33513235 PMCID: PMC8054777 DOI: 10.1093/ptj/pzab028] [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: 02/17/2020] [Revised: 09/18/2020] [Accepted: 12/22/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Partial foot amputation is often associated with decreased mobility and function. Recent advances in custom carbon-fiber dynamic ankle-foot orthoses (CDOs) have improved gait, pain, and function following musculoskeletal trauma and can benefit individuals with partial foot amputation. However, limited information is available related to CDO use outside the military. The purpose of this case report is to describe the course of care and outcomes of a civilian provided with CDOs after bilateral transmetatarsal amputation. CASE DESCRIPTION A 72-year-old man had a blood-borne bacterial infection (septicemia) of unknown origin at 68 years of age, developed limb-threatening necrosis of the hands and feet, and received bilateral transmetatarsal amputations with skin grafting. The patient initially used foam toe fillers and cushioned shoes but was functionally limited and experienced recurrent ulceration. He was fitted with bilateral CDOs 39 months after amputation and completed device-specific training with a physical therapist. RESULTS After 1 week with the CDOs, ankle range of motion during gait was reduced, but greater than 40% increases were observed in bilateral ankle plantarflexor moments and ankle plantarflexion push-off power compared with the toe fillers. With additional therapist-directed training focused on gait and activity performance, ankle plantarflexor moments and plantarflexion push-off power further increased when compared with results after 1 week of CDO use. The patient reported marked improvement in quality of life with the CDOs due to improved walking ability on level and uneven terrain, marked improvement in confidence, and reduced pain. CONCLUSION This case reflects the lessons learned and outcomes of a civilian using bilateral CDOs after bilateral transmetatarsal amputation and with poor skin quality. The results from this case study suggest that carbon-fiber CDOs and focused training by a physical therapist can result in improved gait biomechanics, mobility, and quality of life.
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Affiliation(s)
- Kirsten M Anderson
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Richard E Evans
- Department of Rehabilitation Therapies, University of Iowa Healthcare, Iowa City, Iowa, USA
| | - Charles E Connerly
- School of Urban and Regional Planning, The University of Iowa Graduate College, Iowa City, Iowa, USA
| | - Molly Pacha
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA,Address all correspondence to Dr Wilken at:
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Abstract
Fifty years ago, the International Society for Prosthetics and Orthotics was founded in recognition that this unique niche in rehabilitation would benefit from multidisciplinary interactions between specialists in engineering, therapy, and medicine.Since then, field evolved from having a craft orientation toward a technology and clinical specialty. This anniversary provides an opportunity to look back on advances in prosthetics and orthotics, and the clear impact they have had on changing the skills needed by the prosthetist/orthotist as new technology and techniques have emerged. The balance has clearly shifted from mechanical skills to clinical care. The training and skills of the prosthetist/orthotist remain unique and valued in the rehabilitation team, and the primary motivation remains the same as it has been since the creation of the International Society for Prosthetics and Orthotics: the application of external devices where they are suitable to address the many varied needs of persons with disability. This historical perspective puts into context why and how the profession has changed, while also reinforcing that it is the goals set for restoring patient functions that best defines what it is to be a prosthetist/orthotist, not the means we use.
