Application of Machine Tools in Orthoses Manufacture

CNC technology is widely used in the manufacture of medical products. An area in which CNC technology has proven to be extremely useful and innovative is Orthotics and Prosthetics (O&P). O&P laboratories are engaged in the manufacture of individual orthoses and prostheses. The usual manual manufacture of such products takes a long time and requires tremendous experience and skill. In this regard, any engineering solution that improves the quality of the production process; reduces production time, production costs, and physical human labor; and at the same time improves the environmental conditions of the production environment will be desirable. Various designs of CNC machine tools for the manufacture of orthoses or molds for their production are in use today. In most cases, customized commercially available numerical control lathes and milling machines are used, as well as industrial robotic arms, but there are also highly specialized designs. For the mentioned purpose, we also encounter the application of additive manufacturing (AM) devices. Due to the fact that issuing of orthoses is often the subject of cost reduction in healthcare systems, the pursuit of production systems that will be cost-effective and functional, easily implemented, and used primarily in small manufacturing practices is imperative

Effect of custom design insole applications with 3D modelling on baropodometric parameters in individuals with pes planus

It was aimed to investigate the effect of custom made insoles on baropodometric analysis parameters in individuals with pes planus, using objective measurement and production methods. 100 individuals with pes planus, aged between 4-18 years in the study. Individuals who met the inclusion criteria and the medial longitudinal arch index were included in the study. Valgus angles of individuals, plantar measurements of the feet before the use of insoles and after 6 months of the use of insoles were evaluated with the Sensor Medica® device. When the measurement results of the ankle valgus angles of the individuals before and after the insoles were examined, it was observed that there was a statistical decrease in the mean results in both feet (p[removed]

Knee joint kinetics in response to multiple three-dimensional printed, customised foot orthoses for the treatment of medial compartment knee osteoarthritis

The knee adduction moment is consistently used as a surrogate measure of medial compartment loading. Foot orthoses are designed to reduce knee adduction moment via lateral wedging. The 'dose' of wedging required to optimally unload the affected compartment is unknown and variable between individuals. This study explores a personalised approach via three-dimensional printed foot orthotics to assess the biomechanical response when two design variables are altered: orthotic length and lateral wedging. Foot orthoses were created for 10 individuals with symptomatic medial knee osteoarthritis and 10 controls. Computer-aided design software was used to design four full and four three-quarter-length foot orthoses per participant each with lateral posting of 0° 'neutral', 5° rearfoot, 10° rearfoot and 5° forefoot/10° rearfoot. Three-dimensional printers were used to manufacture all foot orthoses. Three-dimensional gait analyses were performed and selected knee kinetics were analysed: first peak knee adduction moment, second peak knee adduction moment, first knee flexion moment and knee adduction moment impulse. Full-length foot orthoses provided greater reductions in first peak knee adduction moment (p = 0.038), second peak knee adduction moment (p = 0.018) and knee adduction moment impulse (p = 0.022) compared to three-quarter-length foot orthoses. Dose effect of lateral wedging was found for first peak knee adduction moment (p < 0.001), second peak knee adduction moment (p < 0.001) and knee adduction moment impulse (p < 0.001) indicating greater unloading for higher wedging angles. Significant interaction effects were found for foot orthosis length and participant group in second peak knee adduction moment (p = 0.028) and knee adduction moment impulse (p = 0.036). Significant interaction effects were found between orthotic length and wedging condition for second peak knee adduction moment (p = 0.002). No significant changes in first knee flexion moment were found. Individual heterogeneous responses to foot orthosis conditions were observed for first peak knee adduction moment, second peak knee adduction moment and knee adduction moment impulse. Biomechanical response is highly variable with personalised foot orthoses. Findings indicate that the tailoring of a personalised intervention could provide an additional benefit over standard interventions and that a three-dimensional printing approach to foot orthosis manufacturing is a viable alternative to the standard methods.Full Tex

Infusing Communication Skills into Financial Accounting Curriculum: A perspective from the Digital Era

This study investigates financial accounting students’ attitudes about several aspects related to modern pedagogies focusing on communication skills development. The paper focuses on areas of students’ need to develop communication skills irrespective of cultural diversity and gender inequality, quiz-based learning, requirements, and assessment. The study employed an online survey of students at one of the largest business colleges in the Sultanate of Oman. The study surveyed 96 currently registered students to cover the research objectives and questions. The findings showed that the students enjoyed a high level of awareness of the importance and relevance of communication skills in relation to future employability. Students believed developing communication importance was not limited to careers in financial accounting as it was also extended to other careers requiring a post-secondary degree. Quiz-based learning strategies were found to be relevant in improving communication skills. The results also highlighted adaptability as a main assessment criterion of communication skills. The study provided bases for higher education institutions in the Sultanate of Oman or other countries to empower the generalizability of the findings. Another possible research could replicate the investigation in other fields of study. This paper brings several implications for instructional practice and pedagogies, as well as for policies of instructional training and development. The study is original in its particular context and specific time during the COVID-19 pandemic as attitudes toward online technologies have been shifting paradigms

Comparing the effectiveness of computer-aided-design/computer-aided-manufacture (CAD/CAM) insoles manufactured from foam-box cast versus direct scans on patient reported outcome measures: A protocol for a double-blinded, randomised controlled trial