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17
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Rehabilitation Engineering: A perspective on the past 40-years and thoughts for the future. Med Eng Phys 2019; 72:3-12. [DOI: 10.1016/j.medengphy.2019.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/28/2019] [Indexed: 11/23/2022]
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CORR Insights®: Do Spatiotemporal Gait Parameters Improve After Pilon Fracture in Patients Who Use the Intrepid Dynamic Exoskeletal Orthosis? Clin Orthop Relat Res 2019; 477:848-849. [PMID: 30376461 PMCID: PMC6437351 DOI: 10.1097/corr.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Do Spatiotemporal Gait Parameters Improve After Pilon Fracture in Patients Who Use the Intrepid Dynamic Exoskeletal Orthosis? Clin Orthop Relat Res 2019; 477:838-847. [PMID: 30811361 PMCID: PMC6437376 DOI: 10.1097/corr.0000000000000487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pilon fractures are high-energy fractures about the ankle observed commonly in both civilian and military trauma populations. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) and Return-to-Run clinical pathway were initially designed to treat military service members after complex battlefield lower extremity injuries. The IDEO has been used to treat nonbattlefield injuries, but, to our knowledge, it has not been studied specifically among patients with pilon fractures. By studying the use of the IDEO in this patient population, we hope to learn how it might improve ambulation in the community, relieve pain, and return patients to work to better identify patients who might benefit from its use. QUESTIONS/PURPOSES The purpose of this study was to determine whether the IDEO would improve gait parameters including velocity, cadence, stride length, and single-leg stance duration in patients with pilon fractures. Our secondary endpoints of interest were reductions in pain and return to duty. METHODS A prospectively collected database of all active-duty IDEO users at a single institution was queried for all patients using the IDEO after a pilon fracture. Patients were included if they were using the IDEO after sustaining a surgically treated pilon fracture and had exhausted all nonoperative therapies. Exclusions were patients with an incomplete gait analysis at the two study time points. Seven patients meeting these criteria were identified. Three-dimensional gait analysis was performed two times: first wearing shoes at a self-selected speed and second after a custom-made IDEO was fabricated for the patient and completion of the Return-to-Run pathway. Patients reported their average pain while ambulating using a numeric rating scale. Gait variables of interest were velocity, cadence, stride length, and single stance time. Return to military service was assessed through the military medical record. To return to duty, a service-specific physical readiness test must be completed. RESULTS Median gait velocity improved from 1.1 (interquartile range [IQR], 0.9-1.2) to 1.3 m/s (IQR, 1.2-1.5; p = 0.01). All other variables did not change: cadence 98.4 (IQR, 93.0-107.2) to 104.5 steps/min (IQR, 103.0-109.0; p = 0.13), affected stride length 1.3 (IQR, 1.0-1.4 m) to 1.4 m (IQR, 1.3-1.6 m; p = 0.07), and affected single stance 0.42 (IQR, 0.41-0.47) to 0.43 (IQR, 0.42-0.44; p = 0.80). Pain did not change between time points: 3 (IQR, 2-3) to 2.5 (IQR, 1-3.5; p = 0.90). Three of seven patients returned to duty. CONCLUSIONS At self-selected walking speeds, we observed no improvements in gait parameters or pain after application of the IDEO that would likely be considered clinically important, and so the device is unlikely to be worth the cost in this setting. It is possible that for higher demand users such as elite athletes, the IDEO could have a role after severe lower extremity trauma; however, this must be considered speculative until or unless proven in future studies. LEVEL OF EVIDENCE Level III, therapeutic study.
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20
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Abstract
This article reviews the surgical treatment of talar avascular necrosis. Specifically, arthrodesis for this complex entity and potential treatment of nonunions are discussed. The hallmarks of treatment are evolving and can range from nonoperative measures to amputations. Nonoperative treatment and the results of current arthrodesis techniques for late-stage avascular necrosis are reviewed. Surgical correction requires an understanding of the condition's natural history, utilization of structural and nonstructural bone grafting techniques, and stable fixation. Although the methods described follow standard orthopedic principles, high-quality evidence and outcome studies are limited for treatment of this challenging and often disabling condition.
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Affiliation(s)
- Jonathon D Backus
- Cornerstone Orthopaedics and Sports Medicine, 3 Superior Drive, Suite 225, Superior, CO 80027, USA.
| | - Daniel L Ocel
- Cornerstone Orthopaedics and Sports Medicine, 3 Superior Drive, Suite 225, Superior, CO 80027, USA
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21
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Totah D, Menon M, Jones-Hershinow C, Barton K, Gates DH. The impact of ankle-foot orthosis stiffness on gait: A systematic literature review. Gait Posture 2019; 69:101-111. [PMID: 30708092 DOI: 10.1016/j.gaitpost.2019.01.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are commonly prescribed to provide ankle support during walking. Current prescription standards provide general guidelines for choosing between AFO types, but are limited in terms of guiding specific design parameter choices. These design parameters affect the ankle stiffness of the AFO. RESEARCH QUESTION The aim of this review was to investigate the impact of AFO stiffness on walking mechanics. METHODS A literature search was conducted using three databases: Pubmed, Engineering Village, and Web of Science. RESULTS After applying the exclusion criteria, 25 of 287 potential articles were included. The included papers tested a range of stiffnesses (0.02-8.17 Nm/deg), a variety of populations (e.g. healthy, post-stroke, cerebral palsy) and various gait outcome measures. Ankle kinematics were the most frequently reported measures and the most consistently affected by stiffness variations. Greater stiffnesses generally resulted in reduced peak ankle plantarflexion, dorsiflexion, and total range of motion, as well as increased dorsiflexion at initial contact. At the knee, a few studies reported increased flexion at initial contact, and decreased peak extension and increased peak flexion during stance when stiffness was increased. Stiffness did not affect hip kinetics and there was low evidence for its effects on hip or pelvis kinematics, ankle and knee kinetics, muscle activity, metabolic cost, ground reaction forces and spatiotemporal parameters. There were no generalizable trends for the impact of stiffness on user preference. SIGNIFICANCE AFO stiffness is a key factor influencing ankle movement. Clear reporting standards for AFO design parameters, as well as additional high quality research is needed with larger sample sizes and different clinical populations to ascertain the true effect of stiffness on gait.
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Affiliation(s)
- Deema Totah
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Meghna Menon
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Kira Barton
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Deanna H Gates
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
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Webster JB. Lower Limb Amputation Care Across the Active Duty Military and Veteran Populations. Phys Med Rehabil Clin N Am 2019; 30:89-109. [DOI: 10.1016/j.pmr.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ladlow P, Bennett N, Phillip R, Dharm-Datta S, McMenemy L, Bennett AN. Passive-dynamic ankle-foot orthosis improves medium-term clinical outcomes after severe lower extremity trauma. J ROY ARMY MED CORPS 2018; 165:330-337. [PMID: 30415216 PMCID: PMC6839716 DOI: 10.1136/jramc-2018-001082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
Abstract
Introduction Individuals with delayed below-knee amputation have previously reported superior clinical outcomes compared with lower limb reconstruction. The UK military have since introduced a passive-dynamic ankle-foot orthosis (PDAFO) into its rehabilitation care pathway to improve limb salvage outcomes. The aims were to determine if wearing a PDAFO improves medium-term clinical outcomes and what influence does multidisciplinary team (MDT) rehabilitation have after PDAFO fitting? Also, what longitudinal changes in clinical outcomes occur with MDT rehabilitation and how do these results compare with patients with previous lower extremity trauma discharged prior to PDAFO availability? Methods We retrospectively evaluated levels of mobility, activities of daily living, anxiety, depression and pain in a heterogeneous group of 23 injured UK servicemen 34±11 months after PDAFO provision. We also retrospectively analysed 16 patients across four time points (pre-PDAFO provision, first, second and final inpatient admissions post-PDAFO provision) using identical outcome measures, plus the 6 min walk test. Results Outcomes were compared with previous below-knee limb salvage and amputees. Before PDAFO, 74% were able to walk and 4% were able to run independently. At follow-up, this increased to 91% and 57%, respectively. Mean depression and anxiety scores remained stable over time (p>0.05). After 3 weeks, all patients could walk independently (pre-PDAFO=31%). Mean 6 min walk distance significantly increased from 440±75 m (pre-PDAFO) to 533±68 m at last admission (p=0.003). The ability to run increased from 6% to 44% after one admission. Conclusions All functional and most psychosocial outcomes in PDAFO users were superior to previous limb salvage and comparable to previous below-knee amputees. The PDAFO facilitated favourable short-term and medium-term changes in all clinical outcome measurements.