Introduction Custom insoles are a routine treatment for many foot pathologies, and the use of computer aided design and manufacture (CAD/CAM) is well established within clinical practice in the UK. The method of foot shape capture used to produce insoles varies throughout orthotic services. This trial aims to investigate the effectiveness of two common shape capture techniques on patient reported outcomes in people who require insoles for a foot or ankle pathology. Methods and analysis This double blinded randomised controlled trial will consider two intervention groups recruited from a National Health Service orthotic service. Participants will be randomly assigned to receive a pair of custom CAD/CAM insoles, manufactured either from a direct-digital scan or a foam-box cast of their feet and asked to wear the insoles for 12-weeks. The primary outcome measure will be the Foot Health Status Questionnaire (FHSQ) Pain sub domain, recorded at baseline (immediately after receiving the intervention), 4-weeks, 8-weeks, and 12-weeks post-intervention. Secondary outcome measures will include FHSQ foot function and foot health sub domains recorded at baseline, 4-weeks, 8-weeks, and 12-weeks. The Prosthetic and Orthotic User Survey Satisfaction with Device Survey recorded after 12-weeks. Transit times associated with each arm measured as the number of days for each insole to be delivered after foot shape capture. Tertiary outcome measures will include participant recruitment and dropout rates, and intervention adherence measured as the daily usage of the insoles over 12-weeks. The change in FHSQ scores for the sub-domains and insole usage will be compared between the groups and time points, and between group differences in time-in-transit, cost-time analysis and environmental impact will be compared. Ethics and Dissemination Ethical approval was obtained from the Health Research Authority, London Stanmore Research Ethics Committee (22/LO/0579). Study findings will be submitted for publication in peer-reviewed journals, conference presentations and webinars. Protocol version: Version 2, 08/092022 Trial registration: ClinicalTrials.gov (Trial number NCT05444192) Strengths and limitations • This trial aims to investigate routine interventions that are used within the NHS, therefore the outcomes have the potential to impact on the decision making within orthotic services across the UK and beyond. • The double blinded design reduces the risk of bias from the participant and the investigator. • Single centre design may limit the cohort. • The multiple follow-up points may lead to drop outs

Validating scanned foot images and designing customized insoles on the cloud

© 2016 IEEE.People with foot problems need special healthcare: foot care. Customized insoles can provide this care. They are inserts that are placed in the shoes. They correct biomechanical and postural inaccuracies in foot. Insole production contains four phases: foot image scanning, image validation, insole design and insole manufacturing. Currently, image scanning and validation is separated in location and time, i.e. podiatrists take images and insole designers validate them at different location and at different time. A cloud-based solution, the CloudSME one-stop shop simulation platform, enables remote access to image validation and insole design service deployed and running on the Cloud. The remote access allows podiatrists validating scanned image while the patient is in their offices. The simulation platform also supports remote design of customized insoles

A scoping review of digital fabrication techniques applied to prosthetics & orthotics: Part 2 of 2—orthotics

Introduction: Traditionally, orthosis manufacturing is time and labor-intensive. Digitalization of some of the fabrication process is already ubiquitous, yet extension across device types could reduce the burden of manual labor and advance automation to help unblock access to assistive technologies globally. It seems, however, that appropriately strong evidence is holding this back. This review looks to thoroughly examine the current state of evidence to make this clear. Objectives: To identify gaps in the literature that create barriers to decision-making on either appropriate uptake by clinical teams or setting research directions, by identifying what forms of evidence the current research literature provides to the orthotics community. Study design: Scoping literature review. Methods: A comprehensive search was completed in the following databases: AMED, MEDLINE, EMBASE, Global Health Archive, CINAHL Plus, Cochrane Library, Web of Science, ACM, IEEE, and Engineering Village, resulting in 3487 articles to be screened. Results: After screening, 121 lower limb orthosis, 104 upper limb orthosis, and 30 spinal orthosis articles were included in this review. For some areas such as CAD/CAM-produced insoles and spinal orthoses, the evidence base is strong. For most additive manufacture articles, long-term, larger-scale studies as well as research into training requirements are lacking. Conclusion: The advantages of digital fabrication technology that could streamline orthotic device production in many cases are still blocked by a lack of strong formal evidence, ie large longitudinal studies with a range of evaluation measures. Increased collaboration between clinicians, patient/service users, academia, and industry could be a route to addressing these gaps and creating a better pathway to market for new technologies

3D numerical modelling and manipulation of a shoe last.

As global competition continues to increase causing market windows to shrink and product life cycles shorten, manufacturers today can no longer function without advanced design tools. These market pressures dictate that designers must embrace new, faster and better design technologies than ever before if they are to remain competitive. This is especially true in the shoe industry with the employment of up-to-date methods of design and manufacture. The development of modem CAD/CAM systems, the availability of powerful hardware at reasonable cost and vast improvements in colour graphics capabilities have made the automation of the footwear design process feasible at low cost. All of this economically justifies the creation of a system for direct shoe last design without a prototype model last. A specific onscreen methodology of a shoe last design directly from individual anthropometric data has been proposed and evaluated. A numerical methodology for onscreen visualisation with application of a new scheme of segmentation of the last surface and further manipulation of the last elements in order to create new last styles have been developed. In order to achieve this, the principles of shaping the last, the laws governing its deformation when changing the heel height and the list of possible modifications to its shape have been defined. Five global manipulation procedures have been implemented, in particular those that relate to changing the heel height. Special software has been written to visualise the results. Experimentation has proved the validity of the approach. Lasts of similar style but with different heel heights were measured and numerically modelled to compare with computer generated and modified last models. The accuracy proved to be within the limits of practical and traditional constraints