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Affiliation(s)
- Peter Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK.,Blatchford, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - R Phillip
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - S Dharm-Datta
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK
| | - L McMenemy
- Centre for Blast Injury Studies (CBIS), Imperial College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Headley Court, Surrey, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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24
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Potter BK, Sheu RG, Stinner D, Fergason J, Hsu JR, Kuhn K, Owens JG, Rivera J, Shawen SB, Wilken JM, DeSanto J, Huang Y, Scharfstein DO, MacKenzie EJ. Multisite Evaluation of a Custom Energy-Storing Carbon Fiber Orthosis for Patients with Residual Disability After Lower-Limb Trauma. J Bone Joint Surg Am 2018; 100:1781-1789. [PMID: 30334889 DOI: 10.2106/jbjs.18.00213] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom energy-storing carbon fiber ankle-foot orthosis developed for lower-extremity trauma patients. Studies conducted at the military treatment facility where the IDEO was developed demonstrated benefits of the IDEO when used with the Return to Run Physical Therapy (RTR PT) program. The current study was designed to determine if results could be replicated at other military treatment facilities and to examine whether early performance gains in patient-reported functional outcomes remained at 12 months. METHODS Study participants included service members who had functional deficits that interfered with daily activities at least 1 year after a traumatic unilateral lower-extremity injury at or below the knee. Participants were evaluated before receiving the IDEO, immediately following completion of RTR PT, and at 6 and 12 months. Agility, strength/power, and speed were assessed using well-established performance tests. Self-reported function was measured using the Short Musculoskeletal Function Assessment (SMFA). The Orthotics and Prosthetics Users' Survey was administered to assess satisfaction with the IDEO. Of 87 participants with complete baseline data, 6 did not complete any physical therapy and were excluded from the analysis. Follow-up rates immediately following completion of the RTR PT and at 6 and 12 months were 88%, 75%, and 79%, respectively. RESULTS Compared with baseline, improvement at completion of RTR PT was observed in all but 1 performance test. SMFA scores for all domains except hand and arm function were lower (improved function) at 6 and 12 months. Satisfaction with the IDEO was high following completion of RTR PT, with some attenuation at the time of follow-up. CONCLUSIONS This study adds to the evidence supporting the efficacy of the IDEO coupled with RTR PT. However, despite improvement in both performance and self-reported functioning, deficits persist compared with population norms. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Robert G Sheu
- Naval Medical Center San Diego, San Diego, California
| | - Daniel Stinner
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - John Fergason
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Joseph R Hsu
- Carolinas Medical Center, Charlotte, North Carolina
| | - Kevin Kuhn
- Naval Medical Center San Diego, San Diego, California
| | - Johnny G Owens
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Jessica Rivera
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Scott B Shawen
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jason M Wilken
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Jennifer DeSanto
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yanjie Huang
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel O Scharfstein
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ellen J MacKenzie
- METRC Coordinating Center at Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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25
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Younger A. Custom Energy-Storing Carbon Fiber Orthosis for Lower-Limb Trauma: Can the Results Be Obtained Outside the Designing Center?: Commentary on an article by Benjamin K. Potter, MD, et al.: "Multisite Evaluation of a Custom Energy-Storing Carbon Fiber Orthosis for Patients with Residual Disability After Lower-Limb Trauma". J Bone Joint Surg Am 2018; 100:e136. [PMID: 30334897 DOI: 10.2106/jbjs.18.00871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Alastair Younger
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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26
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de Kruijff LGM, Prins M, van der Krans A, Hoencamp R, van der Wurff P. Combat-related foot injuries: impact on gait and functional outcome. J ROY ARMY MED CORPS 2018; 164:322-327. [DOI: 10.1136/jramc-2017-000870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 11/04/2022]
Abstract
IntroductionPrior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis.MethodIn nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire.ResultsSignificant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59).ConclusionsThis study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler’s angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler’s angle and physical performance.Clinical TrialThe Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).
